In the second of our series of posts looking at the Coalition government’s Improving Outcomes – A Strategy for Cancer, published in January, we take a more detailed look at what the strategy says about cancer drugs, chemotherapy and surgery (we’ll cover radiotherapy later in the series).
Cancer is the number one fear for the British public, and people understandably want to know that if their fear became reality they would have access to the best available treatment. As a result, stories about cases where this doesn’t happen often grab the health headlines.
Aiming to improve the situation, the Coalition’s strategy sets out ways to
- increase access to cancer drugs
- drive up access and quality of chemotherapy services
- make sure that people have access to the latest techniques in surgery
To do this, they plan to make more money available for cancer drugs and introduce a new pricing system; monitor data on access to and quality of chemotherapy in the NHS; and encourage surgeons to train in the latest surgical techniques.
Let’s look at some of these methods, and how they might work in practice.
Improving access to cancer drugs
Cancer drugs – and their availability on the NHS – probably generate more column inches than any other aspect of cancer treatment. The strategy document outlines two schemes – the Cancer Drugs Fund and Value Based Pricing – designed to improve the availability of new drugs, (although neither is technically a ‘new’ announcement). Both measures aim to make access to cancer drugs more straightforward.
As we blogged about last year the Government’s Cancer Drugs Fund set aside £50m to be spent between October 2010 and April 2011 (the “Interim” Cancer Drugs Fund) and a further £200m per year from April 2011 to April 2014. The fund aims to provide access to drugs which doctors recommend, but that would not otherwise be funded by the NHS. The Interim Cancer Drugs Fund is already up and running across England.
Value Based Pricing – which applies to all drugs – will be introduced from April 2014 and has three aims:
- Better access for patients to drugs
- More innovative drugs
- Better value for the NHS.
This all sounds very wise but we need to look at the detail to make sure that it works for cancer patients. The government have asked for views on the Value Based Pricing system and we’re working on our response to this consultation now.
Naturally, we’re in favour of moves to increase access to cancer drugs – but access must be fair. It’s vital that both of these measures result in all cancer patients getting equal access to drugs, to guard against widening the gap in access to treatment for cancer.
In response to their consultation on the Cancer Drugs Fund, we recently shared our views with the Department of Health. We made a few suggestions, including putting in place a national process for identifying drugs that should be routinely prescribed under the Fund. We also want a process to be put in place to scan the market for soon-to-be-launched drugs.
We think this will help ensure that, no matter where you live in England, those holding the drug fund purse strings have the most up-to-date information about potential treatments.
Chemotherapy – carrots and number-crunching
When it comes to chemotherapy, the new cancer strategy focuses on delivering safe, high-quality chemotherapy services. The plan is to use financial incentives (carrots rather than sticks) to improve quality and choice of chemotherapy services for patients, and reward improvements in patient experience. Another important aspect is improving the collection of data on chemotherapy use across the nation, which would then be used to improve variations in access and quality.
We agree that collecting data on chemotherapy is a really good idea and will be useful in monitoring the availability and quality of chemotherapy services. But it’s vital that there are no delays in publishing the data – we’ve already seen delays in the publication of similar data for radiotherapy.
There need to be clear incentives to make sure the data is collected and published by the deadline of April 2012.
Surgery – not just a number
The strategy’s focus here is on finding ways to encourage the use of the latest techniques, with hospitals being rewarded for training surgeons in the most up-to-date methods. This builds on the lessons learned from the success of LAPCO – a national training programme in laparoscopic (‘keyhole’) techniques for bowel cancer.
Keyhole surgery is less invasive and patients often recover quicker. LAPCO was set up by the Government’s National Cancer Action Team to ensure that all suitable patients have access to laparoscopic surgery, and as the strategy highlights, it has achieved that aim.
There is also a particular interest in increasing the number of older people being given surgery for cancer. Evidence suggests that older people are less likely to have their cancer operated on than younger people, which may be affecting on survival rates.
The Strategy aims to address this by ‘testing tools to help clinicians assess patients according to their biological rather than chronological age and offering tailored packages of support to older patients’.
In other words, decisions about operations would be based on a person’s general health and fitness, rather than their age alone, and would provide the necessary aftercare.
In our opinion, national surgical training programmes like LAPCO are to be welcomed, and we’re keen to keep the impetus going for these national schemes, where there is a need.
But we’re very concerned that older people are still missing out on cancer surgery, even when they are fit enough for it. Cancer can develop at any age, but is most common in older people – around three-quarters of cases occur in people aged 60 and over. As more of us live longer it is vital that the option of having surgery for cancer is based on physical fitness and not just on age.
It will be important to look at the impact of the proposed ‘tools’ in tackling this issue.
Keeping an eye
We’ll be monitoring the way the Government puts these plans into practice over the coming months. And we’ll shortly be looking at what the strategy says about radiotherapy in an upcoming post.
There’s more about our views on a number of policy issues affecting cancer services, visit the policy pages of our website.
Kate Aldersey is a policy researcher at Cancer Research UK