主页 > 医学讨论 >
【medical-news】癌症治疗不仅仅是费用问题
DOI:10.1016/S0140-6736(07)60755-7
TITLE: Cancer treatment: not just a question of costs
The incidence of cancer is increasing worldwide. In developed countries, longer life expectancy but also better diagnostic abilities explain this increase, whereas in developing and middle-income countries, the time bomb of tobacco-related and viral-induced cancer is starting to show its toll. Projections estimate 15 million new cancer cases every year by 2020. Over the past decades, cancer research has led to astonishing progress in prevention, cure (especially in childhood cancers), and extending lives and improving quality of life.
However, whether and to what extent patients benefit from this progress depends on where they live. In large parts of Africa, cancer is only diagnosed in the late stages, pain relief is lacking, and palliative care is in its infancy. The diagnosis of cancer means a slow and painful death. At a 2-day conference in London, UK, last week—organised by Oxford University researchers—African Health Ministers, international health and development organisations, physicians, UK government officials, and cancer charities came together to shine a spotlight on Africa's growing cancer crisis. With a declaration and a resolve to put cancer firmly on donors' and African governments' agendas, a first and important step to allow African people to benefit from progress in cancer prevention and treatment has been made.
In developed countries with modern health-care systems, access to new and effective treatments and preventive interventions should not be an issue. However, in an in-depth report published last week as a supplement to the Annals of Oncology, Bengt Jönsson, an economist from the Stockholm School of Economics, and Nils Wilking, a clinical oncologist from the Karolinska Institute, Stockholm, Sweden, assessed access to new cancer drugs in 25 countries. They then linked differences in availability to differences in cancer mortality. Of five major European countries, France had the highest overall 5-year cancer survival rate with 71% for women and 53% for men, and the UK had the lowest, with 53% for women and 43% for men. The UK, together with New Zealand, Poland, the Czech Republic, and South Africa, had the lowest and slowest uptake for many new drugs, whereas Austria, France, Switzerland, and the USA had the highest uptake. This is in stark contrast with the finding that the UK is, together with Sweden, the European country that spends most public money per head on cancer research.
In the report, the UK was singled out for particular criticisms. With its cost-effectiveness analyses by the National Institute for Health and Clinical Excellence (NICE) it is a world leader, or so the authors argue, in creating yet another barrier or hold-up to making new drugs widely and quickly available. NICE shot back with an immediate press release and called the report flawed and inaccurate, and pointed out that the drug-industry sponsored report failed to recognise the introduction of its rapid approval process. “It is the job of NICE to put the health of patients and the public first, not the profits of the pharmaceutical industry”, said Andrew Dillon, NICE's Chief Executive. In reality, NICE has to look beyond the health of people and weigh up how affordable a particular treatment is by estimating the costs per life-year gained.
Yes, the authors did compile their report with an unrestricted grant by Roche Pharmaceuticals, which is clearly acknowledged, and some—but by no means all—of the drugs they assess in detail, such as trastuzumab for breast cancer and bevacizumab for colon cancer, are made or marketed by Roche. But to dismiss this very detailed report that looks beyond pure usage data and tries to assess outcomes in three different ways is premature and petulant.
Linking differences in survival to access to new drug treatments is, of course, not the whole explanation. A paper, published by authors from the Royal College of Radiologists in Clinical Oncology, concluded that radiotherapy activity needs to be increased by 92% in England to allow adequate access to radical or adjuvant postoperative radiotherapy in all patients. In 2005, 55% of patients did not have radiotherapy within the maximum recommended wait of 28 days. Clearly, cancer treatment in the UK has lagged behind. The Department of Health has recognised this and released a report last week, outlining a strategy for developing a world class radiotherapy service for England.
All countries with publicly funded health care need to decide on comprehensive national plans and strategies to achieve the maximum possible gain in survival and quality of life for cancer patients. If costs are the predominant consideration, health systems are failing their people. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 RESOURCE: The Lancet 2007; 369:1665
柳叶刀 2007; 369:1665
阅读本文的人还阅读：
作者:admin@医学,生命科学 2010-09-25 05:11
医学,生命科学网