Letters Cancer drugs, survival, and ethics

The Association of Cancer Physicians responds to “Cancer drugs, survival, and ethics”

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6487 (Published 05 December 2016) Cite this as: BMJ 2016;355:i6487
  1. Adam Dangoor, consultant medical oncologist1,
  2. Johnathan Joffe, consultant medical oncologist2,
  3. Adam Januszewski, medical oncology specialist trainee3,
  4. Janine Mansi, consultant medical oncologist4,
  5. David Cunningham, consultant medical oncologist5,
  6. Peter Selby, consultant medical oncologist6
  7. On behalf of 17 other authors and members of the Association of Cancer Physicians, UK
  1. 1Bristol Cancer Institute, Bristol Haematology and Oncology Centre, Bristol BS2 8ED, UK
  2. 2Huddersfield Royal Infirmary, Huddersfield, UK
  3. 3Imperial College, London, UK
  4. 4Guy’s and St Thomas’ Hospital, London, UK
  5. 5Royal Marsden Hospital, London, UK
  6. 6St James’s University Hospital, Leeds, UK
  1. adamd{at}doctors.org.uk

As UK health professionals specialising in the drug treatment of cancer, we think that Wise’s analysis strays into the territory of unbalanced opinion.1 We welcome discussion of topics that we debate ourselves; his article is a useful counterpoint to the hyperbole we often see in the media around incremental improvements in treatment. But he conflates problems from different healthcare systems and fails to credit specialists for maintaining high ethical standards and having awareness of treatment limitations.

Conflicts of interest are a potential problem, perhaps most clearly demonstrated in the US where reimbursement through Medicare means that doctors may benefit from prescribing more expensive drugs; fortunately, the NHS has no such perverse incentives.

Wise describes the approval of drugs with evidence of minimal gains in survival. But he does not mention that most will not be approved by NICE in the UK or be in routine use. Significant gains in survival due to systemic treatments have unquestionably been made, in both adjuvant and metastatic settings.2

Members of the Association of Cancer Physicians lead initiatives to improve efficacy and quality of care. These include data collection and publication3 and educational workshops. We have collaborated with patients to produce a strategy document to drive care improvements,4 and we have developed treatment consent forms with Cancer Research UK to encourage full and frank discussions with patients.5

Oncologists are very conscious of the financial constraints on healthcare systems, and they work with patients, charities, research institutions, government, and drug companies to develop more effective, targeted treatments. Supporting patients at the end of life to make the best decisions for them and their families, with empathy and kindness, is one of the things that make our job so rewarding.

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