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Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4530 (Published 04 October 2017) Cite this as: BMJ 2017;359:j4530

Re: Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13

This paper provides further evidence that most new cancer drugs have not been shown to improve survival or quality of life, and that when survival gains are shown they are not always clinically meaningful.(1)

Wise previously drew attention to over permissive new drug approval systems internationally, and the almost routine offer of chemotherapy without adequate guidance on benefits and risks that deprives patients of deserved empowerment: their potential and right to choose only palliative (best supportive) care rather than drugs.(2)

This paper is a further wake-up call to oncologists, general practitioners and patients for an early palliative care approach integrated with disease-modifying care - that is giving personalised support to patients to help them socially and emotionally as well as whatever cancer medication may be required. This approach should be started at diagnosis of a life-threatening illness, when people start to worry, rather than in the final weeks when it is too late to prevent and treat most problems. This may spearhead the realisation of realistic medicine,(3) and it represents a major contribution to health promotion towards the end of life. Our recent analysis and embedded video gives a rationale for this approach to be triggered earlier than later.(4) https://www.youtube.com/watch?v=vS7ueV0ui5U

If palliative care were a drug, the manufacturers would be busy due to the great demand for such a beneficial treatment with no toxic side-effects. The general public would be calling for it, and patient support groups would be approaching politicians.

However “palliative care” has a bad press as it’s associated wrongly with imminently dying. Promoting early palliative care is to everyone’s advantage: patients, carers and the health service at large. Being able to offer compassionate support that covers all dimensions of need, and communicating and planning openly would prevent many treatments that are likely to cause more harm than good. The expense and toxicity of cancer drugs mean we have an obligation to expose patients to such medication only when they can reasonably expect an improvement in survival or quality of life.(5)

We must offer palliative care or “palliatosin” as an active choice, an alternative therapeutic option to enable people to live well in such difficult situations.

Scott A Murray, Sebastien Moine

1. Davis C, Naci H, Gurpinar E, Poplavska E, Pinto A, Aggarwal A. Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13. BMJ. 2017;359.
2. Wise PH. Cancer drugs, survival, and ethics. BMJ. 2016;355:i15792.
3. The Scottish Government. Realising Realistic Medicine: Chief Medical Officer's Annual Report 2015-16. http://www.gov.scot/Resource/0051/00514513.pdf.
4. Murray SA, Kendall M, Mitchell G, Moine S, Amblàs-Novellas J, Boyd K. Palliative care from diagnosis to death. BMJ. 2017;356.
5. Prasad V. Do cancer drugs improve survival or quality of life? BMJ. 2017;359 j4528.

Competing interests: No competing interests

13 October 2017
Scott Murray
St. Columba's Hospice Chair of Primary Palliative Care
Sebastien Moine
University of Edinburgh
Usher Institute of Population Health Sciences & Informatics, University of Edinburgh