Many of the new generation of cancer drugs are designed to target specific genetic mutations in a patient’s cancer – these are often known as ‘targeted’ medicines.
Several are already available on the NHS; more are on the way. These targeted medicines hold great promise in treating cancer in a more personalised way in the future, but they’re not without limitations – in 2012 we blogged about the challenges the NHS is facing as this new type of cancer treatment becomes more widely available.
Unfortunately, there is still variation around the NHS in the availability of the tests used to determine if a patient would benefit from a targeted medicine or not – known as ‘molecular’ diagnostic tests.
This is despite clear commitments in the Government’s 2011 cancer strategy to make these tests available.
We think it is vital that the NHS is set up to ensure that patients can be tested – and receive these drugs if they need them – no matter where they live.
What is a ‘molecular’ diagnostic test?
As we outlined above, molecular diagnostics test a patient’s cancer for particular genetic mutations. This can then help doctors work out the best course of treatment for that patient – be that a certain type of chemotherapy, or a targeted drug if available for the type of genetic mutation – giving the patient the best possible chance of a good outcome.
As well as helping patients get the best, evidence-based drugs for their condition, these tests can mean patients can avoid side effects from the drugs that will probably not work for them.
Molecular diagnostic testing can also:
- save NHS money by avoiding prescribing drugs that won’t work for certain patients;
- future-proof the NHS by supporting uptake of new, personalised treatments;
- help the NHS become a world-leader in stratified medicine trials.
And on top of all this, the concept of targeted medicines is well-developed in cancer – but it can also apply to other diseases too.
What’s the current situation?
In 2011, the Government said in its Cancer Plan for England that it would “develop a commissioning and funding structure to enable the efficient delivery of high quality molecular diagnostic testing through centres of excellence.”
We are really disappointed to say that little progress has been made.
We’ve discovered that in England, there’s considerable variation across the country – both in the tests’ availability, and in how doctors can pay for them. As an example, in 2011 we surveyed labs that provide these types of test.
That survey showed that thousands of patients, including non-small cell lung cancer and colorectal cancer patients, were missing out on testing that could help them get the most appropriate treatment for their cancer.
Our evidence was used by the Department of Health when it consulted on the set up of a national service. We responded, but as far as we are aware no action was taken after this, although we acknowledge that this came at a difficult time when the NHS reforms were taking place.
As a comparison, Scotland has a national service established to provide these tests for all cancer patients that need them. And patients in Northern Ireland are pretty well covered by its major cancer centre in Belfast.
But Wales, like England, doesn’t have a nationally coordinated service.
We know from our survey, and from talking to people in labs, that a national service would help improve things for patients. But there needs to be comprehensive data from all countries to better understand the extent of variation in access to tests.
But it’s not just about access. Because there isn’t a policy for a national service, it means that there is variation in how labs across England pay for these tests, with some labs absorbing the costs and others using income from other services. In some circumstances pharmaceutical companies pay for tests.
This is obviously not an ideal situation. And all this means that some patients are not getting tested and are not getting the drugs that could help them.
What needs to be done about it?
The NHS recently launched its vision for the next five years, and personalised care is a major theme, as is tackling variations in access to treatments.
As we set out in our Cross Cancer Out campaign, we want the Government and NHS England to do what they promised back in 2011 and establish a nationally coordinated service. This is vital to ensure consistency across England in terms of access and quality. NHS Wales should also look into this and develop a system appropriate for Welsh patients.
We firmly believe that a molecular diagnostic service would help patients get the treatment they need, and help to bring forward the era of truly personalised medicine.
And while cancer may pave the way, this will benefit patients with other diseases in the future.
Emlyn Samuel is a senior policy manager at Cancer Research UK