Why should older patients pay the price of failures of holistic care and HTA?

roger WilsonA debate between two medical oncologists over whether younger patients should get priority when it comes to access to very expensive drugs with the potential to prolong life was recently published online by Cancer World. In this guest post, Roger Wilson, a patient advocate and Honorary President of Sarcoma Patients Euronet, argues that giving patients a voice in these discussion is the only way to move on from these “simplistic, inward looking  solutions”.

The push to use age as a determining factor in drug funding permissions is blatantly discriminatory. There are better methods and measures for discerning eligibility, if only someone researched them properly.

The pharma industry is not interested in this research. Its business model (which determines its approach to pricing) is encouraged by the current inadequacy of HTA and political decisions such as England’s Cancer Drugs Fund. Indeed the latter encourages higher prices.

When the current UK government came to power in 2010 they vowed that by 2014 we would have a value-based approach to funding decisions. Its nearly 2015 and there is no sign of it but as there was no research into how value could be defined let alone measured, its no wonder we are back to simplistic thinking about age.

The core issues here are about the holistic treatment of a patient. Just looking at the disease (albeit hosted by a person) does not take into account the needs of the whole person. This debate should be about integrating supportive care into oncology practice, about losing the barriers between palliative care and oncology, about educating patients on the balance between cure and end-of-life care so that when disease is truly incurable patients make rational decisions themselves.

Another cycle of chemo given to a dying patient is immoral. Living and dying have to become palatable points for discussion. This will deliver benefits for individuals and society and could well cut drug costs. While politicians, healthcare administrators, academics and doctors are the main voices on this issue simplistic inward-looking solutions will result.

Get patients involved, introduce some earthy common sense.

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