The London Cancer New Drugs Group Meeting 2008

The London Cancer New Drugs Group

After welcoming delegates, Professor Adrian Newland opened the meeting with an introduction to the LCNDG, of which he is chair. He explained that the group exists to facilitate consistency of approach in London, by informing the managed entry of new drugs in cancer, and to promote the cost-effective and equitable provision of all medicines used in cancer management. The Cancer Reform Strategy acknowledges the LCNDG as an information source of particular relevance, which can help in making decisions about the use of new treatments where NICE guidance is not available. Recommendations developed by the group, based on clinical effectiveness, cost and likely service impact, are posted online at www.druginfozone.nhs.uk.

Professor Newland then went on to succinctly contextualise the rest of the day, by looking at the current state of play in commissioning for cancer. He noted that, since publication of the Cancer Plan (2000), spend on cancer drugs across England has almost doubled from £332 million to £560 million in 2003/04, but that there are still considerable inequalities in spend between PCTs. Furthermore, while expenditure has increased in line with funding, it remains only a small fraction of that spent nationally overall in health care (£9.9 billion in 2003/04) and well below the per capita average spent elsewhere in Europe (contributing to the explanation of the poor UK position in the European league table of overall cancer 5-year survival).

Indeed, cancer is not the dominant recipient of NHS funding—average per capita costs for the patient with cancer were £76 in 2004/05, versus £124 and £142, respectively, for cardiovascular disease and mental health. Finally, when one considers that funding for cancer pays for those drugs approved by NICE as well as those not approved and those never likely to be approved by NICE—including growth factors, anti-emetics, bisphosphonates, etc—Professor Newland’s comment that “it looks like a lot, but when you’re trying to spend it, it doesn’t seem like a lot” rings true.

With a whole raft of new molecular therapies, among others, working their way through the pharma pipeline, something needs to be done to push the cancer agenda, while bearing in mind the very real stresses that cardiovascular disease and mental health, as well as other health problems, place on the commissioning agenda.

The news was not all bad though. Inequalities in cancer services across regions and slow, or indeed, low, uptake of new and existing cancer drugs in the UK versus other European countries aside, great strides have been made in the care of patients with cancer since the Cancer Plan was published: death rates from all cancers have fallen; NHS waiting time targets for access to consultants, diagnosis and first treatment have been met; and the experience of treatment and care has significantly improved.

The question is, can the Cancer Reform Strategy and more effective commissioning strategies help to make the news ‘all good’ despite the growing numbers of patients living with and beyond cancer in our ageing population?

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