Week 55: still considering ablation and the Norwegian Government's awesome cancer strategy

Written by Lars Haakon Soraas

Week 55 in the war on lung cancer has passed. This post is one day delayed compared to normal as we had the pleasure to host another two year old from yesterday to today. With two kids in the house, it was challenging to get time to write the weekly update last night. Anyway, here we go:

  • In order to try to make a decision on ablation or not, we decided to get a PET scan done. Dyanne did this today and we should get the results in a couple of days. The scan might help us to better understand whether the size increases found on the last CT scan indeed are cancer or something else. If they are likely to be due to cancer, we will (probably) go for ablation with Professor Edward Leen in London.
  • Dyanne still has some cough and an itchy throat. And she has been a bit more tired than normal.

Dyanne is going to Frankfurt again this coming Wednesday and will return on Thursday. And Dyanne’s parents will be in Oslo from Wednesday this week and for 10 days or so.

In other news: I have been emailing with a bureaucrat in the Ministry of Health here in Norway. It turns out that the government actually has a goal to improve the survival of cancer patients. The goal is buried quite deep down in the National Cancer Strategy 2013-17. It should be noted that the goal is neither concrete, nor measurable. It should also be noted that the government does not plan to actually evaluate whether they reach the goal (that would be difficult anyway, as the goal is not measurable). They have also not bothered to give this national “goal” as targets to the regional health trusts. So, I think we should make a big applause to the Norwegian government for being so extremely ambitious and incredibly committed to improving outcomes for cancer patients. With leaders like these… well, I guess we have long ago concluded that we are better off leading ourselves in this battle.

Another interesting insight from my communication with this health bureaucrat is the following: The government has implemented a system for evaluation of “new methods” to be employed by the health care system. The system is, aptly, called New Methods. A new method can be anything from a new drug, a new medical device or any other new kind of treatment. If someone proposes a new method, there is a standard process with clear responsabilities for who should evaluate and, ultimately, decide about whether the new method should be implemented or not. So far so good.

There is only one problem with the system: no one is actually responsible for submitting new any ideas. Anyone can do it, but no one has to do it. We obviously don’t need to worry about the expensive ideas: a company that has spent millions on developing a new drug will surely make sure it is suggested to this New Methods system. However, if a new promising treatment method emerges that is actually not backed by any commercial interest, chances are that no one will actually go through the motions to propose it. So, if green tea turns out to improve outcomes for bladder cancer patients, don’t expect Norway’s hospitals to start offering it. No one will be in charge of suggesting that it is used, and if it is not suggested, and then evaluated, it cannot be used.

Unsurprisingly, it turns out that most methods that are proposed for the New Methods system bare backed by commercial interests. If you have a new drug, or device, that you want employed by Norway’s health system, then you have a very clear incentive and will go through the process. However, if an old, off patent, drug can double survival for lung cancer patients, no one is responsible for actually making sure this drug is actually put into the New Methods evaluation system. If this sounds like a recipe for ensuring that all new treatments that are eventually adopted will be expensive drugs or medical devices, it is because it is. Until someone with intelligence and conciousness in the Norwegian health bureaucracy wakes up and realizes that they ought to put someone in charge of digging up cheap and promising treatment alternatives for cancer patients, expect more headlines about expensive new cancer drugs.

And while we are speaking about New Methods, I have, as mentioned in an earlier post, suggested that the drug itraconazole should be offered to Norwegian lung cancer patients. As some may remember, a trial from the US found that this drug could quadrouple survival in lung cancer patients when combined with the standard chemotherapy drug pemetrexed. As lung cancer patients have a habit of dying very quickly, I figured maybe they ought to be offered to try this drug. And as there are no doctors or bureaucrats who are in charge of proposing this idea to the New Methods system, I figured that if I didn’t do it, then no one would do it. I now see that the idea has been posted online. Here you can read more if you are interested.

Finally, we strongly encourage all our friends to sign up and become members of the Norwegian Lung Cancer Society. It is a small organization and, consequently, has limited influence. However, political power is linked to membership. So more members means more resources and more power. So please sign up. It only costs 200 kroners a year. And you don’t even have to be Norwegian. So living in Singapore or London is no excuse for not signing up! Here is the sign-up form.

Have a good Monday night!

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