The 'postcode lottery' effect seems to be diminishing, with medicines becoming widely available

THE use of cancer drugs in England has grown rapidly, and there is less evidence of "postcode prescribing", according to a new report.

The figures, to be announced today in a speech by Mike Richards, the National Cancer Director, show great changes in prescribing over quite a short period, between the second half of 2003 and the first half of 2005. Professor Richards's investigation stemmed from criticism from charities and drug companies that, even when approved by the National Institute for Health and Clinical Excellence (NICE), cancer drugs were not being used widely enough to make a difference.


The NHS is traditionally slow to adopt new drugs, something that NICE was set up to correct. But the evidence was that the system was not working. Professor Richards found, in a report in June 2004, that there was considerable variation in the uptake of drugs between different regional cancer networks.

A lack of money did not explain the differences, which appeared to be attributable to the way that services were organised, and different opinions between cancer specialists on prescription. The professor made recommendations aimed at reducing this variation and ensuring that good drugs were used more widely.

Today, in a speech at a Health Service Journal conference, he will announce that a second study has shown considerable improvements.

The use of cancer drugs increased sharply in the 18 months between the two surveys, by an average of just under 50 per cent. For some drugs, such as rituximab (MabThera), for lymphoma, and temozolomide (Temodal), for the brain cancer glioma, usage roughly doubled in that time.

The use of trastuzumab (Herceptin), for breast cancer, rose by 55 per cent, and imatinib (Glivec), for chronic myeloid leukaemia, by 70 per cent. Both drugs are well known and highly effective.

The report also includes encouraging signs that where patients live now matters rather less than it did in terms of cancer drug prescription.

Professor Richards compared the networks that use the most cancer drugs with those that use the least. In 2003 those at the top of the scale were typically using three or four times as much of the cancer drugs as those at the bottom. By last year the gap had narrowed to between two and three times as much — about twice as much for the most common and widely used.

In the case of Herceptin, for example, ratio fell from just over 4:1 to just under 3:1.

"For every single cancer drug, we are seeing a reduction in the variation," Professor Richards said. "We haven't eliminated all variation but we are moving in the right direction and the recommendations of the first report are beginning to pay off."

He does not expect to see such variations disappear. Some are due to individual clinicians' judgments, some to the patient mix in an area, or the sending of particular types of patient to a different area for treatment. There are also un- certainties about the data.

"But taking all that into account, this is good news," he said. "We are moving in the right direction."

Rosie Winterton, the Health Minister, welcomed the report. "It is fundamental that all cancer patients should have the same access to cancer drugs that have been approved by NICE, no matter where they live," she said. "I am delighted that the cancer director's report shows that considerable progress has been made.

"However, that does not mean we will be complacent — we recognise that there is still more to do. As more people are diagnosed with cancer each year, the NHS must keep improving cancer services so each and every patient receives the best treatment possible."

Labels: No Prescription, Online Pharmacy, Prescription Drugs