Treatment Concerns - Definitions / Living Wills / Palliative Care / Terminal or Excessive Sedation / Organ Donation / DCD or NHBD / Hospice / POLST / DNR

Government-Funded National Health Care: Is This Really What We Want? (2008)

Comment:  It’s truly mystifying that this media outlet can publish an article like this clearly highlighting one of the problems of government-funded healthcare in another country, but refuse to see what is coming down the pike for Americans if government-run, universal healthcare is implemented.  

Pushes for the legalization of euthanasia and physician-assisted suicide will also be stepped up because of strained budgets as well as a general sense of hopelessness among those who suffer. 

Furthermore, money will be diverted away from cancer drug research—and other types of disease research—as the system collapses under its own weight.  Recently, a cancer patient was denied payment for chemotherapy in Oregon by the Oregon Health Plan.  Instead, she was offered assisted suicide.  (See http://www.katu.com/news/26119539.html)  

What else might we expect?  If it’s cheaper to offer a lethal prescription for one to die, why bother investing in training staff in effective palliative care and pain management?  Yes, in Great Britain and Oregon [and soon in WA State], a “right to die” has clearly evolved into a “duty to die.”  –Deb Sturm, RN 

 

Cancer Patients Lose Shot at Longer Life in U.K. Cuts (Update1)

Jack Rosser's doctor says taking Pfizer Inc.'s Sutent cancer drug may keep him alive long enough to see his 1-year-old daughter, Emma, enter primary school. The U.K.'s National Health Service says that's not worth the expense.

Rosser, 57, was told the cost of Sutent, 3,140 pounds ($4,650) per treatment for his advanced kidney cancer, was too high for the NHS — the government agency that funds the nation's health care.

The resident of the town of Kingswood, in southwest England, has appealed the decision twice, and next month may find out if his second plea is successful.

“It's immoral,'' Rosser's wife, Jenny, said. “They are sentencing him to die.''

The NHS, which provides health care to all Britons and is funded by tax revenue, is spending about 100 billion pounds this fiscal year, or more than double what it spent a decade ago, as the cost of treatments increase and the population ages. The higher costs are forcing the NHS to choose between buying expensive drugs for terminal patients and providing more services for a wider number of people.

About 800 of 3,000 cancer patients lose their appeals for regulator-approved drugs each year because of cost, Canterbury- based charity Rarer Cancers Forum said. The U.K. is considering whether to make permanent a preliminary ruling that four medicines, including Sutent, are too expensive to be part of the government-funded treatment of advanced kidney cancer.

`It's Outrageous'

“It's outrageous,'' said Kate Spall, a full-time activist who has helped about 100 patients appeal NHS denials of cancer medicines. “We are not asking for anything new or exciting or novel. We are asking for what the rest of the western world is getting.''

To help curb expenses, the government created the National Institute for Health and Clinical Excellence, known as NICE, in 1999 to review medicines and recommend whether the NHS should fund them.

“There is a view that all treatments should be available. Unfortunately, that's not possible,'' said Peter Littlejohns, NICE's clinical and public health director. “There is a limited pot of money.''

He said the four cancer drugs provide a “marginal benefit at quite often an extreme cost'' and that the agency had to keep in mind that funds spent on the medicines could be used elsewhere to help others at a greater value. “Those are the hidden patients, the ones who benefit from the things the NHS does spend money on,'' Littlejohns said.

NICE Review

NICE is reviewing its Aug. 7 preliminary recommendation that Sutent, Roche Holding AG and Genentech Inc.'s Avastin, Bayer AG and Onyx Pharmaceuticals Inc.'s Nexavar, and Wyeth's Torisel shouldn't be funded in light of their cost of 20,000 pounds to 39,000 pounds a year per patient. All four medicines have been approved by European and U.S. regulators and are sold in other countries as well. A final ruling is expected in March.

While a drug is under review, the decision whether to pay for a therapy falls to the NHS's 156 local organizations, called trusts.

Of the 3,000 applications for exceptional funding for cancer patients a year, the most-requested drug was Sutent, said the Rarer Cancers Forum, which focuses on cancer cases that fall outside the more common ones such as colon, breast, lung and prostate.

Sutent, which stops cancer cells from dividing and chokes off a tumor's blood supply, was first approved for European use in July 2006. Kidney cancer sufferers taking the drug had a median survival rate of 26.4 months, according to a study presented at the American Society of Clinical Oncology in May.

Five Years to Live

New York-based Pfizer provided NICE with Sutent cancer- survival data that were released after its review began to try to persuade the agency to reverse its decision, and has offered to make the first treatment free, company spokeswoman Emily Bone said.

On Nov. 4, the government proposed giving NICE more flexibility in approving higher-cost drugs and allowing patients to buy the medicines themselves without losing access to government-funded health care. Final recommendations on the proposals aren't due until early next year and Rosser can't wait that long for his medicine, Spall said.

Rosser, of Kingswood, England, was diagnosed with cancer four days after Emma was born in July 2007. After operations in August and March to remove a kidney, adrenal glands and bone tumors, he was told he might live two to five years. In July, he was told by doctors that Sutent would help, but the South Gloucestershire Primary Care Trust said it wouldn't pay for the treatment.

`Very Expensive'

“I read the letter and I burst into tears,'' said Rosser, who was forced to retire from his air-conditioning and sheet- metal company because of the illness.

South Gloucestershire, the trust that includes Rosser's home, accepts applications for Sutent funding only for exceptional cases, said Ann Jarvis, director of commissioning at the trust, in an e-mail. “Unfortunately for very expensive drugs, if they are proven to only provide a small benefit we have to prioritize other treatments.''

The trust plans to review its Sutent policy at a meeting next month, spokeswoman Sue Pratt said today.

Kidney cancer patient Kathleen Devonport, a 65-year-old retired factory worker, called it “heartbreaking'' to have to beg her local health officials to provide her with Sutent. The County Durham Primary Care Trust, in northern England, initially turned her down in March 2007, then agreed to supply the Sutent seven months later only after she responded to a cheaper medicine paid for by an anonymous donation.

Offer Vetoed

Jenny Rosser, 41, said she is looking into getting her husband into a clinical trial for Sutent, but so far she has been told that his cancer would need to advanc

e further to qualify.

Meanwhile, he is surviving on painkillers coupled with steroids for inflammation after vetoing his wife's offer of selling the house to pay for his treatments. In late October, he had another operation to remove growths on his spine and neck.

Jenny Rosser said the policies seem aimed more at saving cash than treating people.

“It seems like a money-saving exercise,'' she said. “If a patient dies, tough.''

To contact the reporter on this story: Bruce Rule in London at [email protected]; David Altaner in London at [email protected]

[Last Updated: November 17, 2008,  By David Altaner and Bruce Rule
Bloomberg]