Health reforms 'hampering cancer cures'

BRITISH ASSOCIATION

A culture of collaboration within the National Health Service - rather than competition within its internal market - is the key to curing cancer, medical scientists said yesterday.

The dramatic improvement in the survival rate of children with leukaemia, which was invariably fatal a generation ago, is due to a National Health Service where doctors collaborate on a common treatment strategy rather than any single breakthrough in drugs or treatment.

Such improvements in the prognosis for childhood leu- kaemia, however, have not been matched by a corresponding rise in the survival rate of adults with leukaemia, who receive less publicity, despite 60 per cent of leukaemias occurring in the over-50 age group. About two- thirds of children with leukae- mia survive beyond five years, whereas less than one-third of adult leukaemia patients live that long.

Professor Judith Chessels, a cancer specialist at the Institute of Child Health in London, told the British Association meeting in Newcastle upon Tyne that childhood leukaemia was once one of the most difficult illnesses to treat. "Thirty years ago, leukaemia, the commonest form of childhood cancer, was almost uniformly fatal. Today the vast majority of children with leukaemia survive for at least five years from diagnosis, and many of them are cured.

"This remarkable achievement has come about, not by a sudden and dramatic breakthrough in therapy or the over- night discovery of wonder drugs, but by painstaking clinical trials involving collaboration between doctors, statisticians and basic scientists and thanks to the determination of the children themselves and their families," Professor Chessels said.

"The keynote is collaboration and not competition [within the internal market of the health service]. Progress in childhood leukaemia is slow and steady. It is everyone pull- ing together."

Many of the drugs used in leukaemia treatment have been available for over 30 years. It has taken much longer to use them to their best effect as part of national protocols for treatment, which are behind the dramatic improvements in survival, she said.

"Contrary to popular belief, most children with lymphoblas tic leukaemia - the commonest type - are cured without recourse to bone marrow transplantation." Such transplants are reserved for a minority of high-risk children, Professor Chessels said.

The treatment of adult leu- kaemia has not, however, benefited in the same way, said Professor Stephen Proctor, of the Royal Victoria Hospital in Newcastle. There is a rapid deterioration in survival rates with age and the outlook for patients over 50 "remain extremely poor", because of the different causes of the disease in children and adults.