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We welcome the appointment of a ‘cancer tsar’ to improve the
treatment of patients with cancer in the NHS [1]. However, further
resources and greater transparency in their allocation will be necessary
to improve survival rates in the UK relative to comparable European
neighbours [2].
We have previously reported our efforts in evidence-based
commissioning of cancer services for 1997-98 [3]. Since then we have
repeated the exercise in the 1998-99 and 99-2000 contracting rounds.
However, most available growth monies have been absorbed by significant
increases in activity and pay awards. There has been little money left
for new expensive cancer drugs despite strong evidence of cost-
effectiveness and the increasing willingness of clinicians to set
priorities between cancer treatments. One is left with the feeling that a
randomised controlled trial of evidence based medicine versus shroud
waving (as standard practice) is urgently required.
This process of evidence based commissioning was relatively resource
intensive. Unless there is some perceived benefit for clinicians and
commissioners of care, it will wither on the vine. We do not expect all
cost-effective new treatments will automatically be funded. However,
there should be scope for the evidence to have a greater impact on the
system, and for the emerging National Centre for Clinical Excellence to be
able to say ‘yes’ as well as ‘no’ to costly therapies.
Yours sincerely
June So
Chief Pharmacist
J Howard Scarffe
Professor of medical oncology
Christie Hospital NHS Trust
Manchester M20 4BX
Elizabeth Rous
Consultant in public health medicine
Manchester Health Authority
Gateway House
Piccadilly
Manchester M60 7LP
Robbie Foy
Clinical research fellow
Scottish Programme for Clinical Effectiveness in Reproductive Health,
Department of Obstetrics and Gynaecology,
University of Edinburgh,
37 Chalmers Street,
Edinburgh EH3 9AW
References
1. NHS to have cancer tsar. BMJ 1999; 319:1152.
2. Sikora K. Cancer survival in Britain. BMJ 1999;319:461-2.
3. Foy, R, So J, Rous E, Scarffe H. Commissioner and specialist
perspectives of prioritising new cancer drugs: impact of the evidence
threshold. BMJ 1999; 318:456-9.
Lack of funding will inhibit evidence-based commissioning of cancer treatments
Sir,
We welcome the appointment of a ‘cancer tsar’ to improve the
treatment of patients with cancer in the NHS [1]. However, further
resources and greater transparency in their allocation will be necessary
to improve survival rates in the UK relative to comparable European
neighbours [2].
We have previously reported our efforts in evidence-based
commissioning of cancer services for 1997-98 [3]. Since then we have
repeated the exercise in the 1998-99 and 99-2000 contracting rounds.
However, most available growth monies have been absorbed by significant
increases in activity and pay awards. There has been little money left
for new expensive cancer drugs despite strong evidence of cost-
effectiveness and the increasing willingness of clinicians to set
priorities between cancer treatments. One is left with the feeling that a
randomised controlled trial of evidence based medicine versus shroud
waving (as standard practice) is urgently required.
This process of evidence based commissioning was relatively resource
intensive. Unless there is some perceived benefit for clinicians and
commissioners of care, it will wither on the vine. We do not expect all
cost-effective new treatments will automatically be funded. However,
there should be scope for the evidence to have a greater impact on the
system, and for the emerging National Centre for Clinical Excellence to be
able to say ‘yes’ as well as ‘no’ to costly therapies.
Yours sincerely
June So
Chief Pharmacist
J Howard Scarffe
Professor of medical oncology
Christie Hospital NHS Trust
Manchester M20 4BX
Elizabeth Rous
Consultant in public health medicine
Manchester Health Authority
Gateway House
Piccadilly
Manchester M60 7LP
Robbie Foy
Clinical research fellow
Scottish Programme for Clinical Effectiveness in Reproductive Health,
Department of Obstetrics and Gynaecology,
University of Edinburgh,
37 Chalmers Street,
Edinburgh EH3 9AW
References
1. NHS to have cancer tsar. BMJ 1999; 319:1152.
2. Sikora K. Cancer survival in Britain. BMJ 1999;319:461-2.
3. Foy, R, So J, Rous E, Scarffe H. Commissioner and specialist
perspectives of prioritising new cancer drugs: impact of the evidence
threshold. BMJ 1999; 318:456-9.
Competing interests: No competing interests