LB41

Uptake of National Institute for Health and Clinical Excellence (NICE) approved drugs in Dukes C colorectal cancer and early breast cancer patients

Anna Williams, Michael Sadik, Andrew Conn

Bradford Teaching Hospitals NHS Foundation Trust, UK

Background
National audits of NICE approved cancer drug usage by Cancer Network have shown significant regional variations. This retrospective review analysed the uptake of NICE approved adjuvant therapies in colorectal cancer and breast cancer within a Cancer Unit.

Method
New patients with Dukes C colorectal cancer, lymph node positive early breast cancer and herceptin positive early breast cancer seen between April 2007 and March 2009 were identified. Patients who received oxaliplatin or capecitabine for Dukes C colorectal cancer, or docetaxel or herceptin for early breast cancer were compared to those who did not.

Results
41 of 49 patients with Dukes C colorectal cancer received adjuvant chemotherapy. 16 received capecitabine and 22 received oxaliplatin and fluorouracil (OxMdG). Patients receiving capecitabine were older than OxMdG patients (70 v 58 yrs, p<0.05) and had fewer positive lymph nodes (N2 stage 31% v 55%).

74 patients were seen with lymph node positive early beast cancer. 73 of these received adjuvant chemotherapy and in 16 it contained docetaxel. Of the remaining patients 37 received epirubicin then cyclophosphamide, methotrexate and fluorouracil (Epi-CMF). Patients receiving adjuvant docetaxel were significantly younger than Epi-CMF patients (49 v 54 years, p<0.05) and had a higher Nottingham Prognostic Index (5.8 v 4.7).

Of 32 HER2 positive patients 29 received adjuvant herceptin. 3 patients did not receive herceptin; 2 declined treatment and 1 was advised not to have herceptin due to poor cardiac function.

Conclusion
Decisions regarding whether to use adjuvant therapies in both Dukes C colorectal cancer and early stage breast cancer are based on a patient specific assessment of the risk of the cancer returning as well as of each patients fitness. It is possible that regional variations in drug use may therefore be explained by socio-economic factors rather than a reluctance of Oncologists to use NICE approved drugs.