Global recession tightens grip on cancer services and research spending 

Reduced access to expensive cancer treatments; reduced investment in drug discovery; and less support for cancer sufferers and survivors could all be on the horizon in continental Europe and in the UK, as the global financial crisis continues to squeeze the budgets of governments, companies, and private individuals. These are the conclusions of a series of inter-related reports published in the March issue of The Lancet Oncology.

The reports also discuss how the patchy provision of screening programmes and unequal spending on cancer care within Europe and the UK, mean the blow to cancer-care provision inflicted by the economic downturn will be felt more keenly in some areas than in others.

In the first of two Special Reports, The Lancet Oncology highlights disparities in access to cancer services across Europe, and finds equal access to novel cancer drugs is a long way off. As Nils Wilking (Karolinska Institute, Sweden), co-author of the Comparator Report on Patient Access to Cancer Drugs in Europe, points out: “Per capita spending on drugs (new as well as pre-1999) is significantly lower in the UK compared with France and almost all other western European countries”.

The deepening economic crisis looks set to reduce this spending further. Commenting in the second Special Report, Nick Bosanquet (Imperial College, London, UK) says: “In Europe there are likely to be informal steps towards rationing access to new treatments as governments seek to contain spending; we are already seeing this in the UK through the restrictions placed on the uptake of expensive drugs by the National Institute for Health and Clinical Excellence (NICE).” Additionally, Alan Maynard (University of York, UK) emphasises the UK Institute of Fiscal Studies has estimated NHS funding may equate to zero real growth for the 3 years after 2010. Reflecting on the rest of Europe, Maynard also adds: “In Europe some will fare better but some will fare worse, notably Ireland and the Baltic republics.”

Programmes of cancer support and research that rely on charitable funding are also likely to feel the squeeze, with rising unemployment and falling sales and profits conspiring to reduce donations by companies and private individuals. Cancer Research UK is forecasting a 4–5% drop in income in 2009 compared with 2008, and Macmillan Cancer Support predicts that the recession will be especially hard on people affected by cancer who rely on them for financial support.

As purse strings tighten across the board, so the need becomes more pressing for efficient administration and an equitable distribution of cancer services. A situation far removed from the current inequalities and waste highlighted by The Lancet Oncology in this month’s editorial, the Leading Edge.

Commenting on the widening inequalities in access to cancer treatments across the UK, The Lancet Oncology says: “This makes a mockery of the concept of a ‘National’ Health Service, when the four countries within the UK each have different interpretations…In the current global recession, a root and branch re-evaluation of services, focused on patient-centred medicine…would undoubtedly improve care for patients with cancer; reduce polarisation in accessibility; and possibly even shrink healthcare budgets”.