Cancer specialist: 'Let NHS patients pay for their treatment'

A leading cancer specialist has warned that NHS patients risk losing out on an imminent revolution in cancer treatment unless they are allowed to pay towards the cost of their care.

Professor Karol Sikora, an expert in the management of cancer at Imperial College London, said at least six powerful cancer drugs would become available over the next year, costing at least £60,000 a year per patient. The "designer" cancer drugs, similar to Herceptin, are among the first to offer targeted therapy for cancers of the breast, lung, kidney and bowel.

But it is unlikely the NHS will be able to afford any of them and the backlog of drugs awaiting approval by the National Institute for Clinical Excellence (Nice) will delay their assessment for at least a year, he said.

Writing in the Journal of the Royal Society of Medicine, Professor Sikora said the dilemma this posed for the NHS could not be ducked any longer. If it declined to pay for the drugs, patients would be forced to go without. The only alternative was to allow patients to top up their NHS care by paying privately for the drugs.

"There is now evidence of a growing use of co-payments to break through the access barriers in the NHS," he wrote. "Cancer patients are beginning to develop sophisticated approaches to buying extra clinical services either from the NHS directly or through the selective use of the private sector to purchase upgrades to their basic NHS care."

NHS patients are officially forbidden from buying their drugs privately as this would mix NHS and private care. The Department of Health says patients must choose whether to be treated on the NHS, and accept what the NHS offers, or to go private in which case all of their care, not just the drugs, must be paid for. A Department of Health spokesman said: "You cannot be both a NHS patient and a private patient at the same time. Co-payments would risk creating a two- tier health service and be in direct contravention with the principles and values of the NHS."

A similar problem applies to expensive devices, such as those offering targeted radiotherapy, which allow a greater dose of radiation to be delivered to the tumour without injuring the surrounding tissue. Although there are 61 radiotherapy centres in the UK, only three routinely offer "intensely modulated" radiotherapy - in Liverpool, Ipswich and London.

A survey by the charity Cancerbackup showed two-thirds of respondents intended to vote in the next general election on the basis of health policy and for 76 per cent cancer was the most important health issue. Professor Sikora said: "No politician can afford to ignore these issues. Yet we are impinging on the very core of NHS doctrine - providing care freely on the basis of medical need, not ability to pay. For the sake of our patients we need to discuss these issues openly."

Cost of 'designer' cancer drugs

£70,000 Avastin - bowel cancer

£65,000 Tarceva - lung cancer

£60,000 Erbitux - bowel cancer

£50,000 Herceptin - breast cancer

£50,000 Glivec - leukaemia

£50,000 Panitumomab - bowel cancer

£40,000 Mabthera - non-Hodgkin's lymphoma

£40,000 Sutent - kidney cancer

£40,000 Nexavar - kidney cancer

£30,000 Velcade - multiple myeloma

Price unknown Tykerb - breast cancer

Prices given are for a year's treatment including administration and medical care costs

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