Section 7 of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013 requires integrated care boards, NHS England and, with respect to their public health functions, local authorities to comply with the recommendations in this evaluation within 3 months of its date of publication.
The Welsh ministers have issued directions to the NHS in Wales on implementing NICE technology appraisal guidance. When a NICE technology appraisal guidance recommends the use of a drug or treatment, or other technology, the NHS in Wales must usually provide funding and resources for it within 2 months of the first publication of the final draft guidance.
When NICE recommends a treatment 'as an option', the NHS must make sure it is available within the period set out in the paragraphs above. This means that, if a patient has stage III (Dukes' C) colon cancer and the doctor responsible for their care thinks that capecitabine or oxaliplatin are the right treatments, they should be available for use, in line with NICE's recommendations.
Clinicians with responsibility for treating people with stage III (Dukes' C) colon cancer should review their current practice and policies to take account of the guidance set out in section 1.
Local guidelines, protocols or care pathways that refer to the care of people with stage III (Dukes' C) colon cancer should incorporate the guidance.
To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in appendix C.
A person with stage III (Dukes' C) colon cancer is offered the following as options for the adjuvant treatment following surgery for the condition:
capecitabine as monotherapy
oxaliplatin in combination with 5-FU/FA.
The individual and the clinicians responsible for treatment decide jointly on the choice of adjuvant treatment after an informed discussion.
Local clinical audits on the management of colon cancer could also include measurement of compliance with accepted clinical guidelines or protocols or with the measures for the treatment of colorectal cancer that are suggested in NICE's cancer service guideline on improving outcomes in colorectal cancers.