Thousands of terminal cancer patients will soon no longer have access to a number of potentially life-extending drugs after recent cuts to the Cancer Drugs Fund.
The Cancer Drugs Fund
The Cancer Drugs Fund, or CDF, is a specific resource set up by the Government to pay for cancer drugs that have not been approved by NICE and are, therefore, not available on the NHS. Since it was established in 2010 it has provided £200m each year, enabling patients to access drugs they would not otherwise have had access to. Before it was set up, many patients had to pay for these drugs themselves if a particular drug was not routinely available on the NHS; or, if they lacked the funds, could end up missing out on treatment that could potentially prolong their lives.
While far from perfect, the fund has certainly been a positive measure for many cancer patients.
Approval may not have been given by NICE for many reasons, including prohibitive cost or lack of data on outcomes for newly developed drugs, or those for particularly rare forms of cancer. For many, access to these drugs is impossible without the CDF.
Funding new treatment
However, in the last year the fund has vastly exceeded its budget, reportedly by as much as 50%, and is now said to be unsustainable. A recent report by the National Audit Office stated that the system would have to change, as the NHS simply could not afford to pay for all the drugs available to patients. The NHS recently announced that the CDF will no longer pay for 16 medicines used in 23 different cancer treatments, including drugs used for breast, pancreatic and blood cancers.
This is not the first time cuts have been made. It has been widely reported that, at the start of 2015, there were 84 funded therapies, but after a number of cuts there are now only 41 available. While the drugs approved by the fund have always been kept under review, and changes made depending on clinical results and new drugs becoming available, the cuts now being made are much more severe and far-reaching.
What next for cancer care?
The drugs will be formally removed from the list of approved treatments on 4 November 2015, and will not affect patients currently receiving them. However, this will nonetheless be a blow to many newly, seriously ill patients who will not be able to access these treatments.
Professor Peter Clark, chair of the CDF, recently said
'We must ensure that we invest in those treatments that offer the most benefit, based on rigorous evidence-based clinical analysis and an assessment of the cost of those treatments.'
This highlights the huge part that cost plays in the decision as to whether a drug will be available through the CDF. This should be a concern for everyone, especially when it is expected that, by 2020, the proportion of people who will be affected by cancer at some point in their lifetime is expected to be 1 in 2. Cancer charities have expressed their distress at the news of the cuts, with the chief executive of Breast Cancer Now saying that it was 'a dreadful day for breast cancer patients', and the Rarer Cancer Foundation describing the cuts as a 'hammer-blow' to patients with rare cancers.
Among the drugs being removed are Kadcyla, used to treat breast cancer, and Avastin, for cervical, breast and bowel cancers, both made by Roche. Roche's chief executive, Severin Schwan, has publically criticised both the decision and the way in which the value of certain drugs is assessed. He also suggested that there would be a ripple effect on research, saying that, if drugs such as Avastin were not made available, then Roche would be unable to conduct clinical trials in England.
Trials often give patients a lifeline and an opportunity to try different drugs when other treatments have not been effective.
Cancer care in the NHS
The NHS is already under scrutiny in this area, as cancer survival rates in the UK are still lagging behind many other European countries. While there have been improvements in survival rates in the UK, studies have shown that, for five of the most commonly occurring cancers, the UK is at least 10 years behind many comparable European countries.
With a limited budget, it is acknowledged that tough choices have to be made by the NHS.
Denying a patient access to a drug that may prolong his or her life is may not in itself be negligent – where a decision to withhold treatment is made at a policy level, that decision can be difficult to challenge. However, the NHS will need to ensure that any further cost-cutting proposals do not put patient safety at risk, or lead to delays in diagnosing cancers that could have been treatable had they been detected earlier.