A postcode lottery still exists for cancer patients with 'exceptional circumstances'

Manchester, UK, 18 November 2008 - A study of patients, at the Christie Hospital, Manchester, has shown that the decision to fund patient care depends more on where the patient lives, than the patient's health circumstances, raising public concern regarding a "postcode lottery" since each decision is made solely by the patients' local Primary Care Trust (PCT). The findings of this study are published in a letter to Clinical Oncology (http://www.elsevier.com/clinonc).

Between July 2006 and May 2008, 102 requests for funding for patients with "exceptional circumstances" were made to a total of 27 surrounding PCTs. The funding decision was gained for 98 patients (4 awaited) and of these, 73% had their applications approved. However, while some PCTs had approval rates of 100%, others had very high rejection rates, with three of the 27 PCTs accounting for over half of all rejections.

Dr Mark Saunders, one of the authors said, "Even though the application process is the same, each PCT interprets whether they feel that a patient's circumstances are exceptional in a different way." He goes on to add" some patients in a clinic may get the drug they applied for, but others, with similar circumstances, do not. This has created a lot of anxiety for patients and considerable extra work for clinicians, hospitals and PCTs."

Furthermore there was found to be a stark variance in the time it took for the PCT to respond to the application, causing further distress for the patient and family. The average time taken was 37 days; however the range was from 0-231 days.

Although this study is concentrated in Manchester, Dr. Saunders points out, "A lack of national guidelines for the application process means that these problems are likely to be encountered across the country. These results underline patients' anxiety regarding availability of new treatments and a post-code lottery".

If a patient cannot gain funding via the PCT, there is now the option of top-up payments for the non-approved treatment. However for many this will be an unaffordable and unrealistic option.

Letter to Clinical Oncology
A post-code lottery still exists for cancer patients with "exceptional circumstances"
Ruth Clarke, Tom Waddell, Janet Gallagher, Kin Lee, Ganesh Radhakrishna, Jim Cavet, Robert E Hawkins, Mark P Saunders (Clin.Oncol 2008; 20(10),
http://dx.doi.org/10.1016/j.clon.2008.09.005)

The National Institute for Health and Clinical Excellence (NICE) produces guidelines with the aim of ensuring equal access to cost-effective treatments throughout England and Wales and treatments that receive positive-guidance are funded and made available for patients. When a treatment has not been approved (or assessed) by NICE, patients may feel that they have 'exceptional circumstances' making the unapproved treatment more appropriate than a standard (NICE approved) therapy and an application for funding has to be made to their primary care trust (PCT - determined by the GP they are registered under).

Clinical Oncology is published by Elsevier on behalf of The Royal College of Radiologists. Clinical Oncology is an international cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. The journal publishes 10 issues a year in print and online. More information can be found at http://www.elsevier.com/clinonc.

The Royal College of Radiologists (RCR) has approximately 7600 members and Fellows worldwide, representing the disciplines of clinical oncology and clinical radiology. The role of the RCR is to advance the science and practice of radiology and oncology, further public education, and promote study and research through setting professional standards of practice. The college publishes two journals with Elsevier, Clinical Oncology and Clinical Radiology. More information on the college, its history and future plans can be found at http://www.rcr.ac.uk.

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