In light of NHS England's plan to remove 25 uses of cancer medicines from the Cancer Drugs Fund (CDF) on 12 March, a new survey has revealed considerable dissatisfaction amongst oncologists with some of the proposed changes. Over three quarters (79%) of oncologists surveyed agree or strongly agree that the cuts will compromise their ability to make optimal treatment choices for their patients, while a similar number (74%) believe the CDF panel placed budgetary considerations ahead of what's best for cancer patients when they made their decisions about cuts to the CDF.
Specifically, almost two thirds of prostate cancer clinicians said that following the removal of cabazitaxel (Jevtana) from the CDF, they expect to manage prostate cancer with less effective treatment for longer, or move patients onto palliative (supportive) care sooner.
Professor Amit Bahl, Consultant Clinical Oncologist and Clinical Director at Bristol Haematology and Oncology Centre commented, "It will be highly detrimental if NHS England goes ahead and de-lists cabazitaxel. It is an important treatment for some men with prostate cancer who may have no other treatment options available to them. It is incomprehensible that as clinicians we will no longer be able to treat patients with important therapies proven to extend survival. Having treated several patients with cabazitaxel I am very aware of the real life difference it makes to their survival and quality of life and would like future patients to have the opportunity to avail this treatment."
Significantly, nearly three quarters (70%) of the oncologists surveyed said that as a result of cutting cabazitaxel from the Fund, outcomes for men with prostate cancer living in England will be worse. Not surprising, given that over three quarters (77%) said that there is a group of patients for which cabazitaxel fulfills an unmet need.
Hugh Gunn, spokesperson for prostate cancer patients' charity TACKLE, added, "12 March will be a truly terrible day for men with prostate cancer and their families if cabazitaxel is de-listed. For many men - myself included - cabazitaxel was going to be the next treatment option. In fact, the last treatment option we had left. At the moment I'm well, but in a few months time I might not be; for the first time in my entire cancer journey I'm frightened."
NHS England's plans to cut drugs from the CDF are surprising, given that English cancer patients are still faring poorly compared to their European counterparts. Cabazitaxel is available across Europe, with countries under much greater financial pressure than the UK such as Kazakhstan, Lithuania, Romania, Greece and Portugal providing funding. The UK spends less on cancer drugs per inhabitant than in other European countries - especially on newer drugs. In England, this is just 8p a day per person. The Cancer Drugs Fund, set up in 2010 to facilitate better access to cancer drugs, only accounts for 0.3% of the total NHS spend and only 2.5% of the NHS drugs bill.
Cabazitaxel is the only active treatment for advanced prostate cancer which is not responsive to any available hormone therapies following initial chemotherapy (docetaxel). Cabazitaxel fulfills an important unmet need in certain patients and has been proven to extend survival in advanced prostate cancer. By de-listing this drug, NHS England is denying some patients with no other options, access to a vital, life-changing treatment.
Tarja Stenvall, General Manager for Sanofi in the UK, commented, "The decision to cut cabazitaxel is out of step with clinical opinion and patient need. We have made an offer to NHS England, the Department of Health and NICE in an attempt to ensure that men get access to the treatment they need. All sides have a responsibility to work together to find a solution for patients. We have asked David Cameron to intervene to make sure we have the opportunity to discuss that solution with the CDF Panel."