Cancer Commissioning—at a global and a local level: London Cancer New Drugs Group Annual Meeting

Introduction

Uncertainty and confusion surrounding the introduction of schemes designed to improve patients’ access to new cancer drugs dominated proceedings at the 2009 London Cancer New Drugs Group (LCNDG) annual meeting, which was attended by more than 150 healthcare professionals and cancer service commissioners.

Other contentious issues included the ambiguity of end-of-life criteria, with which many such schemes are associated, the dilemma of patients having to pay for treatment not sanctioned by the National Institute for Health and Clinical Excellence (NICE), and the growing disquiet over individual funding requests (IFRs).

Adrian Newland (LCNDG Chair and Professor of Haematology, Barts and The London NHS Trust) outlined the main objective of the meeting—to debate the effective commissioning of chemotherapy within the wider context of delivering cancer services in London and elsewhere in the UK. He reported that the total cost of cancer services in the UK is £4.35 billion out of a total NHS budget of about £100 billion. Of that £4.35 billion, only 18% is spent on cancer drugs.

Since 2001, spending in London on NICE-approved cancer drugs has risen from £10 million to £85 million—and although this increase has coincided with an increase in survival from cancer, the UK continues to lag behind the USA and most other European countries. “Despite meeting Government survival targets, we are still not doing as well as we could,” said Professor Newland.

In London itself, there continue to be glaring inequalities of access to cancer care—as judged by mortality rates for all malignancies. Quoting the former Under-Secretary of State for Health, Lord Darzi, Professor Newland said that moving from Chelsea & Westminster to Tower Hamlets, you lose a year of your life with every tube stop.

Meanwhile, the approval process adopted by NICE has inevitably delayed the introduction of new cancer drugs, resulting in an increase in exceptional treatment applications (ETAs). Professor Newland said that one of the main aims of the LCNDG has been to assist the prioritisation and more timely delivery of new cancer therapies across the capital. He commented: “We do not want unrestricted access to new drugs. Their introduction has to be safe and secure.”

Death rates from all cancers have fallen. NHS waiting time targets for access to consultants, diagnosis and initial treatment have been met. “However, inequalities in cancer care are still evident and we need to increase the uptake of both new and existing cancer drugs,” he concluded.

Delegates in the Shaw theatre

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