Kimmo Porkka, head of clinical haematology at the Helsinki University Central Hospital, is concerned that the rising cost of specialized cancer treatments will eventually lead public health services to rank cancer patients in need of treatment.

Finland’s Cancer Register estimates that 250,000 people in Finland have been diagnosed with cancer at some point in their lives. The clear majority, 78 percent, are struck with common forms of the disease, like breast, prostate, lung or intestinal cancer.

The remaining 22 percent, some 21,000 Finnish residents, have a cancer that is classified as rare. Among these, cancers of the blood are most common. There are 140 different known blood cancers, whose onset have not been linked to lifestyle choices like smoking or excess weight, and therefore are apparently random.

Easy to research, but increasingly piecemeal

Haematology specialist Porkka says blood cancers like leukaemia, lymphoma and myeloma are easy to research, as samples of a patient’s blood and bone marrow are relatively easy to examine.

“It is very difficult to obtain samples of stomach cancer, for example, and so cancers of the blood have been the subject of more research even though they are rare. Many new cancer drugs can actually trace their origin back to haematological research,” he says.

Most cancers work in the same way and can be attributed to the same abnormal genes. Antibodies used in immunotherapies to increase the strength of immune responses were developed to cure cancers of the blood, for example, but have also proved effective against solid tumours.

A more case-by-case approach in future

Porkka says the entire field of cancer research is in for a monumental change now that renegade genes in cancer cells can be examined more easily.

“Common cancers, like breast or colon cancer, will also be distributed among very small groups in future, so people with cancer will become increasingly unique and will require a wider variety of treatments,” he says.

This increasing fragmentation will be a challenge for pharmaceutical development, as patient groups will become smaller and smaller. Despite new drugs appearing at a rapid pace, this could mean that it may take ten years before they can be released to the market.

Clinical tests must be held in three phases before new drugs can be authorised for use. In order for a medication to be eligible for reimbursement from Finland’s state benefits provider Kela, yet another study comparing the new drug to standard medication already in use must also be carried out.

Porkka says the entire process is too slow, and partly outdated.

“It is very difficult, almost impossible, to gather enough instances to meet these requirements for rare cancers, a road that even common cancers are set to go down as numbers fall. This is a challenge for the authorities because they have to weigh what should be considered sufficient evidence of a drug’s efficacy for a very small patient group.”

Rigid reimbursement scheme needs an update

Porkka is convinced that cancer treatment will become increasingly personalised in the near future, as health care professionals work to come up with more precise solutions. He is concerned that the rules regarding Kela reimbursements will become even stricter.

“Almost all cancer treatment medication is so expensive that it is unimaginable that patients could pay from it themselves. Drugs to fight cancer should be free, but for many medications this isn’t the case.”

Helsinki’s Department of Oncology has seen yearly expense increases of five percent, a development Porkka feels is unsustainable. Every patient is still receiving treatment, but Porkka is concerned about the future.

“We might have to start thinking about what we can afford, and maybe even soon prioritize some cases for treatment above others. We have to enter into a dialogue with the regulatory authorities and the pharmaceutical companies about how we can best offer treatment to patients who will benefit from it.”

Yle