The difference NICE is making for cancer patients

Source: NHE March/April 2018

Professor Gillian Leng, deputy chief executive and director of health & social care at NICE, describes the efficiency work taking place as part of the organisation’s new cancer impact report.

Over the years, NICE has been involved in producing a range of resources to support professionals to make the best decision for people diagnosed with cancer. Understanding how our work has made a difference is important, which is why we’ve recently published our cancer impact report. The report aims to show how the work of NICE is helping to improve services for people with cancer.

One in two people will be diagnosed with cancer in their lifetime, and the disease is responsible for more than a quarter of all deaths in the UK. With cancer survival rates below the European average, both the NHS Five Year Forward View and the Cancer Taskforce strategy highlight the importance of improving cancer outcomes. Among other things, they identify late diagnosis and variation in access to treatments as key issues that need to be tackled if cancer survival rates are to improve. 

Over the years, NICE has been involved in developing a wide range of guidance and resources to help health and care professionals give patients and their families the best care possible. One of NICE’s first technology appraisals was of Taxanes for treating ovarian cancer. Published in May 2000, it represented a hugely significant move towards giving people access to new and innovative treatments across the NHS. Since then, NICE has produced over 230 evidence-based guidelines, quality standards and technology appraisals aimed at improving outcomes for the almost 300,000 people diagnosed with cancer each year.

Early referrals to a specialist are important because the sooner a diagnosis is made, the greater the chances of survival for a longer period of time. In June 2015, we published an updated guideline on suspected cancer: recognition and referral, which has had an important role in driving improvements. The guideline focused on symptoms patients might experience and prompt a visit to their GP. Our impact report showed that there’s a variation in services across England – in some places people are likely to be diagnosed with cancer at stage 1, whilst other areas cancers are detected at stage 2.

In its inequality impact assessment, the Cancer Taskforce also found that inequalities across different areas of the country existed, predominately within black, Asian and minority ethnic communities. Data from the Office for National Statistics in its ‘cancer survival by stage at diagnosis’ report highlighted the importance of identifying cancer early. It showed that people who have their cancer diagnosed at stage 1 are much more likely to survive for a year than those diagnosed at stage 4. The initial diagnosis for people suspected with cancer usually occurs in primary care, and the NICE guideline clearly identifies those symptoms which should trigger an urgent referral.

Since the launch of the guideline, the annual number of people being urgently referred to specialists has increased, with over 300,000 more urgent referrals in 2016-17 than in 2014-15. In fact, more people with cancer reported being referred to a specialist without having to visit their GP three or more times. The National Cancer Patient Experience Survey records the number of people who say that they saw their GP, and the recent survey showed that people only went to their GP once or twice about the health problem caused by their cancer before they needed to go to hospital. This has improved between 2014 and 2016, with an increase from 75% to 77%.

Access to medicine

NICE has a vital role to play in ensuring that all patients have access to the most clinically- and cost-effective treatments. Patterns of prescribing for cancer medicines used for treating prostate cancer and melanoma show that access to new medicines increases after a NICE recommendation. The NHS is legally obliged to fund and resource medicines and treatments recommended by NICE’s technology appraisal. Since April 2016, it has been agreed that all new cancer medicines and significant new licensed indications will be appraised by NICE.

 A good example of when we recommended drugs which really made a difference was the prescribing of cancer medicines for melanoma. Figures show that there were over 13,000 new cases of malignant melanoma in England, with over 3,000 deaths. Most cases of early stages of melanoma can be treated with surgery with high rates of survival, but for people with advanced melanoma treatment options are limited. Until 2012, the standard therapy for people with advanced melanoma was a chemotherapy medicine known as dacarbazine, but in the past few years, progress has been made with new and innovative medicines. In December 2012, NICE recommended two new medicines for people with melanoma, which was then followed by a rapid increase in prescribing rates.

 We’ve also been working with the UK Government and NHS England to review the Cancer Drugs Fund (CDF) in order to help patients gain access to cancer medicines not routinely available on the NHS. NICE now has the option of recommending medicines for use within the CDF, in cases where a medicine looks promising but there is not enough clinical evidence to show if it is cost-effective. These medicines of uncertain effectiveness are being made available through the CDF, with a managed access agreement between the company and NHS England. While these drugs are in the CDF, more evidence will be gathered to help resolve the key areas of clinical uncertainty.

 As a national body, NICE is working in many ways to support professionals to make a positive impact on improving access to cancer treatments. NICE will continue working to be innovative, looking for clinical and cost-effective treatments and medications as well as developing evidence-based guidance by putting patients at the heart of what we do.


(Top image © baranozdemir)



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