The cost of living

Herceptin is hailed as a wonder drug for breast cancer. But it's only available to the lucky few - and Kasia Boddy isn't one of them
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Indy Lifestyle Online

This is not a diatribe against the NHS. I have had nothing but wonderful treatment in clean hospitals from caring and efficient doctors and nurses. I love the NHS.

This is not a personal diary, either. My own health should really only be of concern to me, my family and closest friends. My experience is fairly standard and I have no desire to make a career out of being ill. I'm writing this only because I have few other options.

In April, my GP examined my right breast (which had been red for a while), found a lump and faxed the breast clinic at Addenbrooke's Hospital in Cambridge. Two days later I had an appointment; six days after that, I had a mammogram, ultrasound and biopsy.

I returned for the biopsy results a week later and was told that it was an invasive carcinoma which needed removing surgically. The results came through on a Friday, and I had surgery the following Tuesday. After my surgery, my GP arranged for a team of district nurses to visit me daily at home. Just over a week later, the pathology results came through. Twelve lymph nodes had tested positive for cancer cells. I would need chemotherapy. That started the following week. I've now completed five cycles and have three more to go. Any hint of a side effect has been followed up and swiftly dealt with.

My story so far is one of impeccable service. I've been incredibly impressed with every aspect of my treatment - in particular, the speed of its delivery, and the kindness and cleverness of my doctors and nurses. It's true I've had to sit about a bit in the oncology waiting room, but that's partly testament to Addenbrooke's reputation. Patients come from all over the country to receive treatment that is not available from their local hospitals. In terms of cancer research and treatment, Addenbrooke's is one of the top places in the world.

My eulogy stops here. I've just found out that the next stage of my treatment will not be available at Addenbrooke's. I will have to go private.

Just as I began my chemotherapy, three of the senior oncologists from Addenbrooke's attended the American Society of Clinical Oncology's annual meeting in Orlando, Florida. There they heard three large trials from the USA and Europe reporting that patients who had received a drug called Herceptin as well as chemotherapy had halved their risk of the cancer recurring. George Sledge, a senior American professor, declared the findings to be "the most stunning results in a clinical trial in my entire professional career".

Herceptin (trastuzumab) is a completely new type of treatment. It is an antibody directed at HER-2, a molecular target on breast cancer cells. It is already a standard treatment for advanced (metastatic) breast cancer.

What is new is the possibility of using Herceptin to treat early breast cancer. Only about a quarter of patients (those with high levels of the HER-2 protein) are suitable candidates. Until now these women had a poor prognosis, since the HER-2 form of the disease is highly aggressive. Herceptin is a major breakthrough for them. I'm writing "them", but I mean "us". Without Herceptin, there is a 50 per cent chance my cancer will return; with Herceptin, it's 25 per cent. I am (I hate writing this) a "high-risk" patient.

The Cambridge breast cancer surgeons and physicians are conservative in their response to new treatments. They tend to resist pressure to switch to new and expensive drugs for marginal benefits. No one in the group, however, had any doubt that they should start using Herceptin as quickly as possible. For every year of delay, eight women in Cambridge will die and 36 will suffer an incurable relapse of their disease. And that's just one region. In Britain, around 1,300 women a year will need the drug.

As a treatment for early breast cancer, Herceptin still needs to receive a licence and approval from the National Institute for Health and Clinical Excellence (NICE). But this does not mean doctors cannot prescribe the drug. As Patricia Hewitt, the Secretary of State for Health, recently said: " It is already possible for a doctor to prescribe Herceptin for patients if the PCT [Primary Care Trust] or NHS trust agrees to supply it at NHS expense and the doctor retains clinical responsibility for the patient." It is certainly possible privately. Every BUPA hospital in the UK is offering adjuvant Herceptin today, and has been for the last month.

Money, not licensing, is the key factor in Cambridge. Herceptin is expensive. A course of treatment costs up to £30,000. Patients receiving the treatment have to undergo frequent heart scanning, which is also expensive. At Addenbrooke's, 50 women a year would be eligible, adding nearly £1m to the bill for drugs and supporting services. Three weeks ago the Addenbrooke's oncologists were told in no uncertain terms by the hospital's managers and Cambridge PCT that they cannot prescribe Herceptin to early breast-cancer patients. The PCT has overspent and says it has no choice, but this is both disingenuous and illogical in public health terms. What is the point of spending large sums on early screening, if you are not going to pay for treatment for early breast-cancer patients? The trust should opt to lead the way in funding care, just as its doctors are leading the way in developing and providing care. Cambridge PCT gets to be one of the world's leading cancer-treatment centres - the price is financial support for its doctors' clinical decision-making.

A Labour government may be able to tolerate patients turning to the private sector for minor operations that would more quickly improve the quality of their lives. A Labour government should not, however, tolerate patients having to sell their homes in order to pay for treatments that may save their lives. Money must be made available straight away, not in sixth months or a year. The national health services of Germany, France and Canada have all decided to start funding Herceptin now, without waiting for licensing or NICE equivalents. The question is not how can the British NHS afford to pay for this, but how can it afford not to?

To push for the immediate provision of Herceptin nationwide, write to Patricia Hewitt and your local MP. For Kasia Boddy's case, write to Malcolm Stamp (chief executive), Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, or David Howarth, MP for Cambridge

Need to know

A number of other drugs are subject to "rationing" as they await approval by the National Institute for Health and Clinical Excellence (NICE), which assesses new treatments for use within the NHS.

* Arimidex

Used to treat breast cancer in post-menopausal women. A decision on whether Arimidex is to be available on the NHS will not be made for another 15 months, despite it already being licensed.

* Aricept

Used to treat Alzheimer's. Aricept was approved in 2001, but in March 2005, NICE started to raise questions on how cost-effective it is, and then put forward a proposal that it no longer be available on the NHS for new patients. Following a public outcry, the Government ordered NICE to reconsider. A decision is expected soon .

* MabThera

Used to treat non-Hodgkin's lymphoma (NHL). The drug was licensed in 2004, allowing it to be used for the treatment of NHL in the latter stages of the disease. However, using the drug in the early stages has also proved to be highly effective, and when combined with other forms of chemotherapy can lead to patients living without symptoms for up to a year and a half. However, a NICE assessment is not due until September 2007.

* Xeloda

Used to treat bowel cancer. Xeloda is available on the NHS for people in the advanced stages, often given post-surgery or when surgery is no longer possible. However, like MabThera it is proving to be highly effective in treating the earlier stages of the disease, particularly when it is given after early surgery to delay or prevent relapse. NICE assessment is due in 2006.

David Bolter

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