Intended for healthcare professionals


Survival is worse in renal cancer patients who were denied new drugs, small study indicates

BMJ 2009; 339 doi: (Published 09 September 2009) Cite this as: BMJ 2009;339:b3661
  1. Roger Dobson
  1. 1Abergavenny

    Patients with renal cancer who were denied access to two new drugs, sunitinib and sorafenib, because their NHS trusts would not fund their use had worse survival outcomes than patients who were allowed the drugs, even though they were all treated by the same clinical team, a small study has shown.

    The results showed that survival in patients who received the new drugs was better than in those who hadn’t applied for funding for the drugs, even though all had similar prognostic factors (hazard ratio 0.46 (95% confidence interval 0.21 to 1.01; P=0.05)) (Clinical Oncology doi:10.1016/j.clon.2009.06.007).

    “This audit has shown substantially improved survival in patients receiving treatment with the new targeted therapies for renal cancer compared with those denied NHS funding and unable to self-fund,” said the lead author, Nick James, professor of clinical oncology at the Institute for Cancer Studies, University of Birmingham.

    “Despite the advice from the health secretary that lack of NICE [National Institute for Health and Clinical Excellence] assessment should not prevent access, many primary care trusts view drugs such as these simply as heavy cost pressures and refuse to approve funding until forced to do so in order to limit costs, with no reference to clinical outcomes.”

    The authors looked at whether primary care trusts’ agreement or refusal to fund sorafenib or sunitinib, both tyrosine kinase inhibitors, affected outcomes among patients being treated at a tertiary referral centre for metastatic renal cell carcinoma.

    Both drugs were licensed for the treatment of advanced renal cell carcinoma in early 2006, but NICE has only recently completed its appraisal of them, although provisional guidance was issued earlier this year.

    “The drugs are still available to NHS patients to a variable degree determined by decisions made locally by their primary care trusts,” the authors wrote. “For most patients in our clinic, access to the drugs is essentially determined by their postcode at the time of the request for funding, rather than by clinical considerations. Patient access to treatment was thus by the infamous NHS postcode lottery.”

    Funding for sunitinib was approved for 37 patients and was rejected for 21; that for sorafenib was approved for eight patients and rejected for 13. Seven patients who were denied funding received one or other of these drugs by paying for them themselves.

    The authors say that fewer patients who received treatment with a drug for which funding was approved died during the study period: eight of 43 patients treated with sunitinib died, compared with 10 of the 15 who weren’t allowed this drug. For sorafenib, the corresponding numbers of deaths were three of nine patients who received it and eight of the 12 whose funding was rejected.

    The authors report that the clinical environment was the same for all patients, so this was unlikely to have been the cause of the differences in survival, and no significant differences were found between the treated and untreated patient groups in all factors looked at, including deprivation index.


    Cite this as: BMJ 2009;339:b3661

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