Article taken from The Times

Have copied part over, for the rest check the link.

Tony

Cancer Drugs or Surgery


CANCER DRUGS OR SURGERY? THERE REALLY IS NO CONTEST

Why are we so obsessed with new cancer drugs? Surgery is the real and unacknowledged hero in the battle against cancer, according to an increasing number of experts, including the Health Minister Lord Darzi. They point out that only 10 per cent of cancers are cured by drugs, while surgery cures half.

Currently, the £700 million spent annually by the NHS on cancer drugs dwarfs the amount spent on surgery. Yet innovative techniques such as robotic surgery not only improve survival and quality of life for people with cancer but give more bang to the NHS buck than expensive drugs.

“Local therapies such as surgery and radiotherapy cure ten times as many people as chemical means,” says Professor Gordon McVie, a senior consultant at the European Institute of Oncology in Milan and former director of the Cancer Research Campaign. “Medical oncologists get all the money spent on them, but the surgeons are the unsung heroes. Surgery is more cost-effective and, if done well, it has a significant effect on improved quality of life.”

In the past decade there have been vast improvements in surgery. Increasing expertise in cancer surgeons, the development of keyhole (laparascopic) surgery and, perhaps most spectacularly, the rise of the robot have meant that cancers can be removed far more cleanly, with less trauma, than ever before. There's evidence that this is having an impact not just on how long people are living but, arguably more importantly, on the quality of the rest of their life.

Better surgical techniques

In prostate cancer, for example, the pinpoint accuracy of the Da Vinci robot (see left) in removing the prostate gland without damaging surrounding veins, nerves and tissue means that patients are free to get on with their lives within days and are considerably less likely to suffer the disabling side-effects that often accompanied traditional surgery, such as incontinence and impotence. The success of this, and other new keyhole surgery techniques, has contributed to a 335 per cent rise in prostate cancer surgery rates in the past ten years. Recent trials have also indicated the efficacy of Da Vinci at performing radical hysterectomies for gynaecological cancers.

In bladder cancer there has been a drop in mortality rates of about 10 per cent in the past 15 years, partly as a result of more advanced surgical techniques being used to remove lymph nodes that may carry cancer cells.

And the fact that more surgeons are choosing to specialise in operating on particular types of cancer has also had a wide effect on cancer mortality and complication rates. The number of patients dying in hospital after removal of oesophageal cancer halved between 1997 and 2005, largely because the surgery was increasingly performed by specialists rather than generalists, according to the Department of Health.

Yet the money allocated to advancing surgical practice can pale into insignificance compared with new cancer drugs. The NHS spent about £100 million on the breast cancer drug Herceptin in 2006, but some estimates say that only about 500 patients actually benefited. That kind of money could train hundreds of surgeons to specialise in the latest techniques, or transform research into new surgical techniques each benefiting thousands of people. One Da Vinci machine costs £1 million to buy and maintain over five years, helping hundreds of cancer patients in that time.

“The thing that is improving cancer cure rates is specialised surgeons focusing on particular operations, doing them more often and getting better at them,” says David Neal, the Cancer Research UK Professor of Surgical Oncology at Addenbrookes Hospital, which houses one of the six Da Vinci robots in the UK. “But until five years ago there weren't the surgeons here trained to do prostate removal properly. Surgery needs an investment of time for training in the latest techniques. I get fed up with the current emphasis on cancer drugs. It gets forgotten that surgery is the single most effective treatment for cancer. The NHS has fallen behind on equipment. In the US, 65 per cent of radical prostatectomies are done using a robot. In Europe it's one in three. But here it's just 1 or 2 per cent.”

Drugs have a limited impact

Professor Neal has high-level support. Cancer experts such as Professor McVie and Karol Sikora, a professor of cancer medicine and honorary consultant oncologist at Hammersmith Hospital, in West London, point out that the days of discovering block- buster drugs helping millions of people are gone, and drug development is becoming increasingly focused on specialist drugs that will help ever-smaller groups of people.

There are signs that the contribution of surgery to curing cancer may finally be acknowledged. Lord Darzi,

the consultant surgeon at St Mary's Hospital, London, who introduced the Da Vinci robot to the UK, is a Health Minister. His input is clear in the Government's new

Cancer Plan, with proposals to establish a new programme to train more surgeons in laparascopic surgery. The Department of Health has promised a £250 million investment in “capital equipment” for cancer over the next three years, but how much of that will be spent on surgery is as yet unclear.

As both a minister and a director of the new Hamlyn Centre for robotic surgery research at Imperial College London, Lord Darzi has to tread a careful line. But he says he agrees that the amount invested in surgery is “minuscule”. He would like to see much more money going into research into the effectiveness of new surgical techniques, then the case for investing in robotic and laparascopic techniques would be unanswerable.

“People don't realise that their only chance of a cure from cancer is through an operation that removes it completely,” he says. “There has always been more emphasis on drugs because the pharmaceutical lobby is so strong. We've got to remember that in pharmaceuticals we have yet to find a magic bullet that has the potential to cure most cancers. But in surgery we already have that.”



Have your say

The skill of Professor David Neal was amazing.
But it would be interesting to have an article on the people who designed and developed the robot. They must surely deserve some mention.

Sorry but did I miss the point?
I would love it if research/drug treatment was advanced enough so that,
The left side of my face was not missing.
I could talk on the phone and be understood.
I could eat and drink properly without having to rely on a peg for back up.
Fluid did not pour down my nose when taking a drink.
'Lumpy food' did not reapear hours later.
I didn't drool cause I can't feel or control my bottom lip.
I could sing without sounding like a strangled toad.
I could snog the face off a hunk, or even kiss for that matter!
Plus, plus, plus.
Was the article a general observation?????
It certainly doesn't take in to consideration OUR situation(s) post op
SusieR

Hi Susie

Not much I can say to your posting except, I did not post the article to upset anyone.

The full article with the link was about a new robot that can operate and cause less damage than a surgeon

And yeah I agree with you the magic drug that cure all cancers would be fantasic.


Regards


Tony

i really wish that i had been given the option for surgery as i would have chose that rather than chemo and rt.a year after treatment finished i am still trying to recover from the effects of the rt.i had to go to the g.p today as i woke up this morning and my tongue would not fit in my mouth it was so swollen and sore,i have noticed that folk who had surgery can eat again which i still cannot do and i miss food so much that somedays i could just cry and i feel sorry for myself just wishing that i could be normal again.i know it takes time but how much time. love to all shirl xxx

Hi Shirl, I don't agree. Obviously I am no expert, although if I went on Mastermind Head and Neck cancer would be my chosen subject, as that seems to been my life for this past year! I don't know what stage your cancer was at but it seems to me that surgery is not offered if the cancer is too advanced, my husbands' was at stage IV. Chances are that if you had had surgery, you would have also had Chemo and R/t as well. Everyday on these pages there is someone suffering from the lasting debilitating effects of surgery and whilst my husband is certainly not the man he was, he is better than lots of others and has achieved success, although we have 4 weekly check up's, the last scan was clear. If he had had surgery, we were told there wasn't enough healthy tissue to rebuild his tongue, he would have had a laryngectomy, all his teeth taken out and his jaw saw through. So everyday, I thank our lucky stars he didn't have surgery

Hi Tony,
You didn't upset me at all!
I'd loved not to have had to have surgery though and live with the after effects. I don't think I'll ever see the day when a drug is introduced to cure cancer and do away with the disfigurement and change of lifestyle that many here have to go through. I'd just hate to see research funding for drugs stopped though, yeah perhaps a robot could do better than a surgeon but any form of invasive surgery is still going to leave a devastating disfigurement for many of us.
Don't take any notice of me ranting on, ha ha, I open my gob (what's left of it!) and all sorts of stuff comes out of it!!
SusieR x

How about this one then. If a drug was invented tomorrow which could cure cancer, average life expectancy would be extended by 30 years. Could the country afford to support the massive rise in the ageing population?

*lol thats harsh but true Ange!
Perhaps thats why people aren't given the drugs needed in early stage alzeimers to??!!
Surgery was never an option for me as the tumour site wasn't easily acessable.
Regardless of what treatment you have it's all brutal and it's all crap! & no one with H&N cancer will have th life they had before.

I had surgery but no chemo or r/t and I'm not having any "lasting debilitating effects." I was lucky, though, that my cancer was still encapsulated and hadn't spread from my tongue.

Neither type of treatment is exactly what I would call a walk in the park, but there are some advantages to both kinds. There are some who've had chemo and rt and feel absolutely sick as a dog but have the benefit of being intact and unscathed by a surgeon's knife. Then there are those who've had surgery and who are--for now--cancer free. Sure, if their cancer recurs, they still have those weapons available in their fight against cancer, but who wants to go around with that oh-so-cheery thought.

Would I rather have the tongue I was born with (i. e., not two-tone and half of it covered with hair), and no scars on my arm (the source of my flap) or neck (trach, modified neck dissection)? Sure, but if that meant I'd run the risk of future health problems as the result of chemo and r/t (these are not friendly substances, after all), I'd have to say no thanks. For me, though, it was a moot point because the stage and location of my tumor made surgery the best option.

Hi Julia,
When did you have your operation? Was it a total glossectomy? I had that myself about 6 weeks ago and now I can only speak with 60% accuracy. Food is tasteless and eating is a really slow process. Are you able to speak and be understood?

Fortunately, like you, I don't have to go for rt and chemo. For that, im thankful.

Hi Sharifah

Like Julia I had a partial glossectomy and no need for rt or chemo. I lost about a third of my tongue, but I have been really lucky in that my speech and eating are hardly affected at all. My operation was last October.

I'd like to welcome you to the site - I hope you will find it as helpful, caring and supportive as I have done.

Love

Gwyn
xxx

Hello Gwyn,
Unfortunately, I am not as lucky for having a total glossectomy. Hwever, I am slowly enjoying my food and getting used to my situation. I find that that although my speech is slurred, I manage to be understood most of the time even over the phone. Where are u from Gwyn?

Luv,
Sharifah from Malaysia

Hi Sharifah

I had my surgery on February 4, 2005. It was a hemiglossectomy, left side of tongue from tip to first molar. I didn't talk at all for the first couple of weeks because I was afraid that I'd break the sutures. When I started talking again, I was the only one who thought I sounded odd. Did the docs make a flap for you? Mine was made from a piece of my right forearm. Eating was difficult once the ng tube was removed, but I've successfully been back on solids for quite a while.

I speak pretty well; people who've just met me don't usually guess what I've had, and people who've known me for years can't tell. I didn't need speech therapy.

Hi Julia,
I am very hppy for you. Yeah, the docs made a flap which was taken from the side of my right breast. This caused my right arm to be quite weak and a bit stiff.

Many people are kind of surprise that I can talk at all. Right now, I can manage semi solids only.

bye.
Sharifah