Pete Martin: Cutting the cost of cancer

Cancer brings a terrible challenge for medical decision-makers as well as relatives. Picture: Getty

Outside, the wind blasted through the trees, raging and rustling through the branches as it wound its way up from the mouth of the Tay. Inside the hospice, like a fading echo of the living world, the storm seemed all but over. Hushed tones; the sound of impossible kindness. Flowers in still life; the scent of forlorn hope.

Along the corridor, my mother lay dying.

As our feet squeaked over the linoleum to the far end, the doors of some rooms were open, perhaps to let in a little life.

In one dimly lit room, you could see a patient in a gown sitting alone. He was hunched motionless in a chair by the window, seemingly pondering the darkness through the glass.

I glanced through another open door. A pale, white-haired woman lay in bed, as if life were leaving her. Her elderly husband raised himself gently to lie by her side. I’d swear I heard her speak his name and whisper “I love you”. How is it that the heart can hold out when all hope is gone?

As for my mum, cancer held her in a grim embrace and would not let her go, at least not peacefully.

For many people, cancer seems the most bitter of human afflictions. It is the body’s ultimate betrayal. Our own cells go haywire – dividing and multiplying uncontrollably, growing and spreading, destroying us from within.

Successful treatments for many types of cancer have improved dramatically over recent decades. Yet we all know that cancer can be a horrendous, life-limiting condition.

But perhaps we are not scared enough. There are more than 200 different types of cancer – with complex, varied causations and baffling pathologies. Some spring from genetic causes (around 10 per cent) or infections (20 per cent). But many are linked to human factors – smoking (25 per cent), diet and obesity (25 per cent), alcohol (6 per cent), sun exposure (4 per cent) and lack of exercise (1 per cent).

You have about 37.2 trillion cells in your body, so you’d think the odds of a few misfiring would be pretty strong. But our bodies are good at cell reproduction. The only trouble is that – like photocopying a photocopy – new cells are a little less good than the one before.

As a result, our “copies” become degraded as we age, and that creates risk. Plus, if we do things which damage our cells and age us prematurely (for example, smoking or sunbathing), we speed up our chances of making a “bad copy”.

So, cancer is a risky business for all of us – and for some more than others. It’s also a costly business. About 30,000 Scots are diagnosed with cancer every year, with average treatment costs of £30,000. And the figures are on the rise. Cancer cases are increasing, and new treatments often have astonishing price tags.

This isn’t just painful and heart-wrenching for patients and families. It’s also a terrible challenge for medical decision-makers.

How do you allocate precious health resources to keep someone alive for a short period? And at what quality of life? This is an incredibly difficult call for “end-of-life” scenarios, or rare conditions.

In England, David Cameron set up a special Cancer Drugs Fund to pay for expensive treatments not normally available on the NHS.

In Scotland, decisions are made differently. The Scottish Medicines Consortium advises on the efficacy and value-for-money of all new treatments. Does a new drug really do more to extend life, and improve quality of life? Does the added benefit justify the rise in cost compared to existing treatments?

Predictably, there are differences in some drugs available north or south of the Border, creating pressure from charities and patient groups. There’s also PR from drug companies pushing to get the green light for costly treatments. But what’s the opportunity cost of paying up? By spending more on cancer, are we valuing one life more than another? Could these funds be better spent for wider, longer-term benefit? It reflects the wider issues facing a financially constrained NHS.

The wonder of science is part of the problem. People are living longer. More elderly and frailer folk can be treated. But we also have people who become chronically ill quite young and, thanks to the NHS, keep living.

Like many of the risk factors for cancer, some of the biggest threats to public health – obesity, smoking, alcohol and drugs, anxiety and depression – are hard to deal with. If not exactly self-inflicted, they seem to be built-in risks in a modern, high-consumption, overstressed, underactive lifestyle. As a result, they aren’t just a financial strain on Scotland’s NHS, they’re an emotional drain on everyone working in our health services.

Earlier this year, after battling bravely with cancer, my brother also passed away. Like many others in life’s cruel lottery, he was a victim of blind bad luck. Too many other families know too well the anguish of seeing their loved ones live in hope and suffer in vain.

Undeniably, we wish the best for those facing perhaps the most difficult challenge in human life. Medicine can achieve so much, and we want to focus our health spending on those whom luck has let down most badly. Because that could be any of us.

For society and for the future, this creates painful decisions. Ever-rising treatment costs can’t be the answer. That’s like jamming the stable door shut with big wedges of public money.

For me, there is only one responsible solution, and I hope it’s not building more hospices. When maybe 60 cer cent of cancers are linked to our own life choices, there’s only one way to afford the best treatments for those in greatest peril. And that’s for the rest of us to take better care of ourselves.

To reduce pressure on Scotland’s health service, we need to avoid predictable risks and live healthy as long as we can.

The idea, as Ashley Montagu put it, is to die young as late as possible. It will take strong public action to help every segment of society do so. But, in truth, better prevention is our best hope.