Dr Rob Glynne-Jones On NICE's credibility on cancer

Published: 29/07/2004, Volume II4, No. 5916 Page 25

The recent report by national cancer director Professor Mike Richards on variations in the use of cancer drugs approved by the National Institute for Clinical Excellence identified lack of capacity as one of the main stumbling blocks.

One way of addressing this is to use oral chemotherapy for colon cancer as emphasised by research presented at last month's meeting of the American Society of Clinical Oncology.

1Although the trial commented on an adjuvant study, it showed that giving patients oral capecitabine cut the number of outpatient appointments to a quarter against patients receiving intravenous treatment.

Colon cancer is the second most common malignancy among women in the UK and the third among men. Around 34,500 patients were diagnosed with colorectal cancer in the UK in 2001 and this will rise to 36,500 in 200.

The pressure on cancer services means that in many centres we are almost at the point of having a waiting list.While this is not good for patients waiting for knee replacements, it is unacceptable for patients with widespread cancer.

Using oral chemotherapy is an efficient way of freeing up scarce NHS resources. But despite NICE guidance in May 2003 stating that patients should be given the option of oral chemotherapy in first-line metastatic disease, recent reports suggest there are very wide variations nationally.

A survey in May this year by Colon Cancer Care found that while oral treatment is convenient for patients and frees up clinician and nurse time, it is only being offered to four out of 10 patients.

Professor Richard's report highlighted differences in clinical practice as one of the causes of national variations in drug use. But to identify the reasons we need accurate data, and his report does not take into account factors such as drugs provided free for trials. The introduction of electronic patient records should give a more accurate national prescribing picture - although we should not be looking for absolute conformity. There must always be a place for clinical decision making.

NICE has helped to reduce postcode prescribing. But we are often stuck with judgements made at least three years ago which do not incorporate recent research.

Even when these drugs are reviewed, the process follows the timescale of the original assessment, ie over one year. In the 21st century, this is too long. Our cancer network protocols and guidelines are updated every six months according to the latest evidence.Why can NICE not do this? It would become an internationally respected and effective body.

Reference

1 Cassidy J et al .Capecitabine (X) vs bolus 5-FU/Leucovorin (LV) as adjuvant therapy for colon cancer (the X-ACT study): positive efficacy results of a phase 111 trial. www. asco. org

Dr Rob Glynne-Jones is Macmillan lead consultant in gastrointestinal cancer at West Hertfordshire Hospitals trust and chief medical adviser at Colon Cancer Care.