Controversial radiotherapy on offer to patients again

Under policies which came into force in April, NHS England stopped routinely paying for selective internal radiotherapy, a treatment for cancerous tumours of the liver, arguing there was not enough evidence of its effectiveness.

However, the treatment has now become the first to be offered under NHS England’s new commissioning by evaluation policy. This means 10 centres will be permitted to offer it as part of a £4.8m formal evaluation programme which will gather evidence on its effectiveness. This will allow NHS England to make a decision on whether to commission it in future.

Ricky Sharma, consultant oncologist at Oxford University Hospitals Trust, one of the 10 centres, said his patients had been waiting “several difficult months for this news”.

“The list of centres means that we can offer SIRT to a large number of eligible patients,” he said. “Some of these patients have no other treatment options available. This represents a significant advance for the NHS in England.”

Currently the treatment is only available to patients where all other routine approaches, such as surgery and chemotherapy, have been unsuccessful. Nationally about 220 patients are expected to be treated in the first year. NHS England has agreed to fund the programme for between one and three years.

Adrian Crellin, chair of the national commissioning body’s SIRT commissioning through evaluation steering group, said: “NHS England is committed to expanding access to all forms of specialist radiotherapy, and we await the outcome of this innovative commissioning programme with some anticipation, as is it will help us determine how best to deliver these important, and life-saving, services to patients in the future.”

NHS England is planning to adopt the commissioning by evaluation approach for five other treatments, including some interventional cardiology procedures. NHS England banned routine funding of the treatments when it took over responsibility for commissioning specialised services in April on the grounds there was insufficient evidence of their effectiveness.

The commissioning by evaluation approach was proposed by the British Cardiovascular Society to address the shortfall in evidence. NHS England says the approach provides an opportunity to access a treatment with “significant promise” for improved quality of life or life expectancy but that is not accessible through a formal research trial.

A spokeswoman could not confirm when evaluation programmes would be up and running for the other treatments.