Innovation and delivery in cancer care
In this year's Conference symposium Karol Sikora, visiting professor
of cancer medicine at Imperial College, London, gave his view of how
cancer services might look over the coming decades. Harriet Adcock (on
the staff of The Journal) reports his predictions for pharmacy involvment
in cancer care Pharmacy is the way forward for direct-to-consumer cancer prevention
and care
Karol Sikora: health professionals must look at imaginative ways
to provide cancer care |
Cancer prevention services will be community based within
a decade, according to Professor Karol Sikora, visiting professor of
cancer medicine,
Imperial
College, London.
Presenting this year’s Conference symposium, Professor Sikora predicted
that the traditional medical model for cancer care would be given up. “A
direct-to-consumer model for cancer prevention done through pharmacy
and clinical pharmacists may be a better way forward,” he said.
In 20 years’ time, nurses, pharmacists, counsellors and physicians
are all going to work as a team. However, Professor Sikora was unsure
how this team would operate and which professionals would take on which
roles. He suggested that specialist services would be provided in the
community rather than being set up in hospitals and clinics. “The
time isn’t right yet, but it will come over the next five to 10
years.”
He commented that unusual providers could take over cancer care and that
these providers could include pharmacists. “You can be completely
innovative. You don’t need to use the National Health Service model.” He
asked how pharmacists might design a cancer chemotherapy suite and suggested
that a clinical pharmacist could run it. “They are probably in
the best position to be the leader,” he said.
He went on to say that, in the NHS, nurses answer to nurses, doctors
answer to doctors and pharmacists answer to pharmacists. “There
are all these chains of command. Why not have a unique structure? Why
not have a cancer prevention unit run by a pharmacist,” he suggested.
Advances in technology
He commented that in the future advances in technology would mean that
up to 70 per cent of patients with cancer would be cured. “Technology
failure is not likely. The future ... is going to be about how society
provides the care, how it pays for it and what model it uses.”
He pointed out that the strains of innovation are everywhere. “It
doesn’t matter if you live in a rich country or a poor country.
We have to prioritise how we can provide optimal cancer care and tailor
it to the financial environment.”
Professor Sikora predicted that nationalised health care structures would
disappear. “There will be regulators and payers of care providing
a safety net for the uninsured. This is inevitable, despite the political
stance [of the Government],” he said.
The biggest change in prevention strategies would be the identification
of individual cancer risk. “Within five years there will be good
genetic testing — not just of high-risk cancer. Multiple gene analysis
will tell us who is likely to get cancer,” he said.
He suggested that by 2023 cancer will have become a controlled illness.
Diagnostics will be important not just in choosing therapy but also in
monitoring.
There will also be personalised medicine — implanted chip monitors
and cancer hotels providing new roles for health professionals. “Nurses
have led the way in the past 20 years. Maybe the next 20 will see the
pharmacist in cancer management,” he said.
Other changes in the way cancer will be manged in the future include
the “de-medicalisation” of palliative care. “Patients,
in future, will be put in charge,” he said. He added that there
will be better pharmacological symptom control and that pharmacists will
be part of the front line as far as how therapies will be paid for.
Professor Sikora predicted that in 20 years time the term “patient” will
have disappeared. “The future will be about people living with
cancer who are consumers of care.”
In terms of chemotherapy, there is a transition going on, Professor Sikora
said. Cancer care is moving out of a cytotoxic era and into a world of
small molecules that inhibit specific targets. “A world of monoclonal
antibodies, a world of gene therapy and a world of cancer vaccines. These
are going to be the treatments of the future,” he added.
He explained that 80 per cent of drugs in phase I development have a
molecular targeted action. “As we go through the development cycle
over the next three to five years ... you will see increasing numbers
of drugs flowing into the pipeline that have molecular targeted effects.” The
human genome project has been the reason for this transition, he added.
Data analysts are predicting that examples of all these new technologies
will receive regulatory approval in the United States by 2012. Furthermore,
the technologies are scheduled to hit the five main cancer types and
will have profound implications for clinical pharmacy, he warned.
When it comes to paying for services, the future could again bring changes. “There
is a demand pyramid for cancer. We’re used to having core services
paid for by the NHS. Above that there are all sorts of demand services
that people want but the system won’t pay for.”
He cited the example of complementary medicine, for which there is a
huge market. “But what about novel drugs,” he asked. He suggested
that patient advocacy groups and articles in the consumer press raise
patient’s awareness of new therapies. The National Institute for
Clinical Excellence acts as a dampener from the centre but there is continuing
tension.
Pharmacy embraces innovation
Responding to a question from Dr Gill Hawksworth, President of the Royal
Pharmaceutical Society, Professor Sikora suggested that community-pharmacy-managed
cancer care could come about quickly.
“You embrace innovation much faster than the public sector,” he
said. “If the pharmacy profession can deliver cancer care better,
faster, cheaper than the current system then it will take over.”
He suggested that one of the drivers for an improved service is the privatisation
of care. “That is against current ideology but there is no doubt
that delivery can be a lot smarter than waiting around in a hospital
pharmacy.”
He added that it is important for health professionals to think creatively. “All
of us, whatever professional box we are in, have got to look at imaginitive
ways in which we can provide the best care from what will always be a
limited resource.” |
