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Patients still being denied access to colon cancer treatments

Published on 28/04/04 at 04:00pm

A new Roche-sponsored survey of patients with bowel cancer has found that most are still not being consulted on the choice of treatment, despite NICE guidance being issued nearly a year ago.

The research carried out by leading charity, Colon Cancer Concern (CCC), for April Bowel Cancer Awareness month found only four out of 10 patients claimed to have any involvement in the choice of their treatment, meaning that many may have been denied the latest treatments.

In May last year NICE recommended two new oral treatments as first line treatment options for the disease, Roche's Xeloda (capecitabine) and Bristol-Myers Squibb's Uftoral (tegafur and uracil in one tablet) and specifically called for 'informed discussions' between patients and clinicians about treatment options before a joint decision was made.

NICE found that the newer oral drugs were likely to be as effective as standard chemotherapy (intravenous fluorouracil/folinic acid) but have far fewer side-effects, although it also added that the older treatments were still sometimes preferable in some circumstances.

In the light of this, NICE said the patient/clinician discussion should take into account contraindications and the side-effect profile of the agents as well as the clinical condition and preferences of the individual discussions which the survey has shown are not happening frequently enough.

Sixty-one percent of patients said they were not offered a choice of which chemotherapy they would receive, while 53% of those not given a choice said they would have chosen the oral drugs over the intravenous treatment.

The charity says it is "unclear where the blockage lies", asking "Is it a result of NHS trusts ignoring the guidance and denying clinicians access to the treatments; because of the need for more patient and clinician education about the treatments; or because clinicians are simply not prescribing them or a mixture of all three?"

The survey comes just one month before NICE is due to publish service guidance on improving outcomes for colorectal cancer, and could influence the emphasis of the final recommendations.

Commenting on the survey, Rob Glynne-Jones, CCC Chief Medical Adviser and Consultant at Mount Vernon Hospital: "The CCC survey highlights the continued NHS problems and flawed implementation that currently surrounds the prescribing of oral chemotherapy: a situation which results in patients not gaining access to the treatments that may be best for them."

He added that if patients were suitable for oral treatment and opted for it, they should receive it.

"This option also has the benefit of freeing up valuable NHS resources for patients who need intravenous treatment. It's the smart thing to do."

Elisabeth Humphries, a bowel cancer patient says she "jumped at the chance" to have oral chemotherapy at home rather than IV treatment in hospital. "It meant that I was able to get on with my life as normal and it has not impacted on my daily routine. I feel lucky that I was offered the choice," she said.

The survey is the second time Roche has funded research into uptake of its drugs following NICE recommendation. In November 2003 the company teamed up with CancerBACUP to publicise its finding that huge regional variations existed in the prescribing of its recommended breast cancer drug Herceptin, precipitating a review of the uptake of approved cancer drugs by National Cancer Director Mike Richards, which is currently ongoing.

A number of new breakthrough treatments for colorectal cancer are either in the pipeline or have already been launched. Merck Pharmaceuticals is expected to launch Erbitux across Europe later this year while Genentech and Roche's Avastin, considered to be a major leap forward in treatment was launched earlier this year in the US as a first line treatment.

Great controversy followed NICE's June 2002 highly limited recommendation of three new colorectal cancer drugs, Sanofi-Synthelabo's Eloxatin (oxaliplatin), Aventis' Campto (irinotecan) and AstraZeneca's Tomudex (raltitrexed).

Charities and a number of oncologists protested against the decision to limit the use of the drug to either second line treatment or a small number of cases, but NICE said it would await further trials, expected this year, before updating its guidance.

Bowel cancer is the UK's second most common cause of death and affects over 36,000 people every year, but is very treatable if caught early.

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