Cancer drugs concern

Chemotherapy can have severe side effects

Cancer patients in the UK may be getting weakened doses of chemotherapy that provide less effective treatment, research suggests.

Audits conducted at 23 cancer units throughout the UK found that doctors reduced chemotherapy levels in a way not seen in the US or the rest of Europe.

Maintaining chemotherapy dose intensity in curable cancers is very important and evidence suggests it does improve a patient's chances of survival

Dr Ruth Pettengell

This is despite strong clinical evidence that maintaining dose levels over a planned treatment period improves survival chances.

The research found that UK centres were reluctant to spend money on the drugs needed to reduce the risk of blood infection caused by high chemotherapy doses.

But the researchers warn that although blood infection, or septicaemia, was a very serious condition, the consequences of cancer returning were likely to be much worse.

The audits showed that 30% of breast cancer and 47% of lymphoma patients in the UK had their chemotherapy treatment modified.

Delays

Either dose levels were reduced at each treatment cycle, or there were delays before the drugs were administered.

An average of 36% of breast cancer patients received less than 85% of their planned chemotherapy dose intensity - a threshold widely accepted by specialists to mean patients are less likely to survive.

Dr Rob Thomas, a consultant cancer specialist at Addenbrooke's Hospital, Cambridge, who contributed to the audits, said: "If you believe chemotherapy improves survival for cancer patients, then you should believe that giving the right dose is crucial to its success."

The two audits were carried out by specialists at four lymphoma and eight breast cancer units with funding from the biopharmaceutical company Amgen.

They showed that supportive anti-blood infection drugs, such as Neupogen, were used in less than 6% of cases in the UK and then often at lower than the most effective levels.

In the USA and other European countries the level of use was about 20%.

White cells

Chemotherapy dose is usually lowered to avoid a common but potentially deadly side effect called neutropenia, which causes the number of white blood cells to fall dramatically.

White blood cells are essential for fighting off infection, so that when this happens there is a risk of septicaemia. About 10% of cancer patients who suffer the condition die.

Neupogen boosts the immune system by increasing levels of white blood cells, making it possible to maintain chemotherapy doses as well as protecting patients from infection.

However, Dr Thomas said: "This drug is vastly under-used in the UK, and current lack of funding continues to severely restrict the prescription of supportive care drugs."

A day's treatment with Neupogen costs about £50.

Typically the total cost per cancer patient is about £1,000.

But experts point out that failing to make the drug more widely available leads to higher spending on hospital care and extra anti-cancer treatment.

Another of the report's authors, Dr Ruth Pettengell, consultant medical oncologist at St George's Hospital in London, said the chief reason for denying cancer patients Neupogen was cost.

"Because it doesn't directly kill cancer cells, but does it indirectly by allowing optimum chemotherapy doses to be maintained, it is classed as a support drug.

"In the current climate it is seen as something dispensable which can be cut.

"Maintaining chemotherapy dose intensity in curable cancers is very important and evidence suggests it does improve a patient's chances of survival."