Pancreatic Cancer

Eric Ollerenshaw Excerpts

Monday 8th September 2014 Westminster Hall

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Thank you, Mr Chope. It is good to serve under you, and we did hear the applause.

I congratulate my colleague the hon. Member for Scunthorpe (Nic Dakin) on such a brilliant start to the debate and I thank him for the support that he has given the all-party group on pancreatic cancer month after month. May I also put on the record that my interest in the subject comes from having lost my partner to pancreatic cancer in 2009, only six weeks after diagnosis? I am grateful for the support that I received, and continue to receive, as a result of my loss from my hon. Friends the Members for Pudsey (Stuart Andrew), for Milton Keynes South (Iain Stewart) and for Redditch (Karen Lumley). They are sat close to me to keep me going in the debate, and I am always grateful for their support.

I decided to campaign on pancreatic cancer and helped to set up the all-party group, which I now chair. As the hon. Member for Scunthorpe pointed out, that has meant starting to meet others campaigning on the same issue. I have met representatives from charities such as Pancreatic Cancer UK, which acts as a secretariat for the all-party group and is ably led by Alex Ford, its chief executive; from Pancreatic Cancer Action, founded and led by pancreatic cancer survivor Ali Stunt; and from the Pancreatic Cancer Research Fund, founded and led by Maggie Blanks, who lost her husband to the disease.

I have also met Maggie Watts, whose petition ultimately led to today’s debate. As it happens, she lost her husband, Kevin, only two months after I lost my partner, so we have shared and similar frustrations. That shared sense of loss, the sense of injustice and the shocking survival rates for pancreatic cancer, along with the small amount of time that can generally be spent with people following diagnosis, drive us all—whether MPs, chief executives, charity workers or volunteers—to raise awareness and, I hope, to bring about change so that others do not have to go through what we did.

I thank Maggie Watts and the hundreds of people who campaigned so hard to get more than 100,000 signatures on their petition. I know it was touch and go, but they have managed it in only the past few days. The effort that they have put in to change the status quo, in honour and memory of their loved ones, should be applauded. I really thank them.

As the hon. Member for Scunthorpe mentioned, the all-party group on pancreatic cancer produced a report last year, which made a number of recommendations on how to improve awareness, diagnosis, treatment and care for pancreatic cancer patients. We did not even broach the subject of research in that report; to have done so would have complicated things unnecessarily. This year, therefore, the all-party group is carrying out an inquiry into how to increase the quantity and quality of research into pancreatic cancer in the UK. We held the last of the four evidence sessions last week and will be producing a report in late October. I want to spend some time talking about issues that emerged from the inquiry.

[Dr Julian Huppert (Cambridge) (LD)]

I thank the hon. Gentleman and the hon. Member for Scunthorpe (Nic Dakin) for securing this important debate. Before I was elected, I used to do research into cancer targets. Pancreatic cancer was one of them, and I was looking for new targets. I support the call for research. An oncologist who worked on the issue and with whom I was collaborating said, “All my patients will die very quickly from this unless they are hit by a car in the meantime. We have to change that situation.”

[Eric Ollerenshaw]

I thank the hon. Gentleman for underlining that critical point about survival rates and their impact on the ability of researchers to get that much-needed research.

The consensus we found was that more work is needed and that one of the reasons why survival rates for other cancers are increasing is that effective screening and markers have been developed to allow early diagnosis, thus giving more time for curative treatments to be given to patients. The other side of the argument, which we will go into, is that what we are looking for is support and treatment to allow survival rates after diagnosis to increase. In this day and age, having only six weeks left in which to make life-shattering decisions is unbelievably difficult for people.

[Naomi Long (Belfast East) (Alliance)]

I am glad that we are able to have this important debate. Does the hon. Gentleman agree that, in addition to the need for primary research, there is a disparity between the UK one-year survival rates and the best survival rates in Europe—it is often as much as 11%? Things are known about pancreatic cancer that we can perhaps learn from to treat and diagnose the condition.

[Eric Ollerenshaw]

The hon. Lady makes an extremely important point, which the all-party group was trying to weigh up. The hon. Member for Scunthorpe made an important point about CT scans and made the important suggestion that there should be pilots. Also, interestingly, he mentioned that the going backwards and forwards between the GP and the specialists delayed diagnosis. There are certainly things that we could learn from other countries.

One of the basic needs that came up from our research was the need for investment in the basic science and biology of tumours, as well as access to better infrastructure that would allow that, such as access to tissue samples. On the latter point, the Pancreatic Cancer Research Fund told the APPG that it was working in conjunction with Barts on creating a specific pancreatic cancer tissue bank, which would help. That is a massive investment for a small charity and it should be applauded.

As Members know, there is a massive shift throughout all cancer research towards personalised medicine. Pancreatic cancer patients could benefit particularly from such an approach, given the nature of the disease and the fact that so many different tumour types are involved. New treatments need to be developed to attack and destroy the cancer cells. That does not mean new drugs alone, but perfecting the use of advanced radiotherapy techniques, such as NanoKnife or CyberKnife, for the benefit of patients and to the satisfaction of the National Institute for Health and Care Excellence, so that they can be provided on the NHS.

All in all, a lot of research needs funding. A key statistic for this debate, as mentioned in Maggie’s e-petition, is that pancreatic cancer receives only 1% of the National Cancer Research Institute’s site-specific spend of £5.2 million a year. That is despite the fact that pancreatic cancer is the fifth biggest cancer killer in the UK, and predicted to become the fourth biggest by 2030. It is responsible for 5.2% of all cancer deaths in the UK. The National Cancer Research Institute itself acknowledges that research into pancreatic cancer and other cancers deemed to have unmet need, such as brain and oesophageal cancers—forgive me if I do not pronounce that correctly—remains “relatively low”.

By “relatively low”, however, the institute means “low”. I contend that £5.2 million a year from the NCRI partner funders is simply not enough to tackle the extreme intransigence of a disease as tough as pancreatic cancer, a disease that has seen—as has been mentioned before and should be mentioned again and again—little change in survival rates over the past 40 years or by comparison with other countries, as the hon. Member for Belfast East (Naomi Long) said.

Why does funding matter? Is money the be-all and end-all? No—other things need to be done as well if research into pancreatic cancer is to become more effective. However, if we look at other cancer types, we see that sharp increases in survival rates from breast, prostate and bowel cancer, for example, have mirrored sharp increases in research spending into those diseases. As Professor Peter O’Hare, chair of Pancreatic Cancer UK’s scientific advisory board—now there’s a powerful job—told the APPG inquiry:

“I think if you simply looked at the history of science, I don’t think you can, as a scientist, start to make guarantees about research. It’s not like a sausage grinder; you don’t put research in and it comes out and you solve the problem. It just doesn’t work that way”—

we totally understand and agree with that—

“there are convoluted pathways and you can’t make guarantees.

However, I think there is a guarantee you can make: if you don’t carry out research, you are not going to move; nothing is going to happen. That’s the guarantee that you could make.”

Some evidence suggests a critical mass, a level at which research needs to be funded, if advances are to start to gather pace. Pancreatic Cancer UK produced a report in 2012, “A Study for Survival”, which demonstrated a level—around £10 million to £12 million minimum—at which the amount of research starts to become sustainable and from which new research proposals and ideas are generated. Those new ideas in turn lead to more funding coming in, and we get a virtuous circle.

We are some way off that level of funding at the moment. National Cancer Research Institute funding partners contribute just £5.2 million at present. Incidentally, we learned during the all-party parliamentary group’s research inquiry that the Department of Health’s contribution to that sum is just £700,000 a year. Although they are growing, charities for pancreatic cancer are still small and supply probably less than £2 million a year between them for research. Where, then, can that extra funding come from? What needs to be done?

In its new research strategy, published in April this year, Cancer Research UK made a welcome move in the right direction, with a promise to increase funding into pancreatic and other cancers of unmet need—brain, lung and oesophageal—twofold or threefold over the next few years. That is great news.

[Mr Stewart Jackson (Peterborough) (Con)]

My hon. Friend is making a customarily powerful and passionate speech. He is aware that the five-year survival rate in the United States is 6%, as against 3.3% in the UK. Is he also aware that, under the Recalcitrant Cancer Research Act of 2012, the US Congress has given a legal imperative for the director of the US National Cancer Institute to produce a strategy to tackle such cancers? We should do the same in the UK.

[Eric Ollerenshaw]

I am grateful for that intervention, particularly as I will go on to mention the Recalcitrant Cancer Research Act—as usual, my hon. Friend has got in before me. He is on exactly the right lines in terms of what we are all thinking.

I have talked about good news and extra money. However, I am not sure whether that goes quite far enough. There is still no ring-fencing per se of money for research into pancreatic cancer, brain tumours and so on. Instead, applications will still have to be made for funding. They will be peer-reviewed and selected from similar applications for research into other cancer types.

The issue is that the reason given by Cancer Research UK for not awarding more funding for pancreatic cancer in the past has been that not enough quality applications have been received, so the doubling or trebling of funding set out in the strategy will happen only if more applications are made. For that to happen, we need more researchers in the field, whether established and respected researchers coming over from abroad, such as Professor Andrew Biankin from Australia, who has recently relocated to Glasgow—as usual, Scotland sets the trend—to carry on his pioneering work there, or new, young researchers starting out in their careers.

We are currently in a Catch-22 situation, however: new researchers do not generally want to enter the field, partly because it is deemed difficult to make advances in it—that puts them off as they fear it will hold back their careers, as the Department of Health’s written response to the e-petition mentioned—and partly because the funding is not there. But the funding is not there because not enough research applications are being made.

I firmly believe that we need to break that vicious circle and to pump-prime research into pancreatic cancer, making sure that we hit the minimum funding level required to gain critical mass. I also firmly believe that the Government can and should play a role in that.

[Dr Phillip Lee]

I have long lamented the fact that celebrity endorsements seem to increase the funding of research into particular illnesses and conditions disproportionately in terms of the impact that those conditions and illnesses are having on broader society. Does my hon. Friend agree that the Government might want to take into account the funding that certain conditions receive from private sources because they are deemed fashionable, so that greater Government funding can be given to those conditions that are seemingly less fashionable?

[Eric Ollerenshaw]

My hon. Friend makes an important point. It is difficult for Ministers and boards to make decisions about what is or is not fashionable. Nothing we are trying to do, in getting pancreatic cancer higher up the agenda, is aimed at taking away from the advances being made for other cancers. We all welcome those. We simply want fairer funding ourselves, and some recognition of the impact of this particular cancer. We are not asking to take away from anything else, but unfortunately we are asking the Minister for something extra.

I come now to the Recalcitrant Cancer Research Act, which my hon. Friend the Member for Peterborough (Mr Jackson) mentioned. It was passed in 2012 in the United States, and requires the director of the US National Cancer Institute to prepare a special strategy for recalcitrant cancers in the US. A recalcitrant cancer is defined as a cancer type with a five-year survival rate of less than 20% that kills more than 30,000 US citizens a year.

The result of the Act has been more focus on pancreatic and lung cancer research in the US, as well as a welcome increased focus on and awareness of those cancer types more generally. I would like the Minister to consider whether the British Government need to produce their own recalcitrant cancer research strategy, commissioned and produced either by the Department of Health or the National Institute for Health Research. Such a strategy should focus not just on pancreatic cancer but on other cancers of unmet need—those with low survival rates.

If a British strategy were to use the US definition of “recalcitrant”, it would cover pancreatic cancer, which has a survival rate of just under 4%; lung cancer, for which it is 10%; oesophageal cancer, for which it is 15%; brain tumours, for which it is 19%; and stomach cancer, for which it is 19%. That would help to give a focus.

[Sir Andrew Stunell (Hazel Grove) (LD)]

I apologise to my hon. Friend for arriving late—I was at a Statutory Instrument Committee. My brother-in-law died of pancreatic cancer in July in the United States. I draw my hon. Friend’s attention to the fact that research has then to go on to produce outcomes, and we are still a long way from that. I hope he will agree that it will be a long-term project.

[Eric Ollerenshaw]

I thank the hon. Gentleman for that. I think everybody here—all the people who signed the e-petition and the hon. Members who are here to support the debate—realises that it will be a fairly long journey. We are trying to say that we want a quicker start to that journey, please, given what has happened.

I will not detain hon. Members for too much longer, but I want to finish by mentioning a hobby-horse that I have mentioned in previous debates: the need for more and more effective treatments for pancreatic cancer to be made available on the NHS. The treatments do not need to be discovered; they already exist. Last week, I spoke in the House about the need for the National Institute for Health and Care Excellence to reform if it is ever to be fit for purpose, at least when it comes to ensuring that patients have access to cancer drugs. That is evidenced by the fact that in 2011-12, NICE, as it is called, rejected 60% of the cancer medicines it assessed—an increase since 2010. Simply put, that means that drugs licensed for use in the UK are not being made routinely available on the NHS to all who need them.

The cancer drugs fund for England was introduced in 2010 to clear up the mess—we welcome the fund—and because of it 55,000 patients have been able to access drugs they would not otherwise have managed to access. Those drugs have extended patients’ lives, giving them more time to spend with their loved ones. Unfortunately, the CDF is funded only until 2016. Doctors have to apply for drugs from the fund, which are not routinely available, and any drug on the list could in theory be removed by the CDF panel at any time.

The drug Abraxane, for metastatic pancreatic cancer patients, was added to the CDF list in March this year, following a public campaign and a debate held in the main Chamber. Sadly, however, things have moved on. The Health Secretary recently announced that the CDF will get more money, but the accompanying announcement said that the CDF will be reformed. The precise wording was that it would be more closely “aligned with NICE” and that a new cost-benefit analysis will be introduced when new drugs are considered. Imagine the alarm, Mr Chope, when Sir Andrew Dillon, the chief executive of NICE, said to the Health Committee last week:

“We would like to move away from a situation where…the Cancer Drugs Fund then says yes to the treatments we have said no to…I don’t think that makes any sense. It’s not a criticism of the decision to allocate more money to cancer. It’s about an alignment of processes and methodologies that we need to get sorted out…There is no reason at all why we can’t provide the basis for NHS England’s decisions on cancer treatments just as we do for all other treatments.”

I say to Sir Andrew that there is a reason why: as I have already said, NICE does not work for cancer patients. To treat cancer as if it were like other diseases when it causes so many deaths and when the population is ageing—we know the likelihood of cancer increases with age—is to take a step backwards.

I would be grateful if the Minister commented on the cancer drugs fund. We are worried at the moment. Abraxane has been considered by the fund. We are grateful that it has received ministerial sign-off in Wales. The cancer drugs fund agreed to list it, but now that is with NICE. I hope I am wrong on this, but I suspect that in the near future it will be rejected by NICE for routine use in the NHS in England. It is the first advance in some kind of pancreatic cancer treatment for 40 years, and it looks likely that NICE will reject it. That is a disgrace.

I have held up the Committee for too long, but I do not mind because of the importance of the issue. Just to finish, next year 8,800 people will be diagnosed with pancreatic cancer, of whom 80% to 90% will probably not survive beyond six months. Thousands of relatives and friends will then enter a parallel world: the cancer world.

[Karen Lumley (Redditch) (Con)]

I congratulate my hon. Friend on securing the debate. Does he think that we need to follow the example given to us by the e-petition to educate our constituents? Should we not take part in pancreatic cancer awareness month in November to help raise awareness of this killer disease in all our constituencies?

[Eric Ollerenshaw]

I thank my hon. Friend. If raising awareness was the one thing to come from this petition, all of us who have been affected would say that was positive.

Thousands have signed the e-petition that we are debating because they believe the purpose of government is to make improvements in people’s lives. For the sake of the thousands of cases to come, and for those of us left behind, I urge the Minister to help us to prove that our partners, relatives and friends did not die totally in vain.