This Clinical Reference Group (CRG) covers chemotherapy services. Chemotherapy is the use of certain drugs to treat solid tumour cancers and haematological (blood) cancers through the systemic delivery of agents that have anti-tumour effects. Chemotherapy may be given through a number of routes including intravenous (in a vein), subcutaneous (under the skin), intrathecal (around the spinal cord), oral (swallowed) and topical (applied directly to a body surface).
Chemotherapy may be used in any type of cancer, often in combination with other treatments such as surgery or radiotherapy.
Chair: Dr Anna Rigg.
Dr Ernie Marshall
Dr Andrew Wardley
Prof Gordon Cook
Dr Lisa Pickering
A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.
Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.
The following service specifications fall within the scope of this CRG:
A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.
The following policies fall within the scope of this CRG:
- Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages)
- Bendamustine with rituximab for first line treatment of advanced indolent non-hodgkins lymphoma
- Bendamustine with rituximab for the treatment of relapsed mantle cell lymphoma
- Bendamustine with rituximab for first line treatment of mantle cell lymphoma in adults
- Bortezomib for relapsed/refractory mantle cell lymphoma policy
- Bortezomib for relapsed / refractory Waldenstrom’s Macroglobulinaemia (all ages)
- Clofarabine for refractory or relapsed acute myeloid leukaemia (AML) as a bridge to stem cell transplantation
- Glucarpidase for the urgent treatment of methotrexate-induced renal dysfunction
- Temozolomide as adjuvant treatment for people with newly diagnosed anaplastic astrocytoma without 1p/19q codeletion following surgery and radiotherapy (adults) (effective from April 2020)
Policy statements are brief documents that define the current commissioning position to support service contracting.
The following policy statements fall within the scope of this CRG:
- Arsenic trioxide for the treatment of high risk acute promyelocytic leukaemia
- Convection enhanced delivery for diffuse intrinsic glioma
- Docetaxel in combination with androgen deprivation therapy for the treatment of hormone naïve metastatic prostate cancer
- Uridine triacetate for the treatment of patients exhibiting early onset severe toxicities following 5-fluorouracil or capecitabine administration (all ages)
The Chemotherapy Dose Standardisation initiative has been developed by NHS England’s Medicine Optimisation and Chemotherapy CRGs. NHS England is supporting the standardisation of chemotherapy doses which will deliver benefits for patients, Hospital Trusts and achieve improved value from our investment in chemotherapy services.
Historically when patients received chemotherapy intravenously their dose would be based on a combination of their height and weight and would mean that pharmacies would waste any medicine left over from vials containing fixed doses. A number of hospitals have already moved to a system of dose banding where a range of doses are delivered to closely match to vial size. This means there is reduced waste and as these doses tend to be ready made it also reduces the waiting time for patients within the chemotherapy unit.
The National Dose Banding Tables are to be used by Hospital Trust Pharmacy Teams to ensure a standard approach to dose banding of Chemotherapy across all Hospital Trusts. The initiative is initially focussed on 19 commonly used drugs. This will help the NHS achieve improved value through the ability to purchase standard off the shelf products.
- National Tables 2mgmL – v6
- National Tables 25mgmL – v2
- National Tables 80mgmL – v2
- National Tables Avelumab 20mgmL – v2
- National Tables Azacitidine 25mgmL – v3
- National Tables Bevacizumab 25mgmL – v2
- National Tables Brentuximab Vedotin 5mgmL – v3
- National Tables Capecitabine v1
- National Tables Carfilzomib 2mgmL v6
- National tables Cladribine SC Litak 2mgml v1
- National Tables Cetuximab 5mgmL – v4
- National Tables Clofarabine 1mgmL – v2
- National Tables Daratumumab 20mgmL v1
- National Tables Doxorubicin Lip (Caelyx) 2mgmL – v2
- National Tables Durvalumab 50mgml v1
- National Tables Eribulin 0.44mgmL
- National Tables Inotuzumab ozogamicin 0.25mgml v1
- National Tables Ipilimumab 5mgmL v1
- National Tables Mesna 100mgmL – v5
- National Tables Methotrexate HD 100mgmL – v2
- National Tables Nivolumab 10mgmL – v2
- National Tables Olaratumab 10mgmL – v1
- National Tables Paclitaxel Albumin 5mgmL – v1
- National Tables Panitumumab 20mgmL – v1
- National Tables Pembrolizumab 25mgmL – v2
- National Tables Pemetrexed 25mgmL v3
- National Tables Rituximab 10mgmL – v4
- National Tables Topotecan 1mgmL – v3
- National Tables Trastuzumab IV 21mgmL – v2
- National Tables Trastuzumab Emtansine 20mgmL – v2
- National Tables Temozolomide PO v2
- National Tables Vinflunine 25mgmL – v2
NHS England has published the first set of product specifications to support the production and supply of ready-made chemotherapy medicines. This supports the chemotherapy dose standardisation programme and the utilisation of standard chemotherapy doses. The specifications will be utilised by procurement teams to ensure the NHS will purchase standard, ready made products across the NHS in England. The scheme provides benefits for patients with ready to use products and drives safety throughout the system by standardising the products that are used. In addition it provides benefits to Trusts and commissioners in reducing waste.
Chemotherapy is the single biggest service area spend within NHS England Specialised Commissioning. In 2016/17 NHS England spent approximately £1.7 billion on the routine commissioning of chemotherapy, with drug costs being the largest proportion of this spend (80%). There is also a high rate of annual growth in these costs of approximately 8-10% per year.