Fiona Macrae
Expensive drugs should be rationed for the old and frail in favour of people in their prime, one of Britain’s top cancer doctors has said.
Professor Karol Sikora, the former head of cancer at the World Health Organisation, said that oncologists are being ‘bombarded by anti-ageist sentiment’.
But his comments triggered an immediate backlash among cancer charities, which said it would be ‘blatant discrimination’ to deny patients treatment based on their age.
Many new, expensive cancer drugs only prolong life for a few months. Professor Sikora said that as the NHS is under increasing financial pressure, age should therefore be taken into account when deciding who should be treated.
He said: ‘You can’t have a rigid cut-off but one has to be realistic – three months of life extension for someone in their 90s has got to be less useful than for someone in their 30s or 40s. It’s getting a sense of proportion.’
His comments come amid fears that changes to the way drugs are prioritised will see the elderly written off on the grounds that they are of less value to society.
Under the proposals by the Government’s drugs rationing body, the National Institute for Health and Care Excellence, a drug’s benefit to wider society will be taken into account as well as its advantages to the individual.
There are concerns the policy will discriminate against the elderly, in favour of the young who can contribute to the economy through childcare or going back to work.
However Nice has insisted it will not only consider age.
Controversial: The NHS rationing body, Nice, fears the Department of Health proposals could see younger people deemed a higher priority for drug treatments (file picture)
Professor Sikora, a former director of cancer services at London’s Hammersmith Hospital, said although it might be considered ‘heresy’, the time has come to raise the issue of justifying expense.
He said that some cancer treatments – such as radiotherapy – were simply too gruelling to give to the frail and elderly.
Concern: Sir Andrew Dillon, the head of the National Institute for Health and Care Excellence, said he feared the rules would lead to older patients being penalised
However, some of the more gentle drugs cost up to £90,000 for a year’s treatment and in most cases would prolong life for just three months, he said.
‘Do we really expect that people in their eighties with multiple insoluble health problems should have the same technology brought to bear on their cancer as those in their prime?
‘My view is that age should be taken into account when comparing the potential benefits of expensive treatments.’ Ciaran Devane, chief executive of Macmillan Cancer Support, said: ‘To deny older cancer patients treatment based on their age alone is unacceptable discrimination.
‘We have a duty to treat people as individuals and assess them based on their fitness for treatment, not date of birth.’
Caroline Abrahams, charity director of Age UK, said: ‘We recognise that NHS budgets are squeezed. But our health service exists to treat everyone equally.
‘Decisions about who should be treated should be based purely on clinical need, not age – anything else is blatant age discrimination.’
Breakthrough Breast Cancer also called on the Government and pharmaceutical industry to find a way of making new drugs affordable and available to all who need them.
A spokesman for Nice said that while age will ‘inevitably come into consideration’ it will never be the deciding factor.
QUALITY OF LIFE VS THE COST: HOW NHS WATCHDOG DECIDES TREATMENTS
Under the current system, Nice determines the cost of a new treatment by working out how much it improves and extends a person’s life compared to existing treatments.
It uses a formula known as ‘quality adjusted life year’ or QALY.
One QALY equals one year of perfect health, or two years of 50 per cent perfect health or four years of 25 per cent perfect health.
Generally, if the cost per QALY is below £20,000, the treatment is deemed cost effective and approved.
If it falls between £20,000 and £30,000, Nice needs ‘persuasion’ to give it the go-ahead.
If the cost is more than £30,000, the drug is not normally approved.
