interviews

Working collectively to improve cancer outcomes for patients

Last year, the cancer vanguard established the Pharma Challenge. Rob Duncombe, pharmacy director at the Christie NHS FT, gives NHE an update on the work and early outcomes.

In October 2015, the national cancer vanguard – led by the Christie NHS FT, the Royal Marsden NHS FT and University College London Hospitals NHS FT (UCLH) – was established with the ambition to help transform cancer care and create scalable and replicable options for NHS organisations across the country. 

Its work, which also includes contributing to the delivery of outcomes from the National Cancer Strategy, focuses on early diagnosis and prevention; speeding up treatment pathways; commissioning; patient experience; and end-of-life care. 

Another important area the vanguard is concentrating on is medicines optimisation. To drive forward this agenda, it launched the Pharma Challenge – where pharmaceutical companies were invited to submit proposals to improve the availability and delivery of cancer drugs. 

Annually the three hospital trusts leading the cancer vanguard spend in excess of £120m on cancer medicines, and year-on-year expenditure is increasing by about 8%, said Rob Duncombe, director of pharmacy at the Christie and chair of the vanguard’s joint medicines optimisation group. 

He added that medication is the biggest intervention health professionals make post-cancer diagnosis, “so it seemed like a very vanguard area to explore”. 

Following discussions with the pharma industry, the vanguard identified that there was an appetite and opportunity to work more closely around optimising the use of medicines and testing a number of different ways of managing them. 

“We launched the Pharma Challenge last year, and by the middle of June we had 39 submissions – from more than 20 companies – come back from the industry about using medicines,” said Duncombe. “We then whittled that down to six projects. A lot of our criteria for determining which schemes we went with were based on how closely they met the Royal Pharmaceutical Society’s medicines optimisation evidence base.” 

Project progress 

Since then the vanguard has progressed a number of projects. UCLH Cancer Collaborative, for example, has partnered with Amgen to map out the most efficient out-of-hospital administration of denosumab, a therapy used for the treatment of secondary breast cancer in the bone. 

Duncombe added that the work, which is nearly complete, has developed an options appraisal document and user guide toolkit for all NHS trusts and CCGs to adopt the model. 

“We have also done a piece of work with Sandoz on improving biosimilars uptake through an education programme, which, again, was testing some boundaries,” he said. “What we wanted was an outcome which supported the introduction of biosimilars in cancer, but wasn’t company-sponsored.” 

The project has led to a process timeline for adoption being developed with accompanying guidance, resources and template documents to support the NHS to enhance biosimilar uptake. 

“The amount of data they have pulled together couldn’t be better,” Duncombe added. “It will, hopefully, become a prime source of material in how you introduce biosimilars in cancer. 

“That, to me, is a fabulous piece of work. It was probably a piece of work the NHS might have struggled to do without the input of the vanguard and Sandoz. It was something that needed to be done, but where do you find the resource to make that happen in a short space of time? It demonstrated what you can achieve by working with pharma colleagues, if everybody goes into it with an understanding of what the outcome is.” 

Two slightly more complex projects include Celgene, in partnership with the vanguard, looking to develop an ‘Interactive Medicines Optimisation and Compliance Dashboard and Evaluation Framework’ using the Systemic Anti-Cancer Therapy dataset; and QuintilesIMS, in conjunction with Merck and uMotif, analysing medicine usage data and quantifying the costs associated with unwarranted variation. 

The latter project is looking at ways of using NHS resources more efficiently within the secondary care setting, improving quality, reducing unwarranted variation in the delivery of care and establishing a more accurate understanding of the patient experience during their treatment. 

“We want to know,” said Duncombe, “is it possible to take all the data sources we have available to us and develop a far more detailed picture of a patient’s journey? 

“We cannot be releasing patient-identifiable data outside the NHS, but equally we want to be able to get the maximum out of all the data we collect. In the NHS, in England, we probably collect more data about patients than any other patient system I know of.” 

He added that the QuintilesIMS work, which is looking at possible variations at the Christie, Royal Marsden and UCLH, will help fuel a discussion the vanguard can have with clinical teams. 

“If there are some of points of variation, let’s now use it as a focus for discussion on how that variation has come about,” said Duncombe. “What does it mean for the overall cost of treatment? If we identify variations in pathways, but the outcome is the same irrelevant of where patients are treated, but the cost is different, then there is an interesting discussion to be had.

“If you can get the same outcome for less money, the experience of the patient is the same, the experience of the clinician is the same, and the outcome is the same; let’s have a discussion to see what, potentially, we need to change to get the same for less.” 

The beauty of the vanguard is that it is bringing people together, noted Duncombe, who added that the Association of the British Pharmaceutical Industry’s code of ethics has been strictly adhered to by all companies involved with the Pharma Challenge. 

“The relationships are done at a very high-level, and we all go into this with our eyes open,” he stated. “It isn’t about using more of a particular drug, it is about working jointly together to get better outcomes for patients.” 

While it is early days, Duncombe added that the whole idea of the vanguard is about knowledge sharing, and it is already providing information to the newly-formed cancer alliances. “We want to be a useful resource for others,” he said, revealing that a possible Pharma Challenge 2 could be in the pipeline for the future.

FOR MORE INFORMATION

W: www.cancervanguard.nhs.uk/pharma-challenge

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