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Number of patients eligible for fast track access to drugs through the cancer drugs fund is slashed

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2197 (Published 08 April 2013) Cite this as: BMJ 2013;346:f2197

Re: Number of patients eligible for fast track access to drugs through the cancer drugs fund is slashed

Dear Editor,
I am writing in response to the article written by Ingrid Torjesen on 13 April in which she discussed the new national arrangements for the Cancer Drug Fund.

From 1 April, NHS England took on responsibility for the operational management of the Cancer Drugs Fund, creating for the first time a single national system for deciding which drugs are available and for which conditions.

As a result of the changes which have been made, not only will we have a system of access which is fairer for all patients throughout the country, but more patients will have greater access to life prolonging cancer drugs, whether they get them through routine commissioning, through the Cancer Drug Fund or through an individual funding request.

The single national list of approved fast track drugs and the cancers they can be used to treat was formed by consensus between the clinical leads for the ten regional Cancer Drug Funds. All 167 different indications present in one or more of the regional Cancer Drug Funds were considered, 75 of which were incorporated into the national list which contains 28 drugs which will treat approximately 70 different cancer conditions.*

Of the drug indications which have not been included in the national list, 55 are now available to patients through routine commissioning. This will make it even easier for patients and clinicians to access them, whilst freeing up capital in the Cancer Drug Fund to fund new fast track applications in the future. Three entirely new cohort policies have since been added to the national list.

The regional Cancer Drug Fund leads came to a consensual decision to not include 27 conditions (indications) in the national list, and the reasons for this are thus:

- 6 drug indications were of such rarity that the Individual Funding Request route was considered the most appropriate for gaining access for treatment
- 12 drug indications had been superseded by more efficacious treatment or less toxic therapy and thus clinical practice had changed to make these cohort policies redundant.
- 5 drug indications existed in which the majority of CDFs had actively assessed efficacy but not approved for reasons of poor evidence of benefit or awaiting the results of further clinical trials.
- 2 drug indications were in which the clinical efficacy data were too immature.
- 1 indication was considered to prejudice the recruitment to a national clinical trial.
- and 1 indication was for a drug that has had recent safety concerns expressed.

Of the remaining 10 indications not considered appropriate to include in the national Cancer Drug Fund list, 5 indications were for a drug which has had its license withdrawn, 1 did not have a license, 1 was for a drug for which the manufacturer had not submitted evidence to a NICE technology appraisal and was thus removed from consideration under the Standard Operating Procedures for the CDF and 3 were for a device (not a drug).

The end result of this rationalisation of the regional CDFs into the national CDF together with transfer of activity into routine commissioning has been to increase the access of cancer drugs across England, not decrease it. Doctors are still able to apply for any cancer drug through the Cancer Drug Fund on behalf of their patients either by a request for a fast track cohort policy or by an Individual Funding Request.
Any patient who is already receiving funding for a cancer drug, or has received confirmation that they will receive funding as part an agreed treatment plan, will continue to receive treatment, despite any changes made to the national list, as long as they and their clinicians consider it clinically appropriate. Any changes to the treatment plan for individual patients will be made as part of the regular clinical reviews of care and this will include any drugs that were prescribed on a time limited basis.
Regards
Professor Peter Clark,
Chair of the National Cancer Drug Fund
* When clinical leads for the ten regional Cancer Drug Funds were selecting the indications which would be included in the national list the wording of some indications were so similar it was deemed that they should be merged into one indication. Therefore the numbers in the paragraph above do not appear to add up.

Competing interests: No competing interests

18 April 2013
Professor Peter Clark
Chair of the National Cancer Drug Fund
NHS England
Quarry House, Quarry Hill Leeds, LS2 7UE