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Health: Cancer

Volume 719: debated on Monday 21 June 2010


Asked By

To ask Her Majesty’s Government whether they have proposals to use photodynamic therapy (PDT) for the treatment of cancer, particularly oral cancer.

My Lords, it is for clinicians to decide on the suitability of treating a patient with photodynamic therapy—PDT. It is then for primary care trusts to consider whether to fund that treatment, taking into account the available evidence. The National Institute for Health and Clinical Excellence has issued interventional procedure guidance on photodynamic therapy for nine cancer indications, including oral cancer.

I thank the Minister for that reply. Does he agree with me that the most important thing, whatever the type of cancer, is early detection? Will he encourage the research that I hear is being done and which we read about in all the newspapers, which entails a very simple blood test that detects cancer at the earliest stage?

My noble friend is absolutely correct. It is now generally agreed that the most important reasons for the lower survival rates in England compared with other European countries are: low public awareness of the signs and symptoms of cancer, delays in people presenting to their doctors, and patients having more advanced disease at the time of diagnosis. We are looking very carefully at how best to achieve earlier diagnosis. There are some key messages on the NHS Choices website and the national awareness and early diagnosis initiative has been under way since 2008. As for my noble friend’s second question, on the blood test, the newspaper reports in recent days have been extremely exciting in terms of the potential. However, it is clear that researchers will have to demonstrate improved clinical outcomes for patients before any large-scale rollout can be applied.

My Lords, given the Minister’s reply, does he agree that targeted screening remains the best way to prevent growth of oral cancer? Given the success of the previous Government in cutting the overall rates of cancer deaths, is he prepared to guarantee that the current investment and screening programme will continue?

The noble Baroness is quite right that screening plays a very important part in the detection of cancer. However, it is not universally applicable to every cancer. In terms of oral cancer, which was the particular subject of my noble friend’s Question, there are difficulties. For example, there is considerable uncertainty about how the disease progresses—its natural history—and we cannot predict which lesions will be malignant and which will not. We need clear guidelines—for dentists, for example—and we do not have those. There is also no clear evidence base for the management of malignant lesions when we find them. However, the National Screening Committee will review its position again in about three years’ time and will no doubt take all the current evidence into account.

My Lords, does my noble friend accept that when we are trying to improve treatments for cancer, we are looking for non-invasive approaches and specific and, so far as possible, less expensive approaches? Photodynamic therapy has been very useful not just for oral cancer but for skin cancers of various kinds, particularly squamous cell carcinoma. Does he accept that encouraging not just dermatologists but also general practitioners to move in this direction will mean that we can have specific, non-invasive and generally quite efficient treatment, and that that is to be encouraged by the Government?

I am very grateful to my noble friend. It may help the House if I briefly explain what PDT is. It is a technique that uses laser or other light sources combined with a light-sensitive drug, which in combination destroy cancer cells. When the light is directed in the area of the cancer, the drug is activated. As my noble friend indicated, although this is an invasive procedure, it is minimally so; and its advantage is that, unlike radiotherapy, no cumulative toxicity is involved, so someone can be treated with PDT repeatedly. However, there are difficulties, one of which is that there is no obvious clinical leadership in this field, and that has to be addressed. There need to be centres of excellence in order for the right lessons to be learnt and the right research to be done.

My Lords, there is no doubt that, once patients are at the hospital, they are likely to get the treatment, but can the Minister assure us that GPs will be encouraged to make speedy referrals? In the cases that I know of, the difficulty has been in getting from the GP to the centre of excellence in order to get the treatment.

The noble Baroness is quite right, which is why in the NHS there is such an emphasis on speed of referral when a GP first suspects that cancer may be present in a patient. This is an area to which we are very alive, and I hope that we will be able to make further announcements about it in due course.

Does the Minister accept that new cancer treatments such as PDT have benefited both from crucial investment by the Government and from partnership with leading cancer research charities? Is he prepared to guarantee that this crucial research will continue to be funded by the Government so that more deaths from cancer can be prevented in the future?

The noble Baroness is quite right. This is a partnership effort, and she may know that a systematic review of PDT has been undertaken as part of the Health Technology Assessment programme, which is an element of the National Institute for Health Research. The final report on that will be published in August, but the institute has already identified that there are not enough high-quality research studies in this area. We know from experts in the field that there are at least three or four areas where further research should be prioritised.

Is the Minister aware that this month is the 50th anniversary of the invention of the laser? At that time its use in medicine could not have been foreseen. Does he therefore accept how important it is to enable universities to continue to do research in this field, in the hope that there will be future inventions, and not to cut them back in this area?

The noble Baroness makes a crucial point. I am sure she will agree that neither basic research nor translational research should be neglected when we look at the research effort. Indeed, my own department is looking carefully at how the barriers to clinical research can be reduced. Therefore, she is absolutely right to focus our attention on the importance of continuing research.