B02. Chemotherapy

Scope

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.

Membership

Chair: Professor Peter Clark, Consultant Medical Oncologist, Clatterbridge Cancer Centre NHS FT.

Ernie Marshall, North
Andrew Wardley, North
Andrew McMillan, Midlands & East
Karen McAdam, Midlands & East
Jonathan Ledermann, London
Martin Gore, London
Andy Peniket, South
Elaine Lennan, South
David Thomson, Lead Pharmacist
Melanie Sturtevant, Patient & Public Voice
Tim Windle, Patient & Public Voice
Duncan Sim, Patient & Public Voice
Suzanne Fennah, Lead Commissioner, suzanne.fennah@nhs.net

Products

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

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:

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:

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:

National dose banding tables

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.

Dose Banded Chemotherapy Standardised Product Specifications

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.