Abstract
BackgroundRising cancer incidence, the cost of cancer pharmaceuticals and the introduction of the Cancer Drugs Fund in England, but not other United Kingdom(UK) countries means evidence of ‘postcode prescribing’ in cancer is important. There have been no systematic reviews considering access to cancer drugs by geographical characteristics in the UK.MethodsStudies describing receipt of cancer drugs, according to healthcare boundaries (e.g. cancer network [UK]) were identified through a systematic search of electronic databases and grey literature. Due to study heterogeneity a meta-analysis was not possible and a narrative synthesis was performed.Results8,780 unique studies were identified and twenty-six included following a systematic search last updated in 2015. The majority of papers demonstrated substantial variability in the likelihood of receiving chemotherapy between hospitals, health authorities, cancer networks and UK countries (England and Wales). After case-mix adjustment, there was up to a 4–5 fold difference in chemotherapy utilisation between the highest and lowest prescribing cancer networks. There was no strong evidence that rurality or distance travelled were associated with the likelihood of receiving chemotherapy and conflicting evidence for an effect of travel time.ConclusionsConsiderable variation in chemotherapy prescribing between healthcare boundaries has been identified. The absence of associations with natural geographical characteristics (e.g. rurality) and receipt of chemotherapy suggests that local treatment habits, capacity and policy are more influential.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-2026-y) contains supplementary material, which is available to authorized users.
Highlights
Introduction of the Cancer Drugs FundHealth authorityReceipt of chemotherapyMean volume, per head of population of prescribed cancer drugs fund chemotherapy in one year, by health authority
The recent restructuring of the National Health Service (NHS), with a move to Strategic Clinical Networks, (SCNs) instead of Cancer Networks; the continued trend for centralisation of cancer services to drive quality and efficiency improvements, and divergent cancer drugs funding policy, with the establishment of the Cancer Drugs Fund in England, but not in Wales, Scotland or Northern Ireland, are all important changes that may impact on equity of cancer pharmaceutical prescribing by geographical region
Variation was expressed as a ratio of the 90th percentile to the 10th percentile of volumes prescribed in another: the findings suggested a range for inter-network variation from 2.6 fold variation (Rituximab) to an 11.6 fold variation (Temozolamide) [6]
Summary
Per head of population of prescribed cancer drugs fund chemotherapy in one year, by health authority. The cost of cancer pharmaceuticals and the introduction of the Cancer Drugs Fund in England, but not other United Kingdom(UK) countries means evidence of ‘postcode prescribing’ in cancer is important. The recent restructuring of the NHS, with a move to Strategic Clinical Networks, (SCNs) instead of Cancer Networks; the continued trend for centralisation of cancer services to drive quality and efficiency improvements, and divergent cancer drugs funding policy, with the establishment of the Cancer Drugs Fund in England, but not in Wales, Scotland or Northern Ireland, are all important changes that may impact on equity of cancer pharmaceutical prescribing by geographical region
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