7 Implementation and audit


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NHS in Wales must usually provide funding and resources for it within 2 months of the first publication of the final draft guidance.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 metastatic colorectal cancer and the doctor responsible for their care thinks that capecitabine and tegafur with uracil is the right treatment, it should be available for use, in line with NICE's recommendations.


Clinicians with responsibility for treating people with metastatic colorectal 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 metastatic colorectal cancer should incorporate the guidance.


To measure compliance locally with the guidance, the following criteria can be used. Further details on suggestions for audit are presented in appendix D.


For the first-line treatment of metastatic colorectal cancer, either capecitabine or tegafur with uracil (in combination with folinic acid) is recommended as an option.


The individual and the clinician(s) responsible for treatment decide jointly on the choice of regimen (intravenous 5-FU/FA or 1 of the oral therapies) after an informed discussion about the relative clinical and cost effectiveness, the side-effect profile of each treatment option and the preferences of the individual.


The use of capecitabine or tegafur with uracil to treat metastatic colorectal cancer is supervised by an oncologist who specialises in colorectal cancer.


Local clinical audits on the care of people with metastatic colorectal cancer could also include measurement of compliance with accepted clinical guidelines or protocols.