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Chemo drug optimisation to improve patient experience of cancer treatment
Tens of thousands of patients requiring chemotherapy could receive treatment closer to home under new plans set out by the health service today.
Substantial savings are also expected to be reinvested in patient care over the next few years thanks to an NHS England programme led by specialist pharmacists to reduce variation in drug doses.
Chemotherapy is the single biggest spend within NHS England’s Specialised Commissioning, accounting for an estimated £1.4 billion a year – almost a tenth of the entire central budget.
The cost of drugs represents some 80% of this spend and is growing rapidly, with annual increases of around 8% due to rising demand and higher charges from drug companies.
NHS England now hopes to reduce variation and wastage in chemotherapy by implementing a national system of ‘dose banding’, where patients will receive optimised doses of drugs, rather than ones which are individually calculated.
For cancer patients, while the quality and safety of outcomes will be maintained, additional benefits of this approach include more efficient services because staff time involved in preparing medicines will be reduced, reduced waiting times for treatment because chemo is ready to give, and greater flexibility in terms of where and when they receive treatment.
Other patients will also see benefits as reduced wastage translates to lower costs for NHS England, allowing the specialised commissioning budget to stretch to more services; in one local example where banding was used for a chemotherapy drug, wastage more than halved.
Cally Palmer CBE, NHS England’s National Cancer Director, said: “This is an important initiative which will contribute to continuing efforts across the health service to meet the ambitions set out in our Cancer Strategy to improve outcomes and quality of life for cancer patients.”
“By embracing this approach, providers can support patients to receive chemo at appropriate times and in places which are more convenient for them, at the same time as reducing workload for professionals.”
Dr Jonathan Fielden, NHS England’s Director of Specialised Services, said: “This is another example of how NHS England is working hard to deliver better outcomes for patients at the same time as achieving better value across health services.
“This common-sense approach will see significant savings made over the coming years, which can help the NHS meet the challenges of rising demand and new, effective but expensive treatments coming forward.”
Dose banding will help speed up plans currently being developed as part of the Chemotherapy Services Review to deliver chemotherapy in a range of community and health settings other than hospitals which would be closer to people’s homes. As work develops to include the new generation of biologic drugs1, patients could even be trained to administer their own treatment in their home.
Hospital Trusts are expected to see benefits through reduced bespoke pharmacy preparation and prescription alterations, quicker and simpler dispensing and fewer errors. It will also enable standardisation of training for health professional working in cancer.
Instead of Trusts buying large single quantities of drugs which are then split into doses by hospital pharmacy teams, under the new programme they will purchase standard ‘single serve’ doses – a process they could also choose to outsource or collaborate with other Trusts on to achieve even greater efficiencies.
Dose banding has been happening at a local level for some ten years; almost 90% of Trusts use it for at least one chemotherapy drug.
However, the practice remains piecemeal and inconsistent; for the 20 most commonly-banded chemotherapy drugs, on average fewer than a third of Trusts are doing so.
By implementing a national approach, NHS England expect that more than 90% of chemotherapy doses will be prescribed and administered in accordance with bandings by March 2018.
A financial incentive scheme, or CQUIN, has been developed and implemented, to encourage Trusts to adapt quickly to the new approach.
This will be supported by new guidance which will be developed with national and regional clinical leaders, including relevant Royal Colleges.
Current resources available to clinicians and Trusts on dose banding are available on the Chemotherapy Clinical Reference Group page.
My husband needed chemotherapy and as a couple we needed a great deal of support and the doseage of his chemo monitored and changed to meet his needs / side effects sometimes on a daily basis .
However his condition was complex having had a transplanted lung , this lead to many side effects , and after nine years of living a positive life post transplant from having being given gift of life , he ended his days with lymphoma , The staff in the community nearer home unfortunately had not received training to deal with his complex issues they always advised that we seek changes to drug regime from specialists at Freeman Hospital .
He needed consistent back up and care , not sure if this approach you suggest of one hat will fit all ?
However it would have been wonderful to have had faith in the chemo treatment process being delivered nearer home enabling an outcome of better quality of life for my husband in his dying days . this would mean provision of specialised staff with competencies to deal with complex drug regimes in community . he also needed a lot of diagnostic tests to find out primary source , would this be available nearer home ??
freeman hospital care was always superb he had great faith in the Specialist services ,he always felt safe with their management of his individual care . Not sure if I like an incentive scheme introduced to encourage ” a quick uptake of scheme “, this adaptation should be initiated if the clinicians in community feel it is funded for correct staffing levels with appropriate skills and knowledge base to delivery quality services .
We’re sorry to hear about your loss, but pleased to that your experience of the care your husband received was positive. How this and other changes could contribute to delivering chemotherapy closer to home will be the subject of the Chemotherapy Services Review, which amongst other things will of course look at staffing and facilities, as well as how other new models of care being developed in some areas can be applied to ensure people needing chemotherapy receive the right care in the right place for them.
This programme has been developed by specialist pharmacists and other clinicians on the Medicines Optimisation and Chemotherapy Clinical Reference Groups. It has also been endorsed by the Chemotherapy Board comprising representatives from the Royal Colleges of Radiology, Physicians and Pathology, British Oncology Pharmacy Association and UK Oncology Nursing Society and other relevant professional bodies.
I understood that chemotherapy needed to be adjusted to each patient and the dose regulated to their weight and other factors. How is this going to work?
A patient’s dose will still be based on their weight and height, but when a precise dose is calculated, for adult patients the dose delivered will be the nearest standard dose; the variation between precise calculated dose and banded dose will never be more than 10% without specific agreement from a clinician. Detailed information on dose banding is available on the Chemotherapy Clinical Reference Group page<https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-b/b15/>