Cancer Drugs Fund condemned as expensive and ineffective

The Cancer Drugs Fund, set up by the government to pay for expensive medicines that the NHS would not normally finance, failed to benefit patients and may have resulted in some of them suffering unnecessarily from toxic side-effects, experts say.

An analysis in a leading cancer journal has found that the fund paid out £1.27bn from 2010 to 2016 – an amount that would have paid for an entire year of mainstream cancer drugs for the NHS.

But medicine it paid for was not worth the money, the report concluded. The analysis in the Annals of Oncology journal looked at 29 cancer drugs approved for 47 different types of treatment (known as indications), some of which were approved to treat more than one cancer. They found that only 18 of the 47 treatments prolonged the patient’s life, and then only by an average of three months.

Many of the drugs were approved by the fund on the basis of clinical trials that aimed only for what is called “progression-free survival”, where there is no sign in a scan or test that the cancer is growing. But patients often did not live any longer because the cancer would come back suddenly with lethal force.

The experts from London, Bristol and New York said that, from the patient’s perspective, increased progression-free survival might not be a benefit at all, since it not infrequently came with toxic side-effects.

Prof Richard Sullivan, of the institute of cancer policy at King’s College London, one of the authors, said the Cancer Drugs Fund had been “a massive health error”.

It was set up in 2010 because of the public outcry whenever the National Institute for Health and Care Excellence (Nice) turned down a new cancer drug for NHS use on the grounds that it was not cost-effective. The establishment of the fund was one of David Cameron’s election pledges. But, said Sullivan, although it was clear from Nice’s assessments that many of these drugs were not good value for money, neither doctors nor scientists nor the cancer charities spoke out against it.

“In science, we demand levels of evidence, but public policy is opinion-based, not evidence-based. You can’t have that in health. Populism doesn’t work,” he said.

Sullivan said that, wrongly, drugstook precedence in most people’s thinking over other treatments. Surgery can be curative and is the most important treatment and radiotherapy is also a valuable tool.

The paper, by Dr Ajay Aggarwal of the London School of Hygiene and Tropical Medicine, and colleagues, warns that other countries that may have been eyeing the Cancer Drugs Fund as a way to deal with the huge problem of soaring costs should think again. “Despite significant expenditure, there remains no evidence that the CDF has delivered meaningful value to NHS patients,” it says. “We recommend the avoidance of similar “ringfenced” drug access schemes in other countries.”

In 2016, as the costs of the fund span out of control, NHS England took action to wind it down in its current form. The CDF conducted its own assessment of the trial evidence behind the drugs it was paying for and struck off 24 of the 47 treatments – just over half of them because they offered insufficient value for money.

“Eighteen of these reversals were based on evidence that existed prior to the introduction of the fund, suggesting wastage of resources, but equally that drugs were given that were ineffective and probably resulted in unnecessary toxicities for patients,” said Aggarwal.

The fund has since reopened, but is now a supportive pot of money to enable evidence to be collected on the performance of promising new drugs. That sort of data should have been collected from the beginning, but was not, say the experts. Hard bargaining with pharmaceutical companies has brought down the prices that they are charging for these drugs.

The Institute of Cancer Research, which has carried out trials on many important cancer drugs, did not defend the fund. “The old Cancer Drugs Fund was always just a sticking plaster and we welcomed its overhaul because it was too expensive, unsustainable, and provided little certainty to patients and their doctors,” said Prof Paul Workman, the institute’s chief executive. “The new, more evidence-based system, where Nice appraises all cancer drugs, should address some of the issues highlighted in this study.

“But while we support the rigorous drug evaluation that Nice carries out, it’s essential that the new system continues to offer fast access to the most innovative and exciting cancer drugs. We need Nice to reform the way it evaluates drugs to place greater emphasis on how innovative they are, to ensure patients are not denied the most promising treatments purely because of their cost.”

But breast cancer charities, which have been strong supporters of the fund in the past, said there was still a need for extra money for cancer drugs. “While the old Cancer Drugs Fund was far from perfect – poor management and a distinct lack of data meant it was left in chaos – it did offer an avenue for people with incurable secondary breast cancer in England to access new treatments unavailable on the NHS,” said Danni Manzi, head of policy and campaigns at Breast Cancer Care.

“It remains a constant uphill battle for people living with incurable breast cancer to get the drugs they so desperately need. Now facing changes to funding systems, including cost caps, women tell us they are even more anxious about getting treatments to give them priceless extra time with loved ones.”

Cancer Drugs Fund condemned as expensive and ineffective

Netflix show condemned for "romanticising" teenager"s suicide

Mental health groups have criticised a new Netflix drama for its “sensationalised” portrayal of a 17-year-old’s suicide, which they say could encourage young people to take their own lives.

The Samaritans, psychiatrists, and mental health campaigners claim 13 Reasons Why could prompt troubled young people to copy the suicide of its central character, Hannah Baker.

“We have a responsibility to protect children and teenagers,” said Dr Helen Rayner, a psychiatrist specialising in children and adolescent mental health who is also a spokeswoman for the Royal College of Psychiatrists. “Dramatic and detailed portrayals of suicide needlessly put vulnerable young people at risk of copycat behaviour as they see how to carry out harmful or potentially fatal acts.

“Graphic depictions of suicide may only influence a small number of viewers, but the consequences can be tragic.”

Ged Flynn, the chief executive of Papyrus, a charity that seeks to prevent suicide among young people, said parents and young people viewing the series should “be aware that when watching this programme there is a danger that suicide is romanticised and sensationalised”.

The US-set series aimed at young people is based on a novel of the same name by Jay Asher. Selena Gomez, the actor and singer, is among its executive producers. Its 13 episodes depict 13 friends of Hannah listening to a tape she made for each of them explaining the difficulties she faced that prompted her to kill herself.

Dylan Minnette and Katherine Langford in episode two of 13 Reasons Why. Photograph: Beth Dubber/Netflix

Sarah Hulyer, a mental health campaigner, said the show’s portrayal of Baker’s plight was irresponsible.

“Mental ill-health and suicide isn’t pretty and while we need to admit that, we also have a duty to look out for the wellbeing of our younger generations and not encourage unhealthy behaviours. By graphically depicting the protagonist’s suicide method, they’re not helping vulnerable young people; they’re encouraging them,” said Hulyer.

“[13 Reason’s Why’s] creators claimed they were hoping to ‘help’ people struggling with the issues shown in the show, but it’s a storyline that is about revenge suicide, demonises counsellors and includes none of the characters reaching out for help and receiving it, it’s not clear exactly what they think ‘helping’ is,” she added.

While she acknowledged that the show has helped thousands of young people think about the lasting impact of suicide, Hulyer asked: “Does a show that depicts a young girl who uses her own death to inflict pain upon others really deserve to be put on a pedestal?”

The number of suicides in the UK among 10 to 14-year-olds has risen from four in 2010 to 10 in 2015, and among those aged 15-19 from 166 to 221 over the same period, according to the Office of National Statistics.

The Samaritans said 13 Reasons Why exposed failings in the UK’s media regulation. “It is extremely concerning that a drama series aimed at young audiences can be produced outside of the UK and made available to UK audiences and yet not subject to UK media regulation. This is simply not acceptable and creates a barrier to protecting our young audiences i the UK,” said Lorna Fraser, a Samaritans media adviser.

The show’s writer, Nic Sheff – who has been open about his own suicide attempt – said he wanted to jolt viewers and make them realise how awful suicide is.

“When it came time to discuss the portrayal of the protagonist’s suicide in 13 Reasons Why, I of course imediately flashed on my own experience. It seemed to me the perfect opportunity to show what an actual suicide really looks like – to dispel the myth of the quiet drifting off, and to make viewers face the reality of what happens when you jump from a burning building into something much, much worse,” he wrote in a blog for Vanity Fair.

“It overwhelmingly seems to me that the most irresponsible thing we could’ve done would have been not to show the death at all,” Sheff said.

In the UK, the Samaritans can be contacted on 116 123. Papyrus are contactable on 0800 068 41 41 or by texting 07786 209 697 or emailing pat@papyrus-uk.org. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

Netflix show condemned for "romanticising" teenager"s suicide

NHS chiefs" spend rises condemned as "double standards" by nurses

The Royal University of Nursing, which carried out the analysis, stated the figures highlighted the increasing disparities on pay for NHS personnel. Photograph: Christopher Furlong/Getty Photos

Hospital bosses’ pay has been growing far faster than that of frontline NHS workers for the duration of the service’s unprecedented monetary squeeze, prompting angry claims by nurses’ leaders of double requirements.

Senior NHS managers’ salaries have risen by an average of six.one% in excess of the last two years – virtually four occasions the regular charge of 1.6% for nurses, midwives and wellness site visitors, in accordance to new figures.

Some hospital trust chief executives and other senior figures have obtained bonuses of at least £40,000 – much more than a ward sister’s yearly salary – pay rises of up to £30,000 and benefits in type, this kind of as a leased vehicle, worth £10,000, freedom of details requests show.

The disclosures have led the Royal University of Nursing (RCN), which conducted the research, to condemn what it says are unfair and increasing disparities on shell out in England at a time when most NHS workers who seem after sufferers have had pay freezes or small pay out rises.

They come as anger is expanding amongst unions representing the NHS’s one.35 million-sturdy workforce at the selection by the health secretary, Jeremy Hunt, to reject the NHS pay out-overview body’s recommendation that all NHS staff need to get a 1% pay out rise this year. Several of the unions are contemplating undertaking a coordinated programme of industrial action in the autumn, ranging from an overtime ban to likely strike action, in protest.

The RCN mentioned: “People currently on the highest salaries in the overall health service are seeing their rewards accelerating ahead of the earnings of the staff they lead.” Its general secretary, Dr Peter Carter, described the findings as “yet another kick in the teeth for hardworking and loyal nursing staff”.

NHS hospital trusts are in a position to determine with out ministerial interference how much their senior employees must be paid but are anticipated to do so “with obligation and sensitivity to the place of personnel who are subject to national contracts and restraint over their pay out”.

Dan Poulter, the wellness minister, not too long ago insisted that most were carrying out that. But he said that the specifics supplied by hospitals, contained in a new RCN report, “fly in the face of this assertion”.

For instance, the chief executive of Oxford University Hospital NHS Believe in, which runs the city’s John Radcliffe hospital, acquired a bonus of among £40,000 and £45,000, even though one executive received one of £5,000-£10,000 and six other individuals of amongst £10,000 and £15,000.

Similarly, the chief executive of West Hertfordshire Hospitals NHS Trust, which runs Watford standard hospital and other hospitals, also got a £40,000-£45,000 bonus, while 3 executives acquired bonuses of £15,000-£20,000 and a single of £20,000-£25,000.

The chief executive at 10 other hospital trusts and deputy chief executive at a single other each enjoyed pay out hikes of among £15,000 and at least £30,000 throughout 2011-twelve and 2012-13. For instance, the salary of the chief executive of York Teaching Hospitals NHS Foundation Believe in rose from £160,000-£165,000 to £190,000-£195,000.

“It is incredibly worrying that the government believes that trusts are acting responsibly when it truly is clear several are failing to display the leadership they ought to on senior management pay out,” said Carter.

“The government has maintained an iron grip on the pay out and advantages of frontline staff whilst the senior managers’ shell out bill has gone seemingly unchecked. This is the worst kind of double regular and can make a mockery of their insistence that fairness has been at the heart of their selection-making on public-sector pay out.”

Jamie Reed, the shadow health minister, stated: “Difficult-operating nurses and midwives will locate this galling. David Cameron need to have honoured his promise to give frontline workers a spend rise.”

Bosses have been awarded enhanced packages at a time when the support has been acquiring the smallest spending budget increases in its historical past and struggling to provide £20bn in efficiency financial savings in between 2011 and 2015 – the so-referred to as Nicholson Challenge.

The NHS Confederation, which represents senior managers, declined to comment.

The Division of Wellness (DH) said the RCN’s findings were not dependable simply because they had integrated exit packages awarded to some of the 7,250 NHS managers who had misplaced their jobs because 2010 but not carried out the identical with nurses. There are now 16,300 much more clinical employees and 7,250 fewer managers in the NHS than when the coalition took energy in Might 2010, a DH spokesman explained. He claimed that the government’s radical overhaul of the NHS was conserving £5bn, which was far a lot more than the fees of the 7,250 redundancies.

In a separate matter, Carter stated that the NHS would be forced to rely on rising numbers of company and foreign nurses to bridge the gap brought on by cuts to the quantity of pupil-nurse instruction locations.

Speaking from the RCN yearly congress in Liverpool, Carter said: “The NHS, possessing cut the number of places for pupil nurses, is now not receiving the by way of-put, they’re now having to go off to all points of the compass.

“As an illustration, three many years ago, the NHS in London minimize instruction locations by 24%. Now the result of that is beginning to come through.”

NHS chiefs" spend rises condemned as "double standards" by nurses