ABSTRACT
in non-small cell lung cancer (NSCLC) aids selection of patients suitable for lung resection. Guidelines released by the European Society of Thoracic Surgeons (ESTS) in 2014 outline that 100% patients with suspected cN1 or greater NSCLC require invasive mediastinal lymph node staging. Aim(s): The aim of this audit was to collect and analyse data on the adherence to the ESTS guidelines for patients with TNM stage N1 or greater clinical lung cancer in a single surgical centre in Belfast. Method(s): Data of all lung cancer resections between February 2019 and May 2021 were retrospectively reviewed using the Electronic Care record and the Dendrite operative database. 72 patients met the inclusion criteria. Data collection included whether patient received EBUS and/or mediastinoscopy, along with pre-operative N stage (from PET) and post-operative N stage Results: On analysis of the data: * 34% of cN1 patients received staging * 68% of cN2 patients received staging * 4 patients were under staged (cN1 pre resection and pN2 post resection) Conclusion(s): Our results fell short of the 100% standard set by ESTS. It should be highlighted that our audit was during the height of the Covid-19 pandemic. During this time, system pressures in healthcare, particularly in Northern Ireland, were unprecedented. This is highly likely to have impacted these results, particularly in patients where confirmatory staging may not change the eventual treatment. Re-audit is recommended.
ABSTRACT
Objectives: Medicines are currently commissioned in England via Clinical Commissioning Groups (CCGs, following NICE appraisals) or national-level specialised services (that support people with rare, complex conditions) where commissioning is governed by NHS England (NHSE, who issue Clinical Commissioning Policies [CCPs] where there is a need, and no relevant NICE guidance exists). Under the 2019 Voluntary Scheme for Branded Medicines and Pricing and Access (VPAS), NICE committed to appraise all New Active Substances and significant new therapeutic indications by April 2020, except where there is a clear rationale not to do so. This research evaluates how the scope of NICE’s and NHSE’s CCP evaluations have evolved. Methods: Technologies considered under NICE Topic Selection or subject to NHSE CCP were identified from their respective websites and key information extracted (01-Jan-2015–21-Dec-2021). Results: 1,157 topics were considered, an average of 165/year (range:112[2021]–251[2018]). 80% were prioritised for potential NICE guidance, 15% not prioritised, 2% routed to specialised commissioning, and 3% to other programmes/processes. From 2019, 90% of topics were prioritised versus 74% pre-2019 whereas topics routed to specialised commissioning fell from 2.4% to 0.2%. 216 health technologies have been the subject of NHSE CCPs, 49% were for medicines (76% of which were routinely commissioned), at a mean of 11.7/year (range:1[2014]–23[2016]). The most common rationale for a medicine’s CCP was for off-label use (48%), followed by HIV indications (9%, not reviewed by NICE at that time). Conclusions: Since the 2019 VPAS, a greater proportion of (but by no means all) topics have been prioritised for potential NICE guidance and far fewer routed to specialised commissioning. However, NHSE CCPs are still developed for off-label/license considerations and medicines receiving routine licence extensions. Limitations of our analysis include the effects of the COVID-19 pandemic and any changes to Horizon Scanning, which may have acted as confounders.
ABSTRACT
Objectives: The COVID-19 pandemic has placed an unprecedented demand on healthcare systems. Cancer therapy provision has been particularly impacted due to many therapies having immunosuppressive side effects and/or their need for hospital administration. NHS England (NHSE) and the Scottish National Cancer Advisory Medicines Group (NCMAG) have both provided interim treatment recommendations to provide direction for oncologists during this pandemic. This research evaluates these NHSE and NCMAG treatment proposals. Methods: All interim cancer treatment proposals made under NHSE and NCMAG were extracted and compared with the corresponding product label and any NICE/SMC HTA guidance (on 30-Dec-2020). Results: NCMAG made 18 interim cancer treatment proposals (last updated 10-NOV-2020). 33% were for off-label use, 17% were on-label therapies without SMC-recommendations (all manufacturer non-submissions), 11% were for use outside of SMC reimbursement restrictions, 11% related to supportive care, 11% restricted dosing, and 6% stopped use of one drug in favor of another. NHSE have endorsed 48 interim treatment options (last updated 20-NOV-2020). 40% were for off-label use, 19% stopped use of one drug in favor of another, 9% simply stopped use of a drug, 9% were for therapies that were ongoing NICE assessment (half of which were subsequently NICE-recommended), 9% were for on-label therapies that were not NICE-recommended nor undergoing assessment, 9% were treatment dosing modifications (i.e. duration/frequency/combination), and 5% related to supportive care. 33% of proposals by NCMAG had corresponding recommendations by NHSE. Conclusions: In England and Scotland, rapid interim treatment guidance has provided physicians with a greater flexibility in treating patients with cancer with the guidance most commonly focusing on allowing use of certain therapies outside their labels or their SMC/NICE reimbursement restrictions. There is a lack of alignment between England and Scotland, which can only likely be partially explained by differences in drugs recommended by NICE and SMC