Remember, if caught early enough, bowel cancer can be cured.

Some people feel embarrassed about discussing bowel problems with their doctor. By the time the patient seeks medical advice because he or she cannot cope any longer with his or her symptoms,it can sometimes be too late. Be sensible.

The Doctor's Dilemma

date 02/09/2008

One of the best things about my job is that I get to know people I care for over a long period of time. Patients sometimes ask me about new drugs that are simply not suitable for their type of cancer. I try to explain scientifically, rationally and reasonably the detail of how the drug works and why it only works in specific cases.

What is much harder and puts doctors like myself in a really difficult position is when patients ask about drugs that are appropriate for their treatment but are too expensive to prescribe. These are drugs that could potenially influence their outcome either by shrinking their cancer, so it causes fewer symptoms such as pain, or better still - increasing their survival time.

People often have a specific goal - a relative's wedding, a birthday or Christmas with their family - that they are desperate to reach. It's impossible to lie to patients so I am left apologising to those I have cared for.

Often the patients are hugely disappointed with us doctors.

Now that the health watchdog NICE is regularly refusing new therapies to treat cancer, there is a new issuefor us to deal with: what to tell dying patients when they ask if anything more can be done to extend their lives. These are some of the most anxious and distressing times that any person can ever have and the conversations we have with them are pivotal to their future.

It's even harder to explain how NICE works - that it evaluates medicines on the basis of the "number of quality of life years saved" and uses a cut-off of £28,000 a year - an amount that is decreasing, not increasing.

It would be better if it evaluated medicines on the basis of how long they prolong a person's life. E.g. if someone with secondary breast cancer was going to live for six months and a new medicine kept them alive for nine months, their life has been extended by 50 per cent. But NICE thinks it is not cost effective to spend money for just three months and says "no".

NICE refuses to approve new cancer drugs so often that when it says “yes”, as it did with breast cancer drug Herceptin, doctors are shocked. One of the issues that has surprised us is how often NICE says “No” – as it did recently for all four new kidney cancer medicines it was looking at. Doctors sense a lack of balance, discretion and fairness here.

One of the worst situations I can be in is if a patient asks me to choose which drug I would give them – e.g. out of Sutent, Avastin, Torisel and Nexavar in kidney cancer, all of which NICE said “No” to. I am asked: “What would you do if it was your sister or mother?”

If clinical trials are available, doctors should try their best to find one, especially if it contains a medicine that we know is effective – but expensive. Often, however, no trials are suitable.

To look after people, doctors use standard pillars of ethics such as "do the most good", "do the least harm" and the Hippocratic oath, which includes keeping the good of the patient as the highest priority.

It’s hard to do that when we know a potentially great treatment is out there, approved by the European Medicines Evaluation Authority as safe and effective and available in other countries in Europe and the US but we cannot prescribe it because of NICE.

When my colleagues and I were at medical school we did not think such a massive part of our professional lives would be considering the financial costs of new, effective drugs.

Taken from a Daily Express interview with Oncologist Dr Justin Stebbings, senior lecturer at Imperial College, London.

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