Not all cancer patients are equal warns Professor Michaela Higgins

Access to gold standard oncology treatments is inequitable in Ireland.

Speaking at the RCPI Annual Conference, Professor Michaela Higgins, Consultant Medical Oncologist at St Vincents Hospital, provided stark evidence of the growing challenges in targeted cancer care.

“I know what treatment would be best for a patient but increasingly, I cannot prescribe it,” Professor Higgins said.

As the prevalence of cancer increases, the drugs to treat it become more expensive, explained Prof Higgins, comparing cancer treatment to exorbitantly priced wedding shoes.

“Just like weddings, there is a cancer premium,” she said.

“We have seen a sharp increase in oncology drug prices. Yes, a lot goes into the research to develop the drugs but the price of a drug to treat cancer will be higher than the price of drugs to treat other diseases.”

Growing Divide

Once a drug is approved by the European Medicines Agency (EMA), the licence-holder must apply for approval for it to be reimbursed for public patients in Ireland, a process which is currently taking 22 months or longer for oncology medicines.

Since June 2023, three of Ireland’s leading private insurance providers have made EMA-approved cancer drugs immediately available to those with private coverage, while public patients could have to wait up to two years for access to the same drug treatment.

Doctors are in an untenable position – prescribe a less effective treatment protocol, knowing the patient has a higher chance of losing their battle with cancer. Without health insurance to cover the cost of the drugs, patients have no other choice.

The gap widens when you compare Ireland to other countries.

“In the majority of other European countries, the wait time is considerably lower. Germany, for example, is approving the drugs within about 4 months.”

“So, the public vs private access to care issue is exacerbated by the speed at which approval is happening in Ireland compared to the rest of the world.”

A Call to Action

Despite the challenges, Professor Higgins says it is not all bleak and there is something we can do.

“Cancer, for the most part, if caught early, is curable,” she said.

Cancer screening programmes are hugely successful in early identification and the HPV vaccine is highly effective in protecting against cervical cancer. More resources are needed to provide screening for lung cancer.  

Budget 2025 offered renewed commitment for the National Cancer Strategy, including €10 million for new cancer drugs. There will also be a shared EU technology assessment process for new drugs beginning in January 2025.

“I am very grateful and welcome the cancer strategy funding in Budget 2025, but we need to see ring fenced funding year on year,” Prof Higgins said.

She also argued for the need to optimise oncology drug expenditure.

“We need to practice evidence-based medicine,” she said.

This includes clinical trials and expanded access programmes, vial-sharing, and weight-based vs fixed-dose immunotherapy dosing, which would result in significantly less wastage – a common problem currently.

Finally, she issued a call to action to the doctors in the room.

“Use your voice,” she said.

“Advocate for patients, lobby our leaders for overhaul of the drug reimbursement process, and insist on reasonable pricing of cancer drugs.”

One in two people have a chance of developing cancer at some point in their lives.

Cancer effects everyone equally but only the fortunate can access the best targeted care for them.