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.
Chapter 2 of Appraisal and funding of cancer drugs from July 2016 (including the new Cancer Drugs Fund) – a new deal for patients, taxpayers and industry states that for those drugs with a draft recommendation for routine commissioning, interim funding will be available (from the overall Cancer Drugs Fund budget) from the point of marketing authorisation, or from release of positive draft guidance, whichever is later. Interim funding will end 90 days after positive final guidance is published (or 30 days in the case of drugs with an Early Access to Medicines Scheme designation or fast track appraisal), at which point funding will switch to routine commissioning budgets. The NHS England and NHS Improvement Cancer Drugs Fund list provides up-to-date information on all cancer treatments recommended by NICE since 2016. This includes whether they have received a marketing authorisation and been launched in the UK.
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NHS in Wales must usually provide funding and resources for it within 2 months of the first publication of the final draft guidance.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 ovarian cancer and the healthcare professional responsible for their care thinks that paclitaxel is the right treatment, it should be available for use, in line with NICE's recommendations.
Clinicians with responsibility for treating women with ovarian cancer should review their current practice in line with the guidance set out in section 1.
Local guidelines, protocols or care pathways on the care of women with ovarian cancer should incorporate the guidance set out in section 1.
To measure compliance locally with the guidance, the following criteria can be used. Further details on audit criteria are presented in the section on details on criteria for audit.
First-line chemotherapy (usually following surgery) in the treatment of ovarian cancer includes the options of paclitaxel in combination with a platinum-based compound or platinum-based therapy alone.
The choice of treatment for first-line chemotherapy for an individual woman with ovarian cancer is based on discussion between the woman and the responsible clinician regarding the risks and benefits of the options available. The following issues should be discussed: side-effect profiles of the alternative therapies, the stage of the woman's disease, the extent of surgical treatment of the tumour, and disease-related performance status.
Additional courses of treatment with the chosen chemotherapy regimen are offered to women following relapse after the initial (or subsequent) course of first-line treatment, if the extent and duration of the initial (or previous) response is adequate.
Paclitaxel is considered as second-line (or subsequent) treatment for women with ovarian cancer only if they have not received the drug previously as part of first-line treatment.
Only oncologists specialising in ovarian cancer supervise the provision of chemotherapy in ovarian cancer.
Local clinical audits on the management of ovarian cancer also could include measurement of compliance with accepted clinical guidelines or protocols or with the measures for the treatment of ovarian cancer that are suggested in Improving Outcomes in Gynaecological Cancers, Guidance on Commissioning Cancer Services.