Monday 26 August 2019

Bryan Hennessy: 'Cuts are killing our cancer strategy - and devastating those whose only hope is a trial'

Offering hope: Cancer trials can provide people with cancer with access to new and potentially promising treatments that are not yet available through the mainstream health service. Stock photo
Offering hope: Cancer trials can provide people with cancer with access to new and potentially promising treatments that are not yet available through the mainstream health service. Stock photo

Bryan Hennessy

One of the most difficult parts of my job as an oncologist is telling a man or woman sitting opposite me in my clinic that the cancer treatment they are on is not controlling the growth of the cancerous cells in their body and there is no other option available.

While this can be a very uncomfortable conversation for any doctor, for the person with the cancer it is utterly devastating.

My cancer-treating colleagues around the country and I are focused on opening as many cancer trials in Ireland as we can so that we can avoid these heartbreaking conversations and find cures for cancer. Unfortunately it's an uphill battle as the Government is starving cancer trials.

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Cancer trials can provide people with cancer with access to new and potentially promising treatments that are not yet available through the mainstream health service.

While not all cancers respond to trial treatments, during the past 20 years they have extended and improved thousands of lives.

Incidences of cancer in Ireland will double over the next 20 years, so naturally the need and demand for access to cancer trials, which can provide people with options, will also increase.

The National Cancer Strategy published in 2017 acknowledges this.

The previous strategy in 2006 was a game changer for cancer care. We in Cancer Trials Ireland initially believed this recent strategy could be a game changer for cancer research because its target is to double the percentage of people with cancer joining cancer drug trials in Ireland each year from the estimated 3pc with the disease to 6pc by 2020. For this 6pc of the population with cancer, a trial could be life changing and offer hope.

The big problem with the new strategy is that it costs nothing to set a target and no funding has been put behind this target. It is effectively not a target - it is an aspiration.

It gets worse. Not only is there absolutely no possibility that this target will be met anytime in the near future, due to funding cuts Ireland's performance in this area is going backwards.

The genesis of this terrible situation for people with cancer, like problems facing many facets of society, is the continuing fallout of the recession.

In 2014, 3pc of people with cancer in Ireland were on a cancer drug trial. In 2016 the annual grant Cancer Trials Ireland receives from the Department of Health to part fund its portfolio of trials was cut by 20pc and has not yet been reinstated. This cut equates to €750,000 per year and so far represents a total budget cut of €3m. This might not seem like a huge amount in the context of the overall cancer care budget, but for cancer trials it's huge.

As a direct result of this cut the percentage of people in Ireland with cancer on a cancer drug trial has halved to 1.5pc.

So the National Cancer Strategy's target in reality represents a 400pc increase in the number of people on a cancer drug trial from 1.5pc to 6pc within the next 19 months. That will never happen. That's why it's just an aspiration.

What this means in real terms is that many patients are being denied any further options when their treatments are not working. For many, the potential lifeline that trials might offer will never be available to them.

There are trials in areas such as lymphoma, testicular and endometrial cancers that we could open in Ireland and make available to people with cancer, but cannot because of these cuts.

We could pursue opportunities to open trials in Ireland that are available from research organisations outside Ireland in areas such as pancreatic, lung, testicular and cervical cancer, but can't for the same reason.

Compounding the frustration of many of my colleagues is that cancer treatments can be provided to patients through trials at a fraction of what they would cost if provided through the health service. This is because trials are supported by the sponsor companies who supply the drugs free and they contribute towards diagnostics, scans, radiotherapy and lab tests. Often pharmaceutical companies make the drugs available after the trial on compassionate grounds. An independent report carried out in 2016 estimated that the availability of cancer trials saved the HSE a minimum of €6.5m a year in treatment costs.

Cancer Trials Ireland's objective is to test and prove treatments that kill cancer and stop it in its tracks.

All the teams around the country working on trials are having a profound impact on the lives of people with cancer today. This distinguishes cancer trials research from other types of cancer research; it benefits people not only in the future, but also today.

While an ambitious target sounds good and creates a positive sound bite, a target has little value unless its achievement is supported.

The cancer trials target in the 2017 National Cancer Strategy is not being financially supported so will remain meaningless until the policy decision to cut cancer trials funding is reversed.

Professor Bryan Hennessy is the clinical lead with Cancer Trials Ireland. He is a consultant medical oncologist at Beaumont Hospital and Our Lady of Lourdes Hospital

Irish Independent

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