Chemotherapy, or systemic anti-cancer therapy (SACT), is used in the treatment of cancer. It is often used in combination with other therapies such as surgery and radiotherapy.
NHS England Specialised Commissioning is the responsible commissioner for all chemotherapy services (including drug procurement and delivery) across England. The exact scope of NHS England’s commissioning responsibility is set out in the Manual for prescribed specialised services.
Chemotherapy clinical reference group
This service area is supported by a Clinical Reference Group (CRG). The main function of a CRG is to provide the primary source of clinical advice for specialised services and the membership comprises clinical, Patient and Public Voice (PPV) representatives and professional associations. Each CRG is also supported by an NHS England Commissioning Lead and Public Health Lead.
Membership of the chemotherapy clinical reference group:
- Anne Rigg, Chair
- Ernie Marshall, Clinical Member
- Andrew Wardley, Clinical Member
- Gordon Cook, Clinical Member
- Samantha Toland, Clinical Member
- Lisa Pickering, Clinical Member
- Yvette Drew, Clinical Member
- Lindsey Cook, Patient and Public Voice Representative
- Jessica Lewington, Patient and Public Voice Representative, (Bowel Cancer Now)
- Duncan Sim, Patient and Public Voice Representative), Cancer Research
- Emma Foreman, Affiliate Member, (British Oncology Pharmacy Association)
- Catherine Oakley, Affiliate Member, (UK Oncology Nursing Society)
- Neil Bayman, Affiliate Member (Joint Collegiate Council for Oncology)
The Chemotherapy CRG is also supported by an NHS England Pharmacy Lead.
A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the Regional Commissioning Teams to contract services.
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:
Clinical commissioning policies
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:
- Addition of rituximab to first-line standard chemotherapy for CD20 positive B-cell precursor acute lymphoblastic leukaemia (Adults)
- Dabrafenib and trametinib in the treatment of patients with BRAF-mutated anaplastic thyroid cancer
- 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
- Bendamustine for relapsed/refractory classical Hodgkin lymphoma (all ages)
- 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)
- Vismodegib for adults with either Gorlin syndrome or non-Gorlin syndrome related multiple basal cell carcinomas. (Adults)
Clinical commissioning policy statements
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
- Bendamustine for relapsed multiple myeloma (all ages)
- 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)
Chemotherapy waste data collection and evaluation tool
This tool was developed in 2019/20 as part of an NHS England commissioning for quality and innovation (CQUIN). The Chemotherapy Clinical Reference Group has made the tool available to providers who wish to improve their efficiency in reducing chemotherapy waste. It can automate the calculation of waste according to the method agreed by the NHS England Medicines Optimisation Committee.
The tool and accompanying user guide are available below
The tool was originally developed to allow trusts to share their chemotherapy waste for the purposes of benchmarking as part of the CQUIN. There is currently no ongoing support from NHS England available for benchmarking using the tool, however users are free to benchmark within their networks. Any users who experience technical issues with the tool can report them to firstname.lastname@example.org