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31 Aug 2018
by Keira Wallis

Cancer treatment: market trends and the impact on corporate healthcare

Undoubtedly, cancer remains the biggest area of spend in private healthcare and, according to our Clinical Support Team, this is set to continue.

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Recent statistics reveal that one in two people born after 1960 in the UK will be diagnosed with some form of cancer in their lifetime, with 50–74 year-olds accounting for more than half of all new cancer cases in the UK (1). This, coupled with changing age profiles, where it is estimated that by 2020 30 per cent of workers will be over 50 (2), suggests that employers are much more likely to encounter employee groups where cancer is increasingly prevalent.

The median survival time for all cancer types has increased from one year to six years since 1980, supporting the premise that patients with cancer are living longer (1). This can be explained by advances made in cancer therapy, particularly drug treatments which have fewer side effects and can be taken for very long periods of time to keep the disease under control.

Although the NHS has made cancer care a priority, it continues to face considerable financial and workforce challenges associated with its delivery. With less than eight per cent of people in England confident in the NHS’s ability to deliver cancer care in the future and more than 50 per cent of GPs and nurses lacking confidence in the NHS workforce’s ability to provide a quality service (3), it is likely that employers will be faced with rising costs as a result of increasing employee reliance on corporate healthcare schemes.

Advances in cancer treatment

In clinical terms, 2017 was an exciting time for the field of cancer care. Survival rates for cancer patients were recorded at an all-time high and research suggested that with the advent of new therapies, these rates will continue to rise. Notably, in the last year we have seen a number of developments in the area of cancer treatment.

In 2017, the American Society of Clinical Oncology named adoptive cell immunotherapy as the clinical cancer advance of the year. This is quite a distinction, but a well-deserved one. Based on the principle that a patient’s immune system can be engineered in the lab to destroy cancer, these therapies mark a milestone in cancer treatment (4). Unfortunately, the cost of these drugs is estimated at £400,000 per course of treatment and, although NICE appear keen to support these new therapies on the NHS, it is unclear at this stage how these will be funded and if this will be sustainable in the longer term.

Consequently, it is possible that these types of treatments may only be available initially on a private basis which could have considerable impact on the overall cost and sustainability of private healthcare plans.

2017 was also the year that marked a further milestone in the history of precision cancer medicine when pembrolizumab was approved as the first tissue-agnostic treatment for cancer (4). This means that it became licensed for use solely on the basis of the genetic make-up of a person’s cancer, rather than the type of cancer or its location in the body. It is estimated that between 10 per cent and 33 per cent of all cancer cases in the UK could be suitable for this drug (5). Unfortunately, this drug comes at a considerable cost (£150,000 for 12 months’ of treatment). As this drug is used in advanced cancers, treatment must be given regularly to keep the disease under control. It is not known at this stage if this will be available in this context on the NHS.

While the costs of these novel drugs are already deemed prohibitive, the problem is estimated to be bigger than that. Cancer drugs are considered to have increased in price by approximately 10 per cent per year since the mid-1990s and it is safe to say that this is going to continue, especially when drugs are being increasingly used in combinations of two or more agents at a time, effectively doubling the cost (6).

Although the NHS has a strong commitment to cost-effectiveness when making decisions about treatment availability, this is not a determinative factor in the private healthcare provision market, where the drug is considered eligible for cover if it is licensed for use for that particular disease. Therefore, it is likely that employers and their families could increasingly become dependent on corporate healthcare cover to access treatment that the NHS is unable to provide.

Advances in radiotherapy: proton beam therapy

While much of the focus on cancer treatment is placed on drug therapies, it is worthy of mention that in July 2018 the UK opened its doors to the first private proton beam therapy center. While conventional radiotherapy uses high energy beams of radiation to destroy cancerous cells, surrounding tissue can also be damaged (7). Unlike conventional radiotherapy, in proton beam therapy the beam of protons stops once it “hits” the cancerous cells. This means that proton beam therapy results in much less damage to surrounding tissue and therefore is less likely to cause side effects.

Proton beam therapy is useful for treating types of cancer in critical areas and it is used most often to treat brain tumours in young children whose brains are still developing. Proton beam therapy can also be used to treat adult cancers where the cancer has developed near a place in the body where damage would cause serious complications, such as the optic nerve (7).

In addition, new technologies such as stereotactic radiotherapy (a very precise form of radiation) are being used much more in advanced cancers which previously would have not been deemed suitable for this type of treatment. The precise nature of these treatments means they are better tolerated and therefore patients are much more likely to be able to live a near to normal life, remaining employed and making use of their private healthcare provision to continue to keep their disease at bay.

Summary

In summary, it is safe to say that patients with cancer are living longer, thanks to advancing, costly drug therapies and new technologies. This, coupled with a rising incidence of cancer in the workplace means that the claim costs that can be apportioned to cancer treatment will continue to increase. In essence, cancer has become a chronic condition but is not currently treated as such by the corporate healthcare market. As further technologies emerge and costs continue to rise, it has never been more important to obtain expert clinical input to ensure that employers are offering the most appropriate, cost-effective healthcare cover for their employees while being mindful of budgetary constraints.

The author is Keira Wallis, nurse consultant, Healix Health Services.

This article was provided by Healix.

References 

1. Cancer Research UK: Cancer Incidence by age (2017)
2. Houses of Parliament: An Ageing Workforce (2011)
3. Macmillan: From the frontline- workforce pressure on the NHS (2017)
4. Journal of Clinical Oncology. ASCO: American Society of Clinical Oncology: Clinical Advances in Cancer, 2018
5. Dudley J et al. Microsatellite instability as a biomarker for PD-1 blockade. Clinical Cancer Research (2015)
6. Cancer Research UK: Health Economic, the cancer drugs conundrum (2016)
7. NHS England: Proton Beam therapy (2013)

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