Equity of access to treatment on the Cancer Drugs Fund: A missed opportunity for cancer research?

Using mixed-methods, we investigated the CDF in the South West of England (3,193 cancer patients treated through the CDF, April 1st 2011-March 31st 2013) for evidence of: 1) equitable access across socioeconomic groups, age groups, sex and Cancer Network; 2) time-to-treatment by socioeconomic group; and 3) the perception of the CDF as fair, using semi-structured interviews with oncology consultants.

There was no evidence of inequitable access to anti-cancer therapy for those in more deprived areas. For all cancer types there was a lower proportion of women in the CDF cohort than in the Cancer Registry reference population (e.g. melanoma, CDF 36.8% female, reference population 48.7%; difference 11.9%, 95% CI 3.1-20.7%). There was a lower proportion of older patients in the CDF compared with the reference population (e.g. colorectal cancer, CDF 6.9% ≥ 80 years, reference population 30.1%; difference 23.2%, 95% CI 20.2%-26.2%). Interviewed oncologists felt differences in performance status, not age, influenced referral to the CDF, with neither deprivation, nor gender contributing.

Our study suggests that the CDF has differential access by age and sex, but not by deprivation. The absence of high quality CDF data represents a missed opportunity to fully evaluate equity of access and the real-world costs and outcomes of novel anti-cancer drugs.