News Focus

According to the health secretary, It is an obsession of the chattering classes, but cancer remains one of the government's top priorities. As the Britain against Cancer conference debates calls for legislation to ensure services and research are kept up to date, Alison Moore reports The government has made it clear that cancer - along with coronary heart disease and mental health - is one of its top priorities. Yet it was just two weeks ago that health secretary Alan Milburn pondered aloud whether media interest and the obsessions of the middle classes were leading to the devotion of too much energy to the big C at the expense of other, more 'working class', killers.

As far as Dr Ian Gibson, chair of the all-parliamentary group on cancer, is concerned, cancer needs more attention, not less. He wants Britain to adopt the US model by bringing in a national cancer act to ensure services and research are kept up to date.

At a national cancer conference yesterday, he was due to tell delegates that an act based on a 30-year-old US system could stop the feeling that 'we have done cancer, let's move on to something else'.

He told HSJ: 'The only way to do that is to have an act. Ministers change, governments change, priorities change but cancer goes on.'

An act could ensure that budgets for cancer research and treatments increase each year in line with what is necessary to meet the priorities of the National Cancer Research Institute. 'It becomes much more part and parcel of the NHS in a permanent way - the government has to address it each year, ' says Dr Gibson, whose group hosted yesterday's conference. 'At the moment cancer projects are normally funded for three years, but cancer is with us for the long term.'

But is lack of resources at the centre of the problem? Dr Gibson is doubtful, concentrating instead on the need to ensure money gets into the right hands as quickly as possible. He suggests the government should look at education for a steer. Giving headteachers a chunk of money - up to£30,000 depending on the size of school - with the freedom to spend it as they feel fit, has made a real difference on the ground, he says.

'I think it is how the resources are used - we are on a steep learning curve in having to make sure that the money gets as fast as possible to where it is needed.'

But Professor Karol Sikora, professor of cancer medicine at Hammersmith Hospitals trust, argues that the UK can't afford new cancer treatments without major changes to funding mechanisms. 'The new treatments that are emerging will be more expensive than existing ones, ' he says.

'This will present the government and the NHS with a new set of ethical dilemmas on which patients to treat. Ministers must decide soon how these dilemmas will be resolved.

'Concentrating on core packages of cancer care would seem to be the best way - and admitting that we can't have all the drugs within that package.'

That would leave people free to buy excluded drugs. He points out that some patients are already being denied drugs which are known to be effective for their cancers, because of local funding policies. New drugs which inhibit cancer growth and affect the blood vessels around cancer sites will make the issue more pressing.

Dr Gibson feels cheaper drugs could be the answer. Drug costs, he says, are an issue for the government to address with the pharmaceutical companies. 'There is a need for the government to make the pips squeak, ' he adds.

Professor Gordon McVie, direc - tor-general of the Cancer Research Campaign, highlights the need for 'fast-tracking' of proven new technologies, whether they are drugs, diagnostic techniques, new ways of giving radiotherapy or improvements in surgery: 'There is nothing more urgent than cancer, ' he says. 'Seven hundred new patients are diagnosed each day and 400 go on to die. What could be more urgent? Where is the mechanism in the NHS for fast-tracking things that we know will work?'

Such systems are developing elsewhere: in the US, for example, a breast cancer drug has been approved with great speed by the Food and Drugs Administration and quickly made available to every sufferer in the US.

But in Britain drugs have to go through both a regulatory approval process and assessment by the National Institute for Clinical Excellence - and the two processes are usually not concurrent. This can cause long delays before drugs which are accepted as safe and effective in other countries are available to British patients - and then doctors will have to chose to prescribe them, and the local health economy will have to be willing to pay for them.

Accepting more patients onto high-quality medical trials could be one way forward, according to Ellen Stovall, president of the US-based National Coalition for Cancer Survivorship. 'We know that cutting-edge therapies and treatments offer patients the best chance of survival. Scientists and patients are agreed that a far higher number of patients should have the opportunity to take part in trials.'

But the 'postcode lottery' does not just affect treatment: Joanna Rule, chief executive of charity CancerBACUP highlights the discrepancies in information available to patients: 'People know there are variations in access to treatment.

There is the same approach to access to information - there are places where It is very good and places where It is very poor.

'High-quality patient information is not an optional extra, but it is very much at the heart of patient-centred care.'