Prostate cancer drug cleared for free use
Men with late stage prostate cancer today won the right to free treatment with the first drug proven to extend their lives.
Taxotere, which was originally developed to treat breast cancer, typically increases the survival of men no longer responding to hormone treatment by 18.9 months.
Despite having some side effects, it also reduces pain and weight loss, and generally improves quality of life.
The medicines watchdog, the National Institute for Health and Clinical Excellence (Nice) today recommended that Taxotere should be available to all eligible men in England and Wales on the NHS.
Thousands of men with prostate cancer that has spread could now qualify for the drug.
Primary Care Trusts have 90 days in which to comply with the guidance. But although the decision was welcomed by doctors and charities, there are fears that in some parts of the country patients will still be denied the treatment.
A single course of the drug costs around £7,000, to which must be added the cost of extra staff to administer it.
Few options exist for men who become resistant to hormone treatments that stop testosterone fuelling prostate cancer.
Hormone therapies typically work for up to three years. With no further treatment, a patient might expect to live for about another year.
Taxotere, the brand name for docetaxel, fights cancer by blocking the mechanism that allows tumour cells to divide.
A trial published in the New England Journal of Medicine in 2004 provided clear evidence that the drug lengthened the lives of late-stage prostate cancer patients.
Another anti-cancer drug, mitoxantrone, is sometimes given to this group of patients despite not being licensed for prostate cancer in the UK. But although it improves quality of life, a question mark remains over whether mitoxantrone actually increases survival.
In practice both Taxotere and mitoxantrone are given in conjunction with a steroid, prednisolone. Chris Hiley, Head of Policy and Research at the Prostate Cancer Charity, said of the Nice decision: "This is a major step forward in prostate cancer treatment. Until now there has not been a treatment for men with advanced prostate cancer which could extend their lives and reduce their pain.
"We hope this chemotherapy drug will be made immediately available via the NHS to all men with prostate cancer across the UK who could benefit from it, and that no man is denied it on cost grounds. This is vital to improving prostate cancer survival, quality of life and treatment choice.
"It will also be important to find out, as further research into docetaxel is completed, how useful this drug might be in earlier stages of aggressive prostate cancer in younger men."
Prostate cancer is the most common men's cancer in Britain. More than 30,000 men are diagnosed with the disease each year, and around 10,000 die from it.
Although 90% of cases are men over the age of 60, doctors are treating increasing numbers of younger middle-aged patients.
Campaigners have long complained that treatments for prostate cancer have lagged behind those for breast cancer.
John Anderson, chief executive officer of another charity, Prostate Research Campaign UK, said: "Nice guidance supporting the use of Taxotere based regimens for women with late stage breast cancer has been available since 2001.
'It's about time'
"It's about time that men are also able to get to the front of the queue to gain equal access to a treatment that could benefit them. Now that guidance has arrived there is no excuse for men who could benefit not to get access as quickly as possible."
Professor Nick James, Consultant Clinical Oncologist at University Hospital Birmingham NHS Trust, agreed that the move was a "significant leap forward". But he did not expect to see every eligible patient immediately given access to Taxotere.
"We know that some trusts are giving virtually none of these patients chemotherapy, and in addition to the actual cost of the treatment you've got to have enough doctors, nurses and pharmacists," he said.
"I think what will happen is that the drug will become available but to highly selected patients. PCTs can keep to the letter of the law but not the spirit - you can comply with Nice guidance by giving only one patient treatment.
"I suspect this recommendation will be implemented as slowly as possible."
He underlined the marked difference in approach to rolling out new treatments for prostate and breast cancer patients.
Taxotere was licensed for treating prostate cancer two years ago, yet the Nice guidance was only delivered today.
In contrast it took less than six months for guidance to be issued on the controversial new breast cancer drug Herceptin.
Herceptin costs around £20,000 per patient per year, and is only suitable for about 20% of women with breast cancer.
"To a large extent the whole business is politics and lobby driven," said Prof James.
David Cottrell, 65, a retired plant operator from Shaftesbury, Dorset, fought a long personal battle to be treated with Taxotere.
He was diagnosed with prostate cancer in 2000. Doctors recommended treatment with Taxotere in November 2005, but it was refused by the local Primary Care Trust.
After six months of writing letters to the Prime Minister, the Health Secretary, his local MP, the Press, and all his neighbouring PCTs, Mr Cottrell was finally given the drug in April. He married his long-term partner a month later.
He said: "I cannot fault the NHS doctors and nurses who have treated me for prostate cancer, but my cancer keeps returning and has spread to my bones, and that's why I needed docetaxel.
"However, I had to start a campaign to get this drug which no man should have to go through. I am very pleased that Nice has made this decision to give all men like me the chance for a longer life. Docetaxel has made a big difference to my life, and although it makes me nauseous, the pain is so much better.
"I have no idea how long I am going to live, but every extra moment I have with my wife and our four children is a bonus."
Mum's 10 steps to happiness
Bringing up children can leave even the most patient mother feeling tired and irritable at times.
With little time for themselves, many can also feel unfulfilled and unhappy.
But a new experiment has shown mums how to improve their well-being - by teaching themselves to be happy.
And by following the key steps, say experts, all mums should be able to lead a fulfilling and contented life.
The social experiment was launched by Netmums, an online support group set up in 2001 for mothers around the country.
Over 1,000 mums took part in the test, which asked them to follow 10 basic 'happiness principles'.
These included tasks which mothers could perform each day to try and boost their happiness levels, such as saying hello to a stranger, talking to a friend or doing someone else a good turn.
Mothers were also encouraged to do more exercise, watch less television and spend quality time with their partner.
Before the experiment, called 'Making Mums Happy', the participants took a psychological test, to rate their levels of happiness.
On a scale of 1 to 100, the average score was 52. But after following the happiness principles for four weeks, the average score rose to 64 - a rise of over 10 per cent in just 28 days.
Netmums co-founder Sally Russell said yesterday: "Research has shown that mothers are at their least happiest stage in the first few years of bringing up their children because they are so stressed and overworked.
"Social isolation is one of the huge reasons for this, with people living further away from their families and receiving less practical and emotional support.
"Many more mothers now are also working, often juggling too much and finding themselves extremely busy."
Demands
The 40-year-old mother-of-two added: "The demands of looking after little ones can take its toll, and few mums and dads have little, if any, time to themselves.
"If the mother herself is not happy then it has an effect on the children, on the rest of the family and on the community as a whole.
"These steps are about mothers taking a little bit of time within their everyday life to do something more outward and something for themselves to make them feel more happy."
The 10 happiness principles were based on those used in the BBC TV programme Making Slough Happy, where experts worked with 50 volunteers from the Berkshire town to try and raise their happiness levels through experiments and community-based activities.
They involve simple steps such as keeping a diary of 'happy' events, cutting down on television viewing, befriending an elderly person and tending a plant.
Those who took part in that experiment registered a 33 per cent increase in their happiness levels at the end.
Happiness expert Richard Reeves, who worked on the show which was aired last year, said: "Happiness is a serious subject, and people are starting to see it as such.
"Some might say it's all obvious, that it's nothing we don't know. But what's different is that we can start to prove it, measure it.
"We can identify what the ingredients of happiness are."
Dr Jenny Bywaters, director of public health for the National Institute for Mental Health in England, said: "It is really important to spread the message about positive steps everyone can take to improve their sense of well-being and Netmums have shown how small changes can make a big difference."
Painkillers may not cut smokers' colon cancer risk
Last Updated: 2006-07-06 16:25:03 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Aspirin and similar painkillers have been shown to reduce colon cancer risk, but new research suggests the benefits may not extend to longtime smokers.
In a study of nearly 3,300 adults, researchers found that smokers had a higher than average risk of colon cancer, even if they regularly used non-steroid anti-inflammatory drugs (NSAIDs), a class of common over-the-counter pain relievers that includes aspirin, ibuprofen and naproxen. A number of studies have found a lower risk of colon cancer among people who regularly use NSAIDs, such those who take daily aspirin to help prevent heart attacks. NSAIDs inhibit the body's synthesis of prostaglandins, hormone-like substances that may help stimulate the growth and spread of colon cancer cells.But the new findings, published in the journal Cancer Research, suggest that the benefits of NSAIDs may not be enough to counteract the damage from years of smoking."Given the damage that smokers receive over their lifetime, even strong anti-progression agents, like NSAIDs, may be ineffective," write the study authors, led by Victoria Chia of the Fred Hutchinson Cancer Research Center in Seattle.The study included 1,792 adults with colon cancer and 1,501 without the disease. Overall, Chia's team found that current NSAIDs users had a 30-percent lower risk of the cancer than nonusers.Smokers who used NSAIDs, however, still had an elevated risk of colon cancer. Current smokers who were using the painkillers were 70 percent more likely to be diagnosed with colon cancer than NSAID users who never smoked.The greatest risk was found among people who'd never regularly used NSAIDs and had smoked for more than 40 years; they were nearly three times more likely to develop colon cancer than non-smokers who used NSAIDs.In particular, smokers were at risk of a type of colon cancer marked by microsatellite instability, which means the tumor cells show defects in the cells that normally repair the genetic damage that can lead to cancer. Longtime smokers were at risk of these colon tumors regardless of their NSAID use.Researchers are currently studying whether aspirin and other NSAIDs can help prevent colon cancer in people with a higher-than-average risk of the disease. Because prolonged NSAID use can cause side effects, such as serious gastrointestinal bleeding, experts advise people against taking the drugs on their own for the sake of colon cancer prevention.
SOURCE: Cancer Research, July 1, 2006.
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