Terminally Ill Cancer Patients Should Not Be Given 'Futile' Drugs, Doctors Say
Doctors are giving dying cancer patients “false hopes” by prescribing costly drugs when there is little evidence that they have any benefit, a report claims.
A panel of 37 experts, headed by Professor Richard Sullivan from King’s College London, published their findings in The Lancet Oncology journal following a 12-month investigation.
The report argues that, in some cases, spending large amounts of money on drugs that only offer a few weeks life extension is not sustainable and patients should instead receive palliative care.
The “culture of excess” within cancer services means that cost of treatment has risen. The number of cancer patients is also rising, it says.
Published on Monday, the report states: "Evidence shows that a substantial percentage of cancer care spending occurs in the last weeks and months of life, and that in a large percentage of cases, such care is not only futile, but contrary to the goals and preferences of many patients and families if they were adequately informed of their options.
“Therefore, empowering patients through education and shared decision making can potentially improve care and lower costs. Specifically, when patients are informed that their cancer is life threatening, but there is a treatment available, many choose to be treated irrespective of personal costs, and certainly of costs borne by their insurer.
“However, there is potential to improve care and reduce spending by empowering patients to forgo expensive and futile, or low-probability care when this matches their goals and preferences, and by empowering physicians to discuss these issues with their patients, and to recommend stopping disease-directed care when appropriate.”
Around 12 million people are diagnosed with cancer around the world each year. The figure is expected to rise to 27 million by 2030.
This increased number of patients allied to increasing costs means the western world “is heading towards a crisis”, the paper argues.
In the UK the cost of cancer treatment has risen to more than £5 billion, up from £3 billion in 2002.
Speaking to the BBC, Professor Sullivan, said: "We're on an unaffordable trajectory. We either need to manage and reduce the costs or the cost will increase and then inequality rises between rich and poor."
However, charities have reacted angrily to the idea that patients should not be given life-prolonging drugs due to the spiraling costs.
Speaking to the Huffington Post UK, Andrew Wilson, chief executive of the Rarer Cancers Foundation, said: “Money is not the sole issue here. It is a moral issue. We live in a developing world in which end-of-life care is very important.
“We know that over the next 30 years the cost of cancer drugs will increase due to an increasing population. However, this is the same for the treatment of all diseases, not just cancer. So it seems a little unfair just to target cancer.
“The report says that end-of-life drugs may only provide a few extra weeks, but some drugs give several month even years. In regards to the costs, clinicians will often take patients off a drug fairly quickly if there is no perceived improvement.
“And even if a drug did only provide a couple of extra weeks, people should be given the right at the end of their life to get their affairs in order and to say their goodbyes.”
Duleep Allirajah, policy manager of Macmillan Cancer Support, said: “to call palliative care treatment ‘futile’ is extremely unsympathetic and undermines each patient’s personal experience and desire to extend their lives.”
Speaking to the Daily Mail, Rose Woodward of the James Whale Fund for Kidney Cancer, said: "I would hardly call this type of treatment 'futile'.”
“We have kidney cancer patients on the life-prolonging drug called Sutent who have been told they have only two to three weeks to live but who go on to live for a further five years.”
Ian Beaumont, Director of Public Affairs, Bowel Cancer UK said: “While cancer care can be expensive, it is unjust to put a cost on the lives of patients, especially when modern treatments can often give them precious time with their loved ones and increase their length and quality of life."