March 30, 2015, by Emma Thorne
In cancer comparisons, let’s save life years in the quest to save lives
Professor David Walker, Professor of Paediatric Oncology at the Children’s Brain Tumour Research Centre and President of the British Neuro-Oncology Society, on why saving lives in the fight against cancer should not be the only focus, especially for children and young people affected by rare forms of the disease.
The UK’s poor performance in cancer survival statistics requires explanation. The national cancer plan launched in 2002, now in its 4th revision, was launched on the understanding that the “UK should never fall behind Europe again”. Current statistics show that Europe has led the way in improving cancer survivorship and the UK has not, as yet, caught up. The most recent report highlights where there has been progress in the common signature cancers but does not comment upon the rare cancer types, which collectively are more common (55 per cent)) and therefore highly significant in comparative statistics.
The time has come for the UK to prioritise rare cancers for their research and translational initiatives. Two groups of rare cancers that would benefit immeasurably from such a strategy of investment are those that arise in children and young people and those that present as primary brain tumours at all ages. The former group, constitute the commonest cause of death in children and the greatest individual loss of life years per patient. Models of care and research developed in the 70s in paediatric oncology were emulated in the past decade in adult cancer. Brain cancers on the other hand are the commonest cause of cancer deaths up to 40 years of age. Together they have attracted a miserable proportion of cancer research investment — Cancer Research UK is, for the first time, highlighting them for investment in their recent announcement of their five-year strategy. The UK is seen to be punching below its weight in international comparisons of research performance and clinical outcomes in these fields.
Saving lives is laudable but, in economic terms, saving life years makes more sense as a strategy as those people benefiting from research and innovative treatments would have the greatest opportunity to contribute to, and therefore maximise the benefits for, society after their unique experiences of facing cancer and its risks in early life.
Such prioritisation is not prevalent in strategic thinking in the UK. This leads to a starvation of innovation and a deficiency of evidence for launching new research-based treatments in rare cancer generally and in children and young people, in particular.
It is a product of a clash in philosophy between corporate, health service and academic thinking. The corporate, profit-based priorities are currently winning the day. Cancer is an all age disease. When competing with our global partners in health care, let’s focus on saving life years in our quest to save lives.