Analysis

Revamped Cancer Drugs Fund urged to monitor outcomes

A revamped Cancer Drugs Fund (CDF) is due to be launched in April, but the public accounts committee (PAC) has warned that NHS England must set out the fund’s objectives and be prepared to take tough decisions to ensure that it does not overspend in trying to meet them.

A revamped Cancer Drugs Fund (CDF) is due to be launched in April, but the public accounts committee (PAC) has warned that NHS England must set out the funds objectives and be prepared to take tough decisions to ensure that it does not overspend in trying to meet them.

The CDF was set up by the government in 2010 to improve patient access to cancer drugs not routinely available on the NHS. Initially run by the ten strategic health authorities, since April 2013 it has been managed by NHS England. Scotland has its own system, while Wales and Northern Ireland follow National Institute for Health and Care Excellence (NICE) guidance.

The fund has been mired in controversy with spiralling costs and an expected overspend of between 70 million and 90 million for 2015-16. The budget for the CDF was set initially at 200 million, but has been increased

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A revamped Cancer Drugs Fund (CDF) is due to be launched in April, but the public accounts committee (PAC) has warned that NHS England must set out the fund’s objectives and be prepared to take tough decisions to ensure that it does not overspend in trying to meet them.

The CDF was set up by the government in 2010 to improve patient access to cancer drugs not routinely available on the NHS. Initially run by the ten strategic health authorities, since April 2013 it has been managed by NHS England. Scotland has its own system, while Wales and Northern Ireland follow National Institute for Health and Care Excellence (NICE) guidance.

The fund has been mired in controversy with spiralling costs and an expected overspend of between £70 million and £90 million for 2015-16. The budget for the CDF was set initially at £200 million, but has been increased twice and was set at £340 million for 2015/16.

Reassessed

More than 80,000 patients have accessed treatment since the fund began, although a number of drugs have been reassessed and some axed from the CDF list causing concern among patients and charities.

When the CDF was set up it was meant to include funding for treatments not recommended by NICE and drugs not chosen for NICE appraisal, including those for rarer cancers. However, the PAC report reveals a large number of patients supported by the fund had more common types of cancer, such as breast, prostate or colorectal. Meanwhile, the Department of Health and NHS England do not have full data on outcomes for all patients who have used the fund, which the committee branded ‘unacceptable’.

Chair of the PAC and Labour MP Meg Hillier told Cancer Nursing Practice that, although the committee’s remit may be viewed as ‘penny pinching’, good management of initiatives such as the CDF can have significant benefits.

‘One of the real wins of the fund was being able to access drugs for rarer forms of cancer and it was unbelievable that the outcomes were not measured at the time to record the benefits,’ she says.

Uncertainty

A NHS England and NICE consultation about the structure of the new-look fund closed in February. It notes that some cancer drugs are not commissioned routinely due to uncertainty about their clinical benefit, and therefore their cost effectiveness, at the time they are licensed.

As part of proposals, NICE is due to appraise all new cancer drugs that are expected to receive market authorisation. The drugs will be given conditional recommendations so that the fund can use them for a predetermined period.

The drugs will then either receive a positive recommendation from NICE and move out of the CDF into routine commissioning; or they will receive a negative recommendation, leave the CDF and become available only after individual patient funding requests.

Partial solution

In its consultation response, the RCN states that the recommendations offer only a partial solution that may lead to confusion.

It claims nurses and other health professionals can be put under pressure from patients demanding treatment options that are not provided by the NHS or that may not be clinically effective.

The college is also concerned that initial decisions about a drug could be overturned causing ‘significant distress and confusion for patients and families’.

Decline in specialists

Since the inception of the CDF, the number of specialist cancer nurses has declined and the RCN has questioned whether the fund is an effective use of NHS resources.

Susanne Cruickshank, chair of the RCN cancer and breast care forum and reader in cancer nursing at Edinburgh Napier University, says: ‘It is unclear how the newly revamped CDF will function.

‘If it brings clarity to decision making about the use of cancer drugs then nurses will be helped in their conversations with patients and families. However, the risk is that it further confuses the situation.’

Association of the British Pharmaceutical Industry (ABPI) value and access director Paul Catchpole agrees that if drugs are reassessed and removed from the CDF, clinicians may have to have ‘difficult conversations’ with patients over why the drugs are no longer available.

Complicated picture

‘At the ABPI we say that more sustainable changes to the NICE appraisal process are needed so that we can change current access. It is a complicated picture and not just in terms of NICE.’

He suggests that, because each new cancer medicine takes about ten years to get to market, there should be enough time for NHS England to calculate how many drugs are likely to become available in any given year and plan accordingly.

Myeloma UK is a member of the Blood Cancers Alliance, a coalition of charities that last year signed a petition demanding the government review the decision to remove blood cancer drugs from the CDF. The petition was signed by 27,000 patients and their families.

Nurse Monica Morris who is a healthcare professional manager for Myeloma UK says: ‘With access to cancer drugs there is never a one-size-fits-all solution. For nurses to know there are drugs that may help their patients but that they cannot access is difficult.’

The charity offers nurses briefings on policy changes and Ms Morris urges nurses to keep up to date with changes to the CDF so they can try to understand what it may mean for patients.

An NHS England spokesperson says: ‘While we will still have difficult judgements to make, this is a big step forward in ensuring that NHS patients receive the most promising drugs at affordable prices as quickly as possible.’

 

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