New Cancer Strategy

Nicholas Dakin Excerpts

Thursday 19th November 2015 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to follow the hon. Member for Bosworth (David Tredinnick), who painted a very broad canvas of things for us to think carefully about as we take this strategy forward. May I also begin by praising the hon. Member for Basildon and Billericay (Mr Baron) for his leadership in this area and for the way in which Members across the House have worked together in this important field?

It is worth saying from the outset that a large part of the challenges we face are the challenges of success. Success in tackling many cancers has led to a right and proper rise in expectations. It is therefore important to pay tribute to all who work in this field—clinicians, patient groups, charities and a host of other people and organisations—for the outstanding work they do. However, the cost and challenge of treating cancer will continue to rise rapidly during this Parliament. The “Five Year Forward View” projections indicate that expenditure on cancer services will need to grow by about 9% a year, reaching £13 billion by 2020. This growth is between two and three times the rate of other health spend.

The commitment for everyone to have access to the recovery package by 2020 and the development of a quality of life metric by 2017 are welcome, but clear plans need to be put in place for these to happen. It is vital that there are commitments, both in terms of funding and resource, to deliver the full living with and beyond cancer programme, cancer alliances and a workforce review.

A national cancer advisory board, as recommended in the strategy, needs to be set up urgently to hold all the arm’s length bodies to account on delivering the recommendations laid out in the strategy. It is vital that this board is fully independent, with an independent chair. The Government must also fund and implement the recommendations set out in the independent review on choice in end-of-life care to ensure that there is choice and quality in that care.

Such investment in the national choice offer should result in a significant increase in out-of-hospital care, including through district nurses, allied health professionals, pharmacists, social care services and specialist palliative care teams, to ensure that every dying person has access to round-the-clock care seven days a week. That investment should also result in greater co-ordination between services to improve the quality of end-of-life care and to support carers and families; more empowered patients and carers who are able to exercise greater choice in their place of death; a reduction in hospital admissions for people at the very end of their lives; and the use of the latest technologies to support end-of-life care.

As chair of the all-party parliamentary group on pancreatic cancer, I strongly welcome the cancer strategy, and in particular the recommendations relating to improving early diagnosis and improving patient care and end-of-life care. I am concerned, however, that despite recognising the existence of a group of cancers with high incidence but low survival rates—highlighted as group 3 in the strategy—the strategy fails to acknowledge the need for specific actions to tackle the problems unique to that group.

Pancreatic cancer is the fifth most common cause of cancer death in the UK, and it is a clear example of an unmet need in cancer care. On average, one person is diagnosed with pancreatic cancer every hour, yet its five-year survival rate has remained virtually unchanged over the past 20 years and remains shockingly low at around 4%. That is the worst survival rate of the 21 most common cancers.

The hon. Member for Basildon and Billericay rightly welcomed the fact that the strategy recognises the need to improve early diagnosis by reforming the referral system. Improving early diagnosis is the key to improving survival rates. Only 80% of pancreatic cancer patients are currently diagnosed at a stage where surgery—the only real hope of a cure—is still an option, and only 10% go on to receive that life-saving surgery. Ensuring that more patients are diagnosed earlier, while surgery is still a viable option, is therefore essential to improving the appalling survival rates faced by pancreatic cancer patients. That is also an issue for other cancers, such as blood cancers. At present, 50% of acute myeloid leukaemia diagnoses, 37% of myeloma diagnoses and 35% of chronic myeloid leukaemia diagnoses are happening in emergency settings. I echo the comments of the hon. Member for Crawley (Henry Smith) on the excellent work being done by Bloodwise in this area.

The recommendation of a four-week diagnosis target is welcome, and I am pleased that the Department of Health has committed to looking at adopting that recommendation by 2020. I also welcome recommendation 21, which calls on NHS England to pilot the implementation of multi-diagnostic centres as a priority. Such centres would allow patients presenting with vague symptoms, such as abdominal pain, to have multiple tests on the same day, preventing the need for them to present at their GP surgery repeatedly before being diagnosed, thus speeding up their diagnosis. That could be especially significant for pancreatic cancer patients, who report having to visit their GP on multiple occasions before being referred for tests. A UK-wide survey carried out by Pancreatic Cancer UK found that 23% of pancreatic cancer patients had to visit their GP seven or more times before they received a diagnosis. The introduction of multi-diagnostic centres would therefore be a big leap forward.

The call for GPs to have direct access to investigative tests by the end of 2015 is also very welcome. None the less, it is important to ensure that GP surgeries have the imaging capacity—in terms of equipment and of staff training—to carry out investigative tests such as CT scans. Will the Minister tell us what assessment the Department of Health has made of GP practices’ current imaging capacity and the capacity that would be needed to ensure that all GPs were able to carry out investigative tests?

The measures in the strategy to improve patient experience are to be warmly welcomed. National cancer patient experience surveys show that the pancreatic cancer patient experience continues to fall short of expected standards, especially in the lack of appropriate information about their diagnosis, about treatment options and about what to expect following discharge from hospital. Access to a clinical nurse specialist is a key factor in improving the patient experience, but it is also essential to ensure that clinical nurse specialists have the resources needed to provide a good quality service. In a survey of these specialists carried out by Pancreatic Cancer UK in 2015, only 28.36% of respondents said they felt they were able to spend as much time with their patients as necessary and had enough resources to provide a good quality service.

The need for more clinical research into cancer is also highlighted by the new cancer strategy, and I strongly support this recommendation, as the kind of change needed to make any significant impact on survival rates will be achieved only through research: research that will aid earlier diagnosis and screening; research that will result in more and better treatments; and research that, we hope, will offer opportunity for a cure. Despite accounting for 5% of cancer deaths, pancreatic cancer received only 1.4% of the National Cancer Research Institute partners’ research spend in 2014. Although that is an increase on the 2013 research spend, pancreatic cancer research funding continues to lag behind many other areas of cancer research.

The strategy also makes reference to the need for

“a sustainable solution for access to new cancer drugs”.

That has exercised the minds and thoughts of Members from across this House, as well as plenty of people outside it who know a lot more about the matter. It is only a fleeting reference in the strategy, yet access to drugs is one of the most important issues for pancreatic cancer patients. In particular, pancreatic cancer patients face a persistent lack of access to treatments, making access to new drugs especially important. That is demonstrated most starkly by the removal of the life-extending drug Abraxane from the cancer drugs fund list recently. The CDF decision is compounded by the fact that the National Institute for Health and Care Excellence has also reviewed and rejected Abraxane for use on the NHS, on the grounds of it not being cost-effective enough. In a way, that is not surprising, as between 2007 and the end of 2013 NICE recommended only 31% of cancer drugs for use on the NHS. That is why the setting up of the CDF is to be commended, as it is to compensate for this bias by NICE against cancer drugs. The NICE scoring system is even less flexible than the CDF one. Again, it is not fair to judge a new treatment for a disease with such poor survival rates and very few treatment options on the same criteria as other treatments for other cancers and other conditions. We need more imagination and more flexibility if we are to make the strides forward that need to be made.

There is ever such a lot to welcome within the strategy, but it could have gone further, by including measures to deal with group 3 cancers. Despite identifying cancers with high incidence but low survival rates, the strategy has not yet set out any measures aimed at tackling that precise problem. Greater awareness of the symptoms of these cancers, which can be non-specific, alongside more research into diagnosing and treatments, and the creation of a fair and flexible drugs appraisal scheme remain essential. I hope that in taking the work of this strategy forward, the people involved will endeavour to put those things in place.

Cancer Drugs

Nicholas Dakin Excerpts

Tuesday 20th October 2015 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

As ever, it is a real pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Strangford (Jim Shannon), who is an assiduous campaigner on this and many other issues, on setting out the case very clearly in his opening speech.

I will focus on pancreatic cancer, which, as everyone knows, is an extremely aggressive form of cancer with the worst survival rates of any of the most common cancers. The way in which Abraxane has been dealt with by the cancer drugs fund and the National Institute for Health and Care Excellence is illustrative of the challenges in access to other cancer drugs.

When used in combination with standard chemotherapy, Abraxane can extend the life of eligible patients on average by just over two months compared with using gemcitabine alone. However, it is important to note that, in some cases, patients live for significantly longer than two extra months, with some patients on the trial living for more than two years. The hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) captured very clearly how two months can be significant in allowing patients with such an aggressive disease to settle their affairs and manage their situation as best as they can. There has also been a significant increase in the number of patients surviving for more than one year. For a disease in which there have been no drug improvements for more than 40 years, Abraxane is significant in finding a better answer.

Abraxane represents a middle road for pancreatic cancer patients. It is more effective than gemcitabine alone and, although it has considerable side effects, it is less toxic than FOLFIRINOX, which has been shown to extend life for longer but can only be used for the very fittest of patients. Although not all patients will be fit enough to use Abraxane, more patients will ultimately have access to life-extending treatment.

Abraxane was added to the cancer drugs fund in March 2014. That was a moment of great hope and expectation for the pancreatic cancer community, which for so long has had little about which to be positive. However, as new drugs were added to the cancer drugs fund and costs started to rise, a process began of removing drugs from the CDF’s list of approved drugs so that the fund could keep within budget, as the hon. Member for Strangford has outlined. A further review began in July 2015, and a decision was announced in September that Abraxane, along with several other drugs for other conditions, would be removed as of 4 November. That is happening across cancer treatment. For example, lenalidomide, which is currently being trialled on multiple myeloma patients with positive results, is also being removed from 4 November. This is a big problem out there in the real world.

It seems bizarre that a drug can be added to the cancer drugs fund in March 2014, then be removed just 18 months later. It seems wrong that a drug for which there was such strong demand—more than 550 patients accessed Abraxane via the cancer drugs fund in its first year, and the numbers were rising towards the end of the year—should be removed when few other treatments exist. It seems inequitable that the scoring system used by the CDF does not take into account the extremely poor survival rates for pancreatic cancer. We simply cannot have a one-size-fits-all system in which a drug giving substantial relative gain for a disease that has seen hardly any new treatments or improvements in survival for decades is judged by the same standards as drugs for other cancer types that have much better survival rates and many more treatment options.

Abraxane is not one of the most expensive drugs on the CDF. It costs some £8,000 per patient, not the £90,000 for some other treatments. There is considerable public outcry against the decision. One petition on Change.org created by my constituent, Maggie Watts, who lost her husband to pancreatic cancer 40 years after he lost his mother to pancreatic cancer— there has been no change in survival prospects over those 40 years—has exceeded 88,000 names already. Another petition started by the charity Pancreatic Cancer Action on the parliamentary e-petition site has passed 20,000 signatures.

There is a real problem, and a postcode lottery is emerging across the United Kingdom, with Scotland having approved Abraxane for routine use on the NHS back in January 2015 after the drug was assessed using Scotland’s new patient and clinician engagement system. Perhaps, as the hon. Member for Strangford said, we in England can learn from that. Wales used its own assessment to approve the drug for use back in September 2014. However, because NICE has said no to Abraxane in England, the drug will be reappraised in Wales, which might lead to access being removed. Northern Ireland has never had access to the drug because it generally follows NICE decisions and, as things lie, it does not look as if Northern Ireland will have access to the drug in future.

[Mark Tami (Alyn and Deeside) (Lab)]

My hon. Friend has outlined all the hoops that people have to leap through. If their timing is wrong, they may or more likely may not qualify for the drug. That is happening when patients are at their weakest. They are not experts, and they find themselves victims of what can appear to be a very cruel and harsh system.

[Nic Dakin]

My hon. Friend is right that patients and their families are at a critical point, which is why it is important that, on this difficult issue, we try our best to find a way forward that is sensitive to the need for such exceptional drugs in exceptional circumstances. In many ways, the Government should be praised for introducing the cancer drugs fund, but the CDF is clearly not fit for purpose when dealing with such exceptional situations, which is what is needed.

Other countries across the world are taking a leap forward in approving Abraxane for their health systems. Abraxane has been approved on price grounds for reimbursement in Austria, Denmark, Germany and Greece, and it has been given the go-ahead in the USA, Canada and Australia. There is a real danger that patients in the UK will be left behind unless they happen to be in Scotland. Removing access to Abraxane could mean that fewer patients can access trials. Moreover, we could be setting back research into a disease that for many years has had the worst survival rates of the most common cancers. This is an opportunity for a breakthrough in medical research that needs to be taken

I ask two things of the Minister, who goes about his work in an assiduous and effective way. First, can he take steps to examine the processes that NICE and the CDF use to consider drugs so that they take into account the exceptional circumstances surrounding drugs of this nature in areas where there has been no medical process or medical hope for many years? Secondly, will he meet me and the other officers of the all-party group on pancreatic cancer to explore the specific issues around Abraxane?