NEWLY-DEVELOPED immunotherapy drugs are becoming available for treating cancers.

They are truly expensive, some at $150,000 per treatment in the United States giving perhaps a few more months' life extension, but with severe side-effects reportedly quite common.

Official bodies like England's National Institute for Health and Care Excellence have the responsibility for assessing their relative value in terms of "quality-adjusted life years", with a maximum of £30,000 per year. The English cancer drugs fund follows these guidelines. As has been pointed out often, however, one set of treatments may be at the expense of others which can be more broadly effective in maintaining the health of larger population groups.

The dilemma is clear: NHS funding is going to remain tight for the long term, with conflicting demands for treatments, so the provision of costly drugs will increasingly be under scrutiny. It seems inevitable that quite a few sufferers - and not just from cancers - will lose out. It is time we heard from Holyrood what will be recommended, our NHS is under financial pressure too, so the past few years of ducking the issue must end.

On top of all this is the need to reinforce the primary care GP-based system, renew more ageing hospital facilities, and expand the provision of care in the community, all at the same time. Bland statements that spending on our NHS is constantly being increased year-on-year are cop-outs, detailed proposals should be presented for public consultation and review, with the financial restrictions clearly explained.

Joe Darby,

Glenburn, St Martins Mill, Cullicudden, Dingwall.

MANY readers will have loved ones with pancreatic cancer, and as one of Pancreatic Cancer UK's specialist nurses, I understand the devastating impact this brutal disease can have on families. One person is diagnosed every hour and all too often very suddenly, plunging family members straight into a caring role, while they are still trying to come to terms with this shocking news. They may feel confused, isolated, and be unsure where to turn.

To mark Carers Week (June 8-14), we are publishing a new, free booklet for carers and loved ones of people with pancreatic cancer. It explains what the disease is, how to manage symptoms and side effects, how to navigate the healthcare system, and includes details of support for carers too. For more information visit www.pancreaticcancer.org.uk

Dianne Dobson

Nurse Specialist, Pancreatic Cancer UK,

Camelford House,

89 Albert Embankment , London.