Cancer is the second-biggest killer in Ireland, according to the Irish Cancer Society. It accounts for about 30 per cent of deaths every year; heart disease accounts for 31 per cent. More than 9,000 deaths every year are from cancer – one every hour, on average.
These statistics probably won't come as a surprise to many people. What might come as some surprise, however, is which cancers are the most prevalent and deadly. New research initiated and funded by MSD and the Marie Keating Foundation shows that, despite lung cancer being the single biggest cancer killer of women in Ireland, only 7 per cent of the population identified it as such.
Over half of those questioned (57 per cent) believed that breast cancer was the leading cause of cancer deaths in Ireland and nearly a quarter (24 per cent) identified cervical cancer. Additionally, while the National Cancer Registry predicts that lung cancer rates in women will increase by as much as 136 per cent by 2040, more than 40 per cent of those surveyed said they expected lung cancer rates to decrease over the next 25 years, with a further 20 per cent believing that lung cancer rates would stay the same.
Better awareness
While the mortality rate from all cancers is still high it is improving, according to Ger Brennan, managing director for human health at MSD Ireland. "Death rates are falling," he says. "A lot of that is down to better awareness, which is leading to earlier diagnosis and better outcomes for patients. Lung cancer is struggling with early diagnosis, however. We still have too many patients presenting for the first time with stage four lung cancer when it is very hard to treat."
Improved treatments are also having an impact on the overall mortality rate. “Surgical treatment is not changing but we have seen major changes in new innovative medicines,” Brennan says. “New immune-oncology drugs are revolutionising the way we treat cancer, but they are not doing it fairly.”
The unfairness he refers to is the rate at which new drugs are developed for certain more high-profile cancers. For example, since 1997 12 new drugs have been developed for the treatment of breast cancer, while just one new drug has been brought to market in that period for lung cancer despite its higher prevalence.
He believes this may in part be due to a certain blame culture which surrounds lung cancer. It is, after all, strongly associated with smoking.
The new generation of immune-oncology drugs holds out hope for greatly improved outcomes for lung cancer patients, even those who present very late. These drugs differ markedly from traditional platinum-based chemotherapy drugs not only in their effects on cancer but in terms of their impact on patient quality of life as well.
“These drugs harness the body’s own immune system,” Brennan says. “There is less toxicity and much reduced side effects associate with them. Patients treated with them tend to live longer and have much improved quality of life. At present, patients presenting with stage four lung cancer are usually told to get their affairs in order, but immune-oncology drugs offer hope in some cases even at that late stage. The results with melanoma have been quite dramatic with the data very positive.”
Access
A number of immuno-oncology treatments for lung cancer have been licensed in Europe over the past 12 months but access to these new drugs is a problem for patients in Ireland, Brennan says. “The drugs have been approved in Europe, but they have yet to be reimbursed in Ireland. We are still waiting for reimbursement to come through but in the meantime MSD has spent €3 million on a patient-access programme to ensure that people with lung cancer can benefit from these new treatments.”
He believes the framework agreement covering drug reimbursement between the Health Service Executive and the pharmaceutical industry needs to be updated or amended to cater for the emergence of new generations of innovative medicines. “The current agreement will result in €785 million in savings over four years,” he says. “The prices paid are based on an average of 14 European countries and the Irish spend per capita is now pretty much at the European average.
“But we need to look at how we fund cancer treatment. These treatments are already available to patients in the UK, Germany, Italy, Finland, and Greece. The UK has put a special fund in place for innovative drugs. Italy has put €1 billion into its fund. While we need more budget here to fund innovative drugs we also need more transparency around the approval process and the timelines need to be addressed as well. We are anxious to work in partnership with the Government and the HSE on this.”
He points to the number of clinical trials being run by MSD in Ireland as evidence of the company’s commitment to making these new drugs available to patients as soon as possible.
“MSD wants to be seen as a leader in this space,” Brennan says. “We have 18 clinical trials running in Ireland and another three are about to kick off. It’s a great tribute to our people here that we are able to stand over that number of clinical trials. And Irish patients can benefit from trials we are running in other countries as well. If an Irish patient can benefit from a trial we are running elsewhere we will endeavour to put them on the trial without them having to travel from Ireland to do so.”
