Editorial

Abstract

European Journal of Cancer CareVolume 15, Issue 3 p. 213-213 Free Access Editorial First published: 12 July 2006 https://doi.org/10.1111/j.1365-2354.2006.00691.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat There has been much media coverage in the UK and probably elsewhere, regarding the availability of costly treatments or supportive care for cancer patients. It has been focused in the UK because of the National Institute for Clinical Excellence’s role. The National Institute for Clinical Excellence is a Department of Health body which scrutinizes the efficacy and cost of new treatments for all health care, not just cancer. The main contentions for cancer have been directed towards the newer breast cancer drugs and, more recently, EPO and supportive care for fatigue – a major symptom for many cancer patients. Health care costs a huge amount of money and there is not a bottomless pit in any healthcare system. These vary from state-controlled and -organized, part-state and part-private insurance/employer insurance, or a total insurance system except for the extremely financially disadvantaged or for first-aid, life-saving treatment. Rather than a public outcry every time the phrase, ‘postcode lottery’ is coined (variations in treatment not based on need or merit but because of where you live and your local health services deciding what it spends money on) or the notion of rationing is raised (a more perjorative term), it seems that there needs to be a more strategic approach to such decision-making. One idea may be to put a literal premium on expensive health care – for cancer, heart disease, diabetes or whatever. Perhaps, for example, a hypothecated tax as is frequently used in some countries of Continental Europe for older person care. Citizens insure in advance against cancer, dementia, old age or whatever. However, this only deals with the finance. What about the efficacy of treatments? When the development of a new cancer drug hits the headlines in the secular press, it is reasonable to suppose that if you fall roughly within the patient category to receive the drug and it is being hailed as better than other existing treatments, that you should have the opportunity to receive it. However, the science is more complicated and, for some, not only will the new drug not be beneficial, but also it may cause harm to bodily systems not directly involved in the cancer. This may result in at least as bad if not a worse position for patients. It is important for patients’ voices to be heard when there is clear injustice and covert rationing of a ‘good treatment’. What is difficult is knowing all of the facts and understanding the implications of them before protesting. It is exhausting and demoralizing for everyone. On another note, it has been one of those months when I have regularly been confronted with all things complementary and alternative, with regard to cancer – the so-called complementary and alternative methods (CAM). At a recent palliative care conference a paper was presented on the implications of establishing a new CAM service. Issues arose of research, evidence-base, non-regulation of practitioners and the use of volunteers, and the safety aspects of practice. Cost was also mentioned. If the state health service cannot find sufficient funds for ‘standard’ medical care, what chance the funding of CAM from the public taxes? In the USA, there is a new initiative highlighted by Smyth in the European Journal of Cancer (EJC 42.2006.572–573) that of Integrative Oncology. A new book by Mumbar (2006) surveys the principles and practice underlying integrative oncology – bringing together conventional cancer treatment and CAM. The point is well made by Smyth that, at the very least, we should keep ourselves informed as patients will ask our opinion. Also we should be encouraging research-based studies so that conventional treatments and CAM are competing on a level playing field. REFERENCE MUMBAR M.P. (2006) Integrative Oncology: Principles and Practice. Taylor and Francis, Oxford, UK. Google Scholar Volume15, Issue3July 2006Pages 213-213 ReferencesRelatedInformation