Ethical dilemma for doctors must be confronted, says bowel cancer charity
pharmafile | November 22, 2007 | News story | |Â Â Â
Many bowel cancer patients are not being informed of all treatment options because their doctors feel embarrassed about having a financial conversation or raising false hopes about access to new drugs.
A survey conducted on behalf of Beating Bowel Cancer and funded by pharma company Roche found nine out of ten oncologists had found themselves in an 'uncomfortable situation', with over half not mentioning all potential treatments to patients.
In particular, Roche's Avastin and Merck Serono's Erbitux are two new bowel cancer treatments which can add extra months to the lives of patients, but both drugs are not recommended for use on the NHS because of their cost.
Over 90% of the bowel cancer specialists surveyed said they had been in a situation where their preferred treatment regimen involved a drug not routinely funded on the NHS.
Beating Bowel Cancer is now calling for immediate guidance to be made available to doctors to help them in these difficult situations.
Beating Bowel Cancer chief executive Hilary Whittaker said: "Although we empathise with doctors who don't want to raise patients' hopes, we are aware, through speaking to patients, that the vast majority want to be told of all clinically proven treatments appropriate to their condition.
"We want to be reassured that bowel cancer specialists are provided with whatever support they require in order for such conversations with their patients becoming accepted as normal practise."
Specialists say they feel particularly uncomfortable when talking to patients who are well-informed, or with patients who cannot afford treatment privately, or have no health insurance.
But four out of five bowel cancer specialists do not even ask patients if they have private medical insurance, which could partially or fully cover the cost of treatments that are licensed in the UK, but are not available on the NHS.
"The ethical dilemma we are facing on a daily basis is the choice between being open and transparent with our patients about all treatment options they could benefit from, and ensuring that we are not raising false hope," said Dr Bruce Sizer, a leading bowel cancer specialist and consultant in clinical oncology at Essex County Hospital.
Beating Bowel Cancer's survey found that 80% of the specialists had not been given any guidance from their NHS trust about talking with patients about drugs not approved by NICE.
A parallel poll of patients found 82% would prefer to be told about the drugs, even if they are not routinely funded by the NHS.
"This is a very worrying situation," said Hilary Whittaker. "This lack of direction means that doctors are often placing themselves in a difficult position, with no available support. However, we need to ensure that patients are not deprived of their fundamental right to be told of the range of available treatments regardless of whether there is local funding."
NICE produced its final guidance on Avastin and Erbitux in January this year, rejecting any use of the drugs to treat bowel cancer on the NHS, but plans to begin a new review of the drugs in May 2009.
