“What lies behind us and what lies before us are tiny matters compared to what lies within us.”

(Ralph Waldo Emerson)

The decision that the Avastin drug is too expensive to be prescribed on the NHS for bowel cancer patients has obvious relevance for me. Luckily, it isn’t an issue for me now, at least for the immediate future. But the media coverage reminds me how it might have been.

There are around 38,600 bowel cancer patients diagnosed in the UK every year. Avastin is estimated as suitable for around 6,500 of them. They’re the ones who require treatment for “metastatic colorectal cancer” which is a bowel cancer that has spread to other parts of the body. It’s what I had.

The crucial difference between people like me and people who need Avastin is that for me the cancer was operable – they could “just” cut it out. Remember back in the blog when I was celebrating the fact that my liver tumour was like a segment of an orange stuck on the side of my liver – that was why.

For the others, this drug either (a) reduces the symptoms so that it can become operable; or (b) increases the time to death from 19 months to either 22 or 27 months, depending on who you read. The quality of life is also vastly improved – the terminal stage in bowel cancer is often associated with massive fluid retention or extreme jaundicing due to liver failure. You not only die, but you spend your last months in and out of hospital.

But it costs nearly £21,000 per patient for the treatment. If the stats showed that the majority outcome was (a), it would be a no-brainer to justify. But it isn’t the case necessarily.

A truly horrible thought for me is this: would I spend £21,000 of my family’s money for an extra 3 or 6 or 9 months of life? Or would I prefer it to be there for paying the mortgage, etc. I read in the papers that it is “immoral” not to spend the money on people who want the drug on the NHS. I wonder if it is “moral” to spend it on yourself when it buys so little in the big scheme of things. I’m like anyone else – if someone gave me £21K worth of anything for free and it had a benefit I would not say no, but the moral challenge isn’t relevant if it is someone else’s money.

At this moment, perhaps smug in the luxury of my lucky outcome, I would not spend the money.

But let me put my luck into perspective. I was diagnosed as T4N2M1 which is top of the charts. The stats for people in this group who live for at least 5 years is a miserable 5%. If bowel cancer is going to come back, it will usually do so within two years of surgery. As of today I have only got as far as one year cancer-free. If my cancer doesn’t come back within five years, I am probably cured.

So, it could be a dilemma I will face again someday. Over my dead body, as they say 🙂

David Bowie – Five Years