Intended for healthcare professionals

Analysis

The responses to the “cancer drugs scandal” must fully involve patients—an essay by Tessa Richards

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4956 (Published 31 October 2017) Cite this as: BMJ 2017;359:j4956
  1. Tessa Richards, patient and senior editor, patient partnership
  1. The BMJ, London
  1. trichards{at}bmj.com

After finding that most new cancer drugs appear to confer little clinical benefit, The BMJ’s Tessa Richards reflects on her cancer journey and argues that decision making in cancer must improve, to involve patients at every level

It sometimes feels as though the frequency of “healthcare scandals” is increasing. The veil is lifted, and the public gets disturbing new insight into healthcare’s harsher realities. The Mid Staffordshire scandal was a notable example1; the US opioid crisis a more recent one.2 Last month, what might be termed a “cancer drugs scandal” hit the headlines.

The trigger was a package of articles in The BMJ laying bare that the approval of most cancer drugs by the European Medicines Agency and the US Food and Drug Administration in 2009-13 was based on “flimsy or untested surrogate outcomes.” To the limited extent that the impact of these drugs has been studied over time, they seldom appear to deliver “clinically meaningful benefit.”3 A Mail Online headline was blunt: “The costly cancer drugs that don’t help patients.”4

A second worrying message, not picked up by newspapers, came from an oncologist in a response to The BMJ’s articles: that “production line systems adopted by the NHS . . . encourage doling out of chemotherapy without thought.”5

These messages warrant wide debate and should give pause for thought to those lobbying for accelerated access to new cancer medicines, including patient organisations. The cost to the public purse is mind boggling6; the cost to patients who directly bear the burden of ineffective and toxic treatments, incalculable.

The struggle to cope with debilitating side effects

As a patient and patient advocate I repeatedly hear, read, and observe stories of bravery, disillusion, and despair. Many patients and carers, including me,7 are deeply traumatised by their cancer journey. Fellow …

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