Does the Public Prefer Health Gain for Cancer Patients?
A Systematic Review of Public Views on Cancer and its
Published online: 29 April 2017
Ó The Author(s) 2017. This article is an open access publication
Background Policies such as the Cancer Drugs Fund in
England assumed a societal preference to fund cancer care
relative to other conditions, even if that resulted in lower
health gain for the population overall.
Objective The aim of this study was to investigate the
evidence for such a preference among the UK public.
Methods The MEDLINE, PubMed and Econlit electronic
databases were searched for studies relating to preferences
for prioritising cancer treatment, as well as studies relating
to preferences for the characteristics of cancer (severity of
disease, end-of-life). The searches were run in November
2015 and updated in March 2017. Empirical preference
studies, studies of public views, and studies in English
Results We identiﬁed 24 studies relating to cancer pref-
erences. Two directly addressed health trade-offs in the
UK—one showed a preference for health gain in cancer,
while the other found no such preference but provided
results consistent with population health maximisation.
Other studies mostly showed support for cancer but did not
require a direct health trade-off. Severity and end-of-life
searches identiﬁed 12 and 6 papers, respectively, which
were additional to existing reviews. There is consistent
evidence that people give priority to severe illness, while
results for end-of-life are mixed.
Conclusion We did not ﬁnd consistent support for a pref-
erence for health gains to cancer patients in the context of
health maximisation. The evidence base is small and the
results are highly sensitive to study design. There remains a
contradiction between these ﬁndings and the popular view
of cancer, and further work is required to determine the
features of cancer which contribute to that view.
Key Points for Decision Makers
Policies such as the Cancer Drugs Fund in England
assume there is a societal preference to fund cancer
care relative to other conditions.
This review ﬁnds that although the public
consistently sees cancer as ‘special’, in the small
number of studies that present respondents directly
with a health trade-off, the results do not consistently
support a preference for health gains in cancer.
There may be speciﬁc attributes of health gain within
the ‘cancer’ label that are highly valued by the public
and should be considered in decision making, in a
way that is not disease-speciﬁc.
Electronic supplementary material The online version of this
article (doi:10.1007/s40273-017-0511-7) contains supplementary
material, which is available to authorized users.
& Liz Morrell
Centre for the Advancement of Sustainable Medical
Innovation (CASMI), University of Oxford, Room 4403,
Level 4, John Radcliffe Hospital, Headley Way, Headington,
Oxford OX3 9DU, UK
Nufﬁeld Department of Population Health, Health Economics
Research Centre, University of Oxford, Oxford, UK
Oxford NIHR Biomedical Research Centre, University of
Oxford, Oxford, UK
Nufﬁeld Department of Primary Care Health Sciences,
Health Experiences Institute, University of Oxford, Oxford,
PharmacoEconomics (2017) 35:793–804