Pancreatic Cancer
(9 years, 10 months ago)
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Nic Dakin (Scunthorpe) (Lab)
There have been several parliamentary debates on pancreatic cancer over the past year, not least the one in Westminster Hall in September in response to the e-petition launched by my constituent, Maggie Watts, which gained more than 100,000 signatures. The petition called for more to be done to improve public awareness and early diagnosis of, and increased research into, pancreatic cancer. It was a positive, constructive debate, with many Members from across the House showing their passion and commitment to upping our game on tackling pancreatic cancer.
The Minister and hon. Members in the Chamber are well aware of the issues, but it is important to put on the record again the seriousness of this disease. Pancreatic cancer is the fifth largest cause of cancer deaths in the UK today, and is set to overtake breast cancer as the fourth biggest cancer killer by 2030. Some 8,800 people are diagnosed with the disease each year, and 8,700 people die from it each year. Five-year survival rates are less than 4%—the worst rate for any of the 21 most common cancers—and have barely changed during the past 40 years. While mortality rates have fallen for most forms of cancer, sadly, those for pancreatic cancer are rising. That is largely due to late diagnosis, with half of all diagnoses made via emergency admissions, which means that less than 20% of patients are diagnosed at a stage when curative surgery remains an option.
Thankfully, these days a majority of cancer patients survive for 10 years. Sadly, that is not the case for pancreatic cancer patients, of whom fewer than 1% survive 10 years. That is why future medical support for pancreatic cancer—greater awareness, early diagnosis, new treatments and faster access to treatments—is so important.
The debate this week is fortuitous as it follows Monday’s announcement that the cancer drugs fund has removed 25 drugs from its approved list. As the Minister will know, there was real anxiety about the pancreatic cancer drug Abraxane being removed. That drug has been shown to extend patients’ lives by an average of about two months, and in some cases by significantly more. It is routinely used around the world as a basic standard of care for pancreatic cancer patients. If it is removed from the CDF, there is a real danger that English patients will be hugely disadvantaged. It was positive news that Abraxane has not been removed from the CDF list.
However, from reading the small print of the CDF decision, it appears that the drug is still under threat of removal. The CDF panel has merely granted a stay of execution while more evidence on Abraxane is gathered. Do not get me wrong: the extra time is welcome—I hope, once more evidence has been provided, that the CDF panel will agree to keep Abraxane for the longer term—but at the moment we are in a state of limbo.
Will the Minister clarify just how much time will be allowed for the drug manufacturer to provide additional evidence to the CDF panel? What specifically needs to be provided for a positive decision? Importantly, will clinicians dealing with pancreatic cancer day to day and patient organisations be allowed to feed into the process and submit their observable evidence to the CDF? I hope that the Minister will agree that an appropriate period should be allowed for sufficient evidence to be collated, presented and analysed. Ideally, gathering evidence over a period from clinicians, using the drug at the coal face, would be the best way to trial commissioning through evaluation. Does the Minister support that approach?
The truth is that the CDF’s decision not immediately to delist Abraxane on Monday is more important than ever because over the Christmas break NICE announced that it would not fund Abraxane routinely on the NHS. Consequently, if Abraxane were no longer on the CDF list, patients in England would not be able to access the drug for free. Its place on the CDF list is now, literally, the last lifeline for some patients.
NICE rejected the drug on cost grounds, yet it costs only £8,000 per patient—much less than some other specialist drugs, which run to tens of thousands of pounds. The issue is the way that NICE calculates cost benefit through its system of quality adjusted life years, which in reality works against cancer drugs, especially for those cancers with poor prognoses such as pancreatic cancer. In this instance I understand that the drug was not even assessed or considered under NICE’s less prescriptive end-of-life criteria. That seems rather strange when the disease we are talking about has the worst survival rate of any common cancer, with the average survival time for metastatic pancreatic cancer patients just two to six months.
Questions have been raised about the effectiveness of the NICE drug appraisal system, with 60% of cancer drugs rejected by NICE in 2012—an increase on figures for 2010. Despite the excellent work that NICE and the CDF have done, there is a strong argument for reform, and I know that a number of models have been considered in the last few years. I urge the Minister to bring together NICE, the CDF, the NHS, charities, the industry, and others to thrash out as soon as possible a new, workable drug appraisal model that everybody has confidence in.
Important as they are in extending life, chemotherapy drugs are not the be-all and end-all. In fact, for pancreatic cancer survival rates to increase substantially we need earlier diagnosis of the disease, and new types of treatment made available to patients as a matter of priority. Will the Minister prioritise a public awareness campaign? Campaigners such as my constituent, Maggie Watts, and fantastic pancreatic cancer charities such as Pancreatic Cancer Action and Pancreatic Cancer UK would, I am sure, be keen to work with the Department, and others, to promote a public awareness campaign that leads to earlier diagnosis.
Some of the trial measures for early diagnosis announced by NHS England last weekend, including direct GP access to CT scans, direct patient referral to specialists, and multi-disciplinary diagnostic centres, are welcome. Measures that are designed to speed referral pathways and stop patients being “ping-ponged” backwards and forwards between GPs and different specialists were raised in the Westminster Hall e-petition debate.
Self-referral may end the tragic cases of patients who get so fed up with being ignored by their GP or hospital that they end up paying for a private scan to confirm one way or another whether they have cancer, and I am optimistic that progress can be made. Perhaps the Minister can provide us with more details about the trials, which I know are being implemented jointly with Cancer Research UK and Macmillan Cancer Support. How many trial areas will be selected? Where will they be? How can patients take part? Perhaps importantly for this debate, will access to tests for pancreatic cancer, such as CT scans, be included in the pilots?
One issue raised in the September debate was the need to prioritise promising new technologies for treating cancers of unmet need—such as pancreatic cancer—as soon as possible. It was welcome when the Minister said in response to that debate that a new NHS England and Cancer Research UK trial into stereotactic ablative radiotherapy—treatments such as CyberKnife—would include pancreatic cancer. That, and other treatments such as NanoKnife, can precisely target tumours, potentially making them very important in the fight against pancreatic cancer where the location of the tumour sometimes makes curative surgery impossible—for instance, when the tumour has grown very close to an artery. Those new technologies could therefore help to reduce the size of the tumour on so-called borderline resectable patients, subsequently making them eligible for full curative surgery. The confirmation over the weekend that NHS England will be carrying out the SABR trial is most welcome. Will the Minister confirm that the trial will include pancreatic cancer? Will she confirm how many patients will be recruited and which centres will carry out the trial? When will it start recruiting?
One of the ways we might gain more rapid data on the efficacy of technologies such as CyberKnife and NanoKnife and benefit patients at the same time is through the commissioning through evaluation programme. The Minister will be aware that the all-party group on pancreatic cancer produced a report in October that made a number of recommendations about how to boost research into pancreatic cancer. I am grateful to the Minister for copying me in to her response to the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who is in his place. He has done an outstanding job of chairing the all-party group and raising issues both in this House and outside relating to this difficult matter. One recommendation suggested including both NanoKnife and CyberKnife in the NHS England commissioning through evaluation programme as a matter of priority. Will the Minister update us on the current funding status for commissioning through evaluation? What consideration will be given to the all-party group’s recommendation to include those technologies in the scheme as a priority?
On a similar subject, and referring to another recommendation from the recent all-party group’s research report, the Minister will know that Genomics England is funding a huge project to sequence the genomes of people with rare diseases and cancer. As things stand, I believe only six types of cancer are included in that project and that pancreatic cancer is not one of them. I therefore ask the Minister to include pancreatic cancer as a priority area as part of that project. Failing that, will she confirm that, under their service specifications with Genomics England, individual centres have the flexibility to add to the types of disease from which they collect and sequence samples? If individual centres were agreeable, they could themselves decide to add pancreatic cancer to their work areas above and beyond the six cancer types agreed nationally.
I note that a new independent cancer taskforce has been established to produce a new national cancer strategy for the next five years. That is truly welcome news. I understand it will look at areas such as early diagnosis, access to treatment, improvements to care, and, vitally, research and innovation. As part of that development, will the Minister consider making sure that the new strategy has a particular focus on prioritising cancers of unmet need? If we are to make real inroads into improving overall cancer survival rates, we must prioritise building research and innovation to better tackle the most difficult-to-treat cancers—those with the lowest survival rates such as lung cancer, brain tumours, oesophageal cancer and, of course, pancreatic cancer.
In conclusion, hopefully in the coming months we will receive confirmation that Abraxane stays on the cancer drugs fund list for the longer term. This is a short-term, but important, step. I hope we will see new treatments, such as CyberKnife and NanoKnife, made quickly available to pancreatic cancer patients, perhaps through the commissioning through evaluation process. I hope clinical trials and research projects, such as the Genomics England project, will prioritise pancreatic cancer for research, and that a new national cancer strategy might prioritise research and innovation into tackling the cancers with the worst survival outcomes. Lastly, I hope the Government will work with all interested parties to introduce a public awareness campaign to maximise early presentation, followed by early diagnosis, leading to earlier action and transforming outcomes for patients with pancreatic cancer.
Eric Ollerenshaw (Lancaster and Fleetwood) (Con)
I am grateful for the opportunity to speak in this Adjournment debate and to my friend the hon. Member for Scunthorpe (Nic Dakin), the deputy chair of the all-party group, for his constant work. He introduced the Westminster Hall debate and it seems that we merry three—the Minister, the hon. Member for Scunthorpe and myself—meet frequently in these debates. But we make no excuses for that.
With the permission of the hon. Member for Scunthorpe, I will let the Minister into a secret; we deliberately went for this debate not knowing the outcome of the cancer drugs fund decision. We must thank everyone involved in the decision to keep Abraxane. Those include the people who signed the petition, and my hon. Friends the Members for Romford (Andrew Rosindell) and for Milton Keynes South (Iain Stewart), the right hon. Member for Hazel Grove (Sir Andrew Stunell) and my hon. Friend the Member for Mid Derbyshire (Pauline Latham), who accompanied me to No. 10 to hand in the petition. I thank also Pancreatic Cancer UK, Pancreatic Cancer Action—as mentioned by the hon. Member for Scunthorpe—Pancreatic Research UK and Maggie Blanks. I thank everybody who put so much effort into this. But as the hon. Gentleman said, it is temporary and we expect something more.
Reference has been made to the period of two months but in terms of the average, that could double the survival rates of most people with pancreatic cancer. I will not repeat the figures but, on average, 24 people today will be diagnosed with pancreatic cancer. Of those 24, 23 will die within a year. That is the situation.
I also thank the Minister and, as the hon. Member for Scunthorpe mentioned—he seemed to mention everything—there is the five-year action plan. We talked about unmet need and the Americans have talked about recalcitrant cancer strategy, but I add my support to the hon. Gentleman that that becomes part of the responsibilities of the taskforce.
I welcome the announcement last month by NHS England that one-year survival rates from cancer would become a measurement for the new clinical commissioning groups from 2015. I believe that that will make a huge difference; not just with pancreatic cancer but with every cancer. Given that that is the only disease that will be measured in those terms, I thank the Minister and her colleagues for getting that through. I also commend the work of the all-party group on cancer led by my hon. Friend the Member for Basildon and Billericay (Mr Baron), which has worked constantly on early diagnosis. That will be a fundamental key in the revolution that is happening in cancer, and we would like to see it happen for pancreatic cancer.
I also thank the Minister for her detailed reply to the all-party group’s report on pancreatic research, “A Roadmap to Change.” We are grateful for that and the group will try to come back on it. But I have one last request; when I met the Minister, we were promised that the chief medical officer would at some point come to the all-party group and discuss the findings. I would be grateful if she used her good offices to ensure that that happens.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I return to the Dispatch Box very rapidly after the debate earlier this afternoon, and on an important topic; one of the most important in my portfolio. I congratulate once again the hon. Member for Scunthorpe (Nic Dakin) on securing the debate. As ever, he is ably assisted by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). They and their colleagues in the all-party group have achieved much in this Parliament in highlighting the needs associated with this dreadful disease and in raising awareness of it.
I have said many times before at the Dispatch Box that improving cancer outcomes is a major priority for the Government and as the annual report on our cancer outcomes strategy in December showed, we are on track to save an extra 12,000 lives by 2015. Sadly too few of them are those suffering from pancreatic cancer, so while we want to see the best possible results for all cancer patients, I appreciate—as we have discussed before—that outcomes are particularly poor for patients with pancreatic cancer. We need to do a lot better.
I was delighted that on Sunday 11 January NHS England announced a new independent cancer task force to develop a five-year action plan for cancer services that will build on the existing work to improve survival rates and save thousands more lives. The taskforce has been set up to produce a new cross-system, national cancer strategy to take us through the next five years to 2020, building on NHS England’s vision for improving outcomes as set out in the NHS five-year forward view. The taskforce will be set up in partnership with the cancer charities and the health system leaders, and chaired by Dr Harpal Kumar, the chief executive of Cancer Research UK. The all-party group might like to consider how it, too, can participate in, and contribute to, the taskforce.
The new strategy will set a clear direction covering the following areas: prevention; early and faster diagnosis; better treatment and care for all; recovery, re-ablement and living with and beyond cancer; research and innovation; end-of-life care; data and metrics; and work force. The taskforce will produce a statement of intent by March this year, with the new strategy published in the summer.
Tackling late diagnosis is, as we have often said, a very important element in achieving our ambition to improve all cancer outcomes. As the hon. Member for Scunthorpe said, however, there is currently no easy way of detecting pancreatic cancer and it can be particularly difficult for GPs to detect and diagnose, especially in its early stages. Symptoms can be complicated by the fact that they are shared with a wide range of benign conditions.
My ears pricked up when, as part of the taskforce announcement last weekend, NHS England launched a major early diagnosis programme, working with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly. These include offering patients the option to self-refer for diagnostic tests, as the hon. Gentleman said; lowering the threshold for GP referrals; creating a diagnostic pathway for vague symptoms like tiredness, which is particularly important for hard-to-spot cancers such as pancreatic cancer; and setting up multidisciplinary diagnostic centres so patients can have several tests done on the same day at the same place—not the ping-ponging around, which can be so debilitating for someone already feeling very poorly. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England, collecting evidence on approaches with a view to implementation from 2016-17.
Turning to the awareness campaign, we have debated the possibility of pancreatic cancer being part of the “Be Clear on Cancer” campaign set before. Since 2010-11, the Department has undertaken a series of local, regional and national campaigns. Public Health England now leads on this work with the Department, NHS England, charities and relevant stakeholder groups.
It has always been difficult to give a positive response with regard to pancreatic cancer to date, because the focus has so far been on those cancers with the largest number of avoidable deaths. As colleagues know, these campaigns are under constant review, and we work with the relevant experts to see what more can be done. All the time, there are small trials going on to see where we can tackle other cancers. Pancreatic is obviously one that experts will keep under review.
The group that makes decisions about the campaigns, the public awareness and primary care steering group, chaired by our national cancer director, Sean Duffy, has considered pancreatic cancer for a possible campaign. To date, it has been unable to recommend it owing to the problems we mentioned about symptoms, but members would be very happy to look at it again if there were new evidence. I sense from all the things going on—particularly some recent announcements—that that point might not be too far in the future.
Jane Ellison
If I recall my diary correctly, I have a meeting with Sean Duffy coming up, and I would be happy to raise that issue with him, along with any other points arising from this debate. It will certainly be on my agenda for discussions with him. I have touched on the matter briefly with him before, but I will pick it up again.
The problems with late diagnosis have been explored before, and it is critical that we get people the most appropriate treatment early. We have discussed radiotherapy before. It can be a very helpful treatment for some patients. As part of its recent announcement, NHS England committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy— stereotactic ablative radiotherapy or SABR, as the hon. Gentleman mentioned. That evaluation programme will mean a significant increase in the number of cancer patients eligible to access this treatment by around 750 a year, and the programme will widen the number of cancers being treated by SABR, including cancer that has spread to another part of the body.
The new investment is in addition to NHS England’s pledge to provide up to £6 million over the next five years to cover NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK and one of which—as the hon. Gentleman knows from our debate last September—relates to pancreatic cancer. As for the hon. Gentleman’s suggestion regarding commissioning through evaluation, I shall raise it with NHS England. I am afraid that we do not yet know which centres or how many patients will take part in the trials to assess the effectiveness of SABR in comparison with conventional radiotherapy or surgery, but I understand that we are likely to have that information in the coming weeks. I will certainly make the decision-makers involved aware of the debate, and of the interest in the outcome of their deliberations.
NHS England’s chemotherapy clinical reference group has set out service specifications defining what NHS England expects to be in place to enable providers to offer evidence-based, safe and effective chemotherapy services. NICE has issued technology appraisal guidance which recommends Gemzar as an option for treating patients with advanced or metastatic adenocarcinoma of the pancreas who meet certain clinical criteria. NICE is also appraising a number of new drugs for pancreatic cancer. NHS commissioners are legally required to fund treatments recommended by NICE in its technology appraisal guidance.
Understandably, the cancer drugs fund has been mentioned this evening. The Government’s reasons for establishing the fund are well documented. At the end of August 2014 it received an additional £160 million, and I welcome the announcement on 12 January by NHS England, which is now responsible for the fund’s operational management, that it too would provide extra money. The CDF panel has decided that further consideration of Abraxane for the treatment of pancreatic cancer is needed, and it will remain on the national CDF list until that has been concluded. I am not yet sure about the timings, but I will undertake to update the all-party group, including the hon. Members for Scunthorpe and my hon. Friend the Member for Lancaster and Fleetwood, in due course.
Let me now say something about NICE appraisals. Representatives of the Department, NICE, 10 key cancer charities and the pharmaceutical industry met in December to discuss the future of cancer drugs commissioning. They committed themselves to establishing a working group to develop a robust process to support the sustainable, long-term commissioning of cancer drugs. The group will meet for the first time, opportunely, on Monday 19 January.
I am glad that the hon. Member for Scunthorpe found the letter about research useful. He and I, along with my hon. Friend the Member for Lancaster and Fleetwood, had a very good meeting with the chief medical officer, and we have followed that up with a response to the all-party group’s excellent report, which was published last October. At our meeting, the chief medical officer said that she would be happy to attend a meeting of the all-party group. I will remind her of that, but I suggest that the hon. Gentleman and my hon. Friend get in touch with her. We would respond positively to that.
The Government are investing a record £800 million over the five years to 2017 in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool pancreas biomedical research unit. The unit is working in partnership with industry and leading research institutions to develop new treatments and diagnostic strategies for pancreatic cancer. The National Cancer Research Institute brings together clinicians, scientists, statisticians and lay representatives. Its upper gastro-intestinal cancer clinical studies group has a pancreas sub-group, which plays a vital role in the development of trials.
Late in 2012, the Prime Minister launched the 100,000 genomes project, which will sequence 100,000 whole genomes from NHS patients by 2017. It focuses on patients with rare diseases and their families, as well as on patients with some types of cancer. We believe that the six cancers that will be covered will give us knowledge and understanding that can be applied to all cancers. Although pancreatic cancer is not one of the six, we expect the project to make a useful contribution in that regard.
I thank both Members who have spoken this evening, I thank the all-party group, and I thank all those who campaign tirelessly for progress on pancreatic cancer. We know that achieving improved outcomes for people with the disease is a huge challenge, but I believe that the change that we all desperately want to see will come. I welcome the new cancer taskforce, which will be leading the way, and I undertake to write to its independent chairman, drawing his attention to this evening’s important debate and the work of the all-party group.
Question put and agreed to.