The British Columbia Cancer Agency (BCCA) Compassionate Access program (CAP); A web-based submission process for all non-standard treatment regimens

Abstract

17533 Background: Access to new and expensive cancer treatments is a major contemporary issue in both private and public health care systems. Implementation and public funding of new chemotherapy protocols at BCCA is subject to approval by the Priorities and Evaluation Committee (PEC) and Systemic Therapy Program (STP). Reports of new therapies lead to evaluation by BCCA Tumour Groups who advance protocols to PEC for approval and STP for funding. In the period of data evolution, or prior to STP approval, funding for these therapies may be requested through CAP via province-wide online access. Methods: CAP submissions are required for non-STP approved therapies: where standard therapies are contra-indicated, being used for different indications, being prolonged or substantially modified: or to confirm eligibility for expensive STP-approved regimens. The original CAP paper process has been transformed to a web-based secure data entry form with links to BC Cancer Information System (CAIS) for patient demographics, diagnosis and stage, and to currently approved protocols. Online demonstration will be available for presentation. Results: From its inception in July 2006 to Dec. 2007, 5816 CAP requests from 203 physicians have been processed with 5000 (86%) approved. Median and mean outcome response times were 1 and 1.4 days. Infrequent users (<10 CAP requests) had lower approval rates than frequent users (77% vs 88%). CAP utilisation varied widely due to physician specialty (eg use of FOLFOX, FOLFIRI-Bevacizumab, sorafenib, maintenance rituximab), practice volumes and oncologists’ philosophies of care. 5% of physicians made 29% of all CAP requests. Representative subgroup outcome analyses have been published (alemtuzumab in CLL [ASCO 2007 abstract 8098]: esophago-gastric cancer [ASCO 2007 abstract 15158]). Conclusions: The BCCA web-based CAP request system is a novel electronic process with rapid turnaround, linking to CAIS, and linkable to outcome data bases (breast, colorectal cancer, lymphoma). Drug utilisation is monitored for patient eligibility, cost and budgetary implications. Prospective collection of response and serious adverse event data by CAP would facilitate outcome analyses of patient subgroups. No significant financial relationships to disclose.