Health: Cancer

Lord Kakkar Excerpts

Thursday 11th November 2010 Lords Chamber

[Lord Kakkar]

My Lords, I thank the noble Baroness, Lady Finlay of Llandaff, for having secured this important debate. I congratulate the noble Lord, Lord Howard of Lympne, on his excellent maiden speech, defined by the strong values that have characterised his contribution to public life over three decades.

I propose to contribute today on the subject of thrombosis blood clotting, which is common in cancer patients, and in so doing refer your Lordships to the entry in the register of interests where I state that I am a practising cancer surgeon; that I am director of the Thrombosis Research Institute in London, where I lead a large programme of research globally on the problem of thrombosis in cancer patients; and that I have a scientific advisory role to a number of pharmaceutical industry organisations involved in thrombosis research.

We have heard about the important advances in clinical outcomes that have attended many cancers over the past two or three decades; that is welcome. That has been achieved through a better understanding of the biology of many cancers, which allows us to characterise them in more detail and to ensure that targeted therapies can be provided to patients, so improving both survival and quality of life. As we have heard, improvements in the outcomes for patients with malignant disease have also been achieved through earlier diagnosis. That is critical, because many of the advances in surgical practice can be applied only to those patients who present with earlier-stage disease, where radical interventions can in some cases cure, and in other cases ensure long-term palliation.

Advances are available beyond intervention in surgery, through new therapies. One of the exciting developments over the past five to 10 years is targeted biological therapies, which definitely improve outcome and survival but are frequently associated with a high frequency of unintended complications. The agents will improve outcome but can be associated with problems such as infection/febrile neutropenia and, of course, thrombosis blood clotting. Blood clots in any patient population develop in the deep veins of the legs and can often grow up the venous system of the leg, break off and pass to the lung, where they occlude the circulation from heart to lungs and can frequently be fatal. In the United Kingdom, the Health Select Committee of the other place in 2005 undertook a report into thrombosis and blood clots in hospitalised patients—a world first for a parliament—and identified it as a problem, with 30,000 deaths a year associated with thrombosis unnecessarily after hospital discharge.

As a result, we now have a system available throughout the NHS of risk assessment for patients coming into hospital, so that those at the highest risk of developing a blood clot can be provided with appropriate interventions to prevent them. One of the most important risk factors for developing a blood clot is the presence of malignant disease. Some 20 per cent of the total burden of thrombosis is seen in patients with cancer and, regrettably, cancer patients who develop a thrombosis are three times as likely to develop recurrent blood clots during the course of their natural history. Even though they are provided with anti-clotting drugs, they are twice as likely to develop major bleeding complications as a result of their use, so it is a problem.

While cancer patients are in hospital, they will be subjected to risk assessment in the perioperative environment or if they are admitted to a hospital bed for other management of their malignant disease. However, the management of cancer patients extends well beyond a short period in hospital. There are important opportunities to improve clinical outcomes through extending risk assessment into the other care environments where patients with malignant disease are managed. As we have heard, that is at home, potentially in hospice, or in other care environments such as ambulatory care for receipt of chemotherapy in the community. The National Institute for Health and Clinical Excellence has excellent guidelines at the moment on the prevention of venous thromboembolism in all patient populations. When it reviews that guidance, will it take the opportunity to look specifically at the problem of thrombosis in patients with malignant disease outside the hospital setting, and undertake some review of the available evidence with regard to risk assessment in the out-of-hospital environment and the potential use of anti-clotting drugs to prevent thrombosis and potentially improve clinical outcomes?

I ask that of the Minister because cancer patients who develop a thrombosis regrettably have a much poorer prognosis than those patients who never develop one during the natural history of their cancer. With so much emphasis directed rightly on early diagnosis and the provision of surgical intervention or chemotherapy and biological interventions to improve clinical outcomes, we also need to pay attention to avoiding unnecessary complications and to ensuring that the whole spectrum of supportive care for those with malignant disease means that they can benefit from increased quantity and quality of life.