Near perfect: better quality care for cancer patients

10 April 2018

A new project between Novartis and London’s Royal Marsden Partners Cancer Vanguard is aiming to improve the quality of care for cancer patients by expanding the role of oncology pharmacists. With cancer care targets continuing to be missed, such collaborative efforts between pharma companies and the NHS could play a vital role in ensuring quicker access to treatments, writes Ross Davies.

If you were born in the UK after 1960, there’s a one in two chance you could be diagnosed with cancer during your lifetime. That’s according to the latest findings by Cancer Research UK. It’s a sobering thought, not least in light of recent reports that cancer care targets are being missed across much of the country.

According to research by Macmillan Cancer Support from 2017, the proportion of patients waiting more than 62 days for oncology treatment has increased by a third over the past four years. Following an urgent referral, commonly by a GP, NHS patients are supposed to begin treatment within two months, having seen a cancer specialist and undergone advanced diagnostic procedures in the interim.

Today, almost one in five people – more than 100,000 patients – are forced to wait longer to be seen. In 2016 alone, there was a 23% year-on-year rise in the number of people missing the target, the report says. The serious problems facing the NHS – lack of funding, not enough staff and caring for an ageing population, to name just a few – have led the organisation to being close to breaking point.

As a result, NHS trusts across the UK are having to come up with new ways of diminishing the pressure and meeting targets. One such example is West London’s Royal Marsden NHS Foundation Trust, which is home to the largest cancer centre in Europe. In November, the Royal Marsden Partners Cancer Vanguard (RMP) announced it was partnering with pharmaceutical multinational Novartis on a new joint working project (JWP) to help increase the quality of care and satisfaction among cancer patients. Referred to in full as the ‘Royal Marsden Partners Cancer Vanguard Oncology Pharmacy Service Improvement Joint Working Project’, the initiative will pilot a new cancer care model that promotes the role of the pharmacist to the fore.

Aiming high

The scope is immensely ambitious. Royal Marsden – which has two hospital sites in Chelsea, in the north-west of the capital, and Sutton, in its south-western reaches – has a catchment population of roughly 3.5 million people. It will run for up to two years, with the ultimate goal of being rolled out across other NHS sites in the future.

The plan, goes the blurb in a recent Novartis press release, is to firstly “assess the current oncology pharmacy service functions and skill mix supporting clinical teams”. The project will then “introduce new models of care to improve the delivery of treatment and enhance the quality and consistency of care for patients”.

The main oncological areas of focus will be around “the main solid tumour pathways”, including advanced melanoma, breast, lung, and renal cell carcinoma. The parties are hopeful the project will be able to provide quantifiable improvements for patients, including quicker, easier access to treatments; the more accurate prescription of drugs and the more convenient delivery of treatments. When it comes to the latter, the benefits of a mobile chemotherapy bus service are said to be under consideration.

“Expanding and enhancing the role of oncology pharmacists will help us to address the increasing pressures on cancer services,” said Jatinder Harchowal, chief pharmacist and clinical director, medicines management and clinical support services, Royal Marsden NHS Foundation Trust, upon the announcement of the partnership. “We are optimistic that the models being trialled here could lead to a significant impact at a national level for cancer patients.”

The new project is one of several JWPs Novartis and the NHS are involved in. “We are proud of our collaborations with the NHS and believe that JWPs such as this are vital for advancing oncology care and services, ultimately leading to improving cancer patient outcomes,” said Barak Palatchi, oncology general manager for Novartis UK and Ireland.

Better care standards

Any improvements recorded in oncology pharmacy functions will be benchmarked against service standards featured in National Institute for Health and Care Excellence, as well as the Revised Chemotherapy Measures for the Manual for Cancer Services 2013.

The project marks the first time pharmacists have been given such precedence, as part of the National Cancer Vanguard programme. Formed in response to the ‘Five Year Forward View’, published by NHS England in 2014, and the independent cancer task force’s 2015 recommendations, the programme is an alliance of health organisations focused on driving innovation in oncology care.

Royal Marsden NHS Foundation Trust is one of the programme's three main partners, alongside University College London Hospitals NHS Foundation Trust and The Christie NHS Foundation Trust.

One particular area of interest for the Cancer Vanguard is the rise of biosimilars, a branch of medicine that has displayed some signs of promise in the field of oncology treatment. In its most reductive sense, a biosimilar is a biological medicine analogous to another biological treatment already on the market.

It’s also much cheaper to produce than original reference drugs. In September, FDA announced its first ever approval for a biosimilar in the treatment of cancer. The drug in question, ABP-215 (formally known as bevacizumab-awwb; Mvasi), is a biosimilar for bevacizumab. This drug, also known by the brand name Avastin, was developed by Amgen and Allergan and is indicated for the treatment of colorectal, lung, brain, kidney and cervical cancers in adult patients.

NHS England is keen to investigate the potential of biosimilars, having recently announced plans to widen its use of biological medicines in a bid to slash up to £300 million from its drug bill by 2021.

Biological medicine

According to a new commissioning framework for biological medicines, including biosimilar medicines, published in September 2017, the goal is for at least 90% of new patients to be given a bestvalue biological medicine within three months of launch of a biosimilar medicine.

But such advances could be tempered by the fact that biosimilars remain something of an unknown quantity, the technology and effects of which have yet to be fully understood, especially in the field of oncology. Not all trusts have given credence to the benefits of biosimilar medicines.

This is something Harchowal is looking to change, as he leads the charge in increasing uptake of biosimilars across NHS Cancer Vanguard sites. By way of example, Royal Marsden was the first UK trust to switch to biosimilar rituximab, an important drug for blood cancers, including lymphoma. According to a Royal Marsden spokesperson, “as a result of Jatinder’s work in this area, uptake of biosimilar rituximab has now reached 80% nationally”.

At a news briefing in March, Harchowal even claimed the level of discounts derived from biosimilars could be even higher than the £300 million earmarked by the NHS. “These are large figures,” he told Reuters. “Without compromising clinical effectiveness, this is a big saving that can be reinvested back into the NHS.”

Some naysayers might see such forecasts as being overly optimistic, but the statistics speak for themselves. Currently, six of the top ten medicines prescribed in UK hospitals, ranked by spend, are biologic drugs. With patents for earlier licenced biological drugs about to expire, there seems to a window of opportunity for biosimilar treatments to become more prevalent.

Close enough

In the meantime, Harchowal and the NHS Cancer Vanguard is looking to push through the availability of biosimilar trastuzumab products at some point this year. The medicine, often known through the brand name Herceptin, is commonly used to treat breast cancer, oesophageal cancer and stomach cancer. The Vanguard Programme is also hopeful adalimumab, also known as Humira, could potentially become available in 2018, too.

At the hospital trusts that make up the Cancer Vanguard programme, there is growing evidence that more store is being set by pharma-NHS partnerships. According to a recent statement by the Association of the British Pharmaceutical Industry, “the best way to research, develop and deliver new, life-changing medicines is in partnership with the NHS”.

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