By Julia Medew
LEADING oncologists have called for cancer treatments to be independently reviewed to ensure toxic and expensive drugs are not being overused at patients' and taxpayers' expense.
Cancer Council Australia chief executive Ian Olver and Melbourne oncologist Ian Haines said a lack of independent research into cancer drug outcomes meant it was difficult to know how effective treatments actually were for patients and those paying for the drugs.
Writing in The Medical Journal of Australia, the doctors said there had been a decline in independent research over the past 10 years, with drug companies often paying doctors for their work and influencing treatment guidelines.
There had also been a shift away in clinical trials from using drugs until maximum response and then stopping the treatment to avoid toxicity, in favour of using drugs for as long as they were tolerated, the doctors said.
"There are no survival or quality-of-life data to support this increase in treatment duration, which adds enormous costs if this design becomes the 'evidence base'," they wrote.
Australia also relied too heavily on the interpretation of clinical studies and their incorporation into guidelines by foreign clinical organisations, particularly those in the United States, which were heavily influenced by drug companies and special interest groups.
"Questions inevitably arise when pharmaceutical companies and medical-device companies with a financial stake in the outcome provide substantial funding for their development and implementation, or when members of guideline committees also have substantial financial associations with industry," they said.
Professor Olver and Dr Haines said Australia needed a comprehensive system to evaluate the outcomes of treatments, particularly after they were approved by the Therapeutic Goods Administration and listed on the Pharmaceutical Benefits Scheme.
"These approvals are often based on data from very carefully selected subgroups of patients in studies that are often designed, funded and interpreted and written by the pharmaceutical company seeking the PBS listing," they said.
The doctors said high-quality data would help patients and their doctors achieve the appropriate balance between efficacy and toxicity of treatments.