Politics of drug funding costs cancer patients

By FRANCESCA MOLD

You've got cancer.

The news comes as a shock but the doctor is reassuring - amazing new drugs have shown excellent results in the treatment of cancer.

The only problem is that you have to mortgage your house, borrow from your family or spend your life savings paying for treatment because health funders have decided your taxes should not be spent on such high-cost drugs.

This scenario is becoming increasingly familiar to thousands of New Zealand patients who are missing out on cancer therapies proven to prolong life or send the disease into remission.

Cancer specialists say funding restrictions mean New Zealand is lagging behind other nations in the kinds of new treatment and technology being offered to cancer sufferers, and something must be done urgently to address the problem.

There are two main reasons new treatments are not being made available. First, New Zealand has no nationally consistent treatment protocols for funding cancer therapies, including newer, high-cost drugs.

Each of the six hospital and health services which provide cancer treatment can decide what it will spend its Government-funded oncology budget on.

Some finance, within reason, whatever a patient's doctor believes is the best treatment, whether it is conventional chemotherapy or a newer therapy outside the mainstream.

Others, such as Auckland Healthcare, say budget constraints and the "requirement to ensure the most equitable use of existing funding for a large population" mean they cannot afford high-cost cancer drugs.

Another reason is the strained relationship between the Government's pharmaceutical funding agency, Pharmac, and drug companies.

Doctors say drug companies are gradually reducing the number of New Zealand-based clinical trials for cancer therapies because they know there is no market further down the track to sell the products to health funders.

The result is that many cancer sufferers are being denied access to new treatments unless they can pay for them.

Aucklander Chris Delaney, diagnosed with bowel cancer two years ago, has spent about $43,000 on new cancer treatments, one of which was imported specially for him.

One of the agents, irinotecan (brand name Camptosar), cost $27,000 for three months' worth of treatment. The other, oxaliplatin (brand name Eloxatin), was brought into New Zealand for the first time for Mr Delaney and costs $1000 a week.

Mr Delaney, a Herald employee, is realistic about his illness. He has accepted that the cancer, which has now spread to his liver, pelvic region and lungs, is terminal.

But he says the new therapies have prolonged his life and given him quality time he otherwise would not have had.

Although he does not expect the Government to fully fund the drugs he has tried, he believes it is unfair that treatment is free in some parts of the country and costs patients in other regions thousands of dollars.

"I find it appalling that there are people out there who are not receiving treatment simply because they can't afford it. It just makes the health system look discriminatory."

Auckland oncologist and researcher Mark McKeage says there is no doubt that New Zealand is lagging behind other countries in terms of access to new cancer therapies.

"There are treatments we don't use that could improve survival times for patients."

Dr McKeage says an option for patients is to take part in clinical trials for newer therapies, which means the drug company pays for the treatment.

But he says that option is becoming less common as pharmaceutical companies' interest in New Zealand trials wanes because there is no future publicly funded market for those drugs.

Cancer Society medical director Dr Peter Dady, a Wellington oncologist, says many of the drugs not being made available in New Zealand are in general use in the rest of the world.

Drugs such as Taxol that are "pretty ho-hum" to the rest of the world have only this week been approved for use at Auckland Healthcare.

Dr Dady says the restrictions on doctors' ability to prescribe cancer treatments are often not as open as an out-and-out ban.

"Doctors are told they can prescribe anything as long as they stick within their budget. But of course, that budget is strictly limited."

They are often forced to "go out on a limb" to ensure their patients have all treatment options.

"Doctors are putting their necks on the block to get their patients treatment. They have had to say, 'We don't care about the rules,' which is not very comfortable sometimes."

Recently, cancer specialists' spirits have been buoyed by the news that a working party, involving the Health Funding Authority, Ministry of Health, Pharmac and oncologists, has been set up to look at the problem of high-cost cancer drugs.

Auckland oncologist Dr Vernon Harvey, who is a member of the working party, says he hopes it will develop a process for assessing the suitability of new cancer drugs and deciding whether they should be funded by Government agencies on a nationally consistent basis.

He also hopes the working party will resolve the issues of inconsistent treatment and the funding of new therapies.

But he is dismayed by a statement from Health Funding Authority spokeswoman Jane Lyon that the organisation believes hospitals already get adequate funding for oncology drugs and that it is simply up to clinicians how they use the money.

"That is just bollocks. The funding of our oncology department has been a disgrace," says Dr Harvey.

"We have consistently been promised extra funding for these drugs but we have never seen it.

"If that is the HFA's attitude then a working party is a bloody waste of time."

Doctors believe it is important there is public debate about the level to which new cancer therapies should be funded.

They say New Zealanders need to decide how much of their health dollar should go on new cancer treatments, or whether sufferers should meet the costs themselves.

Cancer specialists agree that there is no easy answer to a problem that has plagued them for almost a decade. But at the very least, health authorities should ensure that whatever is publicly funded is made available to all cancer sufferers, no matter where they live.

Cancer fight carries higher price for Aucklanders

* This is a corrected version of this story. In the original, the Herald wrongly attributed statements criticising the Health Funding Authority for claiming that there was adequate funding for cancer drugs. The statements were attributed to Auckland oncologist Dr Vernon Harvey when, in fact, they were made by Dr Peter Dady, of Wellington.