Complementary medicine teaching in Australian medical curricula: The student perspective

Background

Use of complementary medicine in Australia is increasing. Despite documented high use, however, perspectives of complementary medicine teaching inclusion within health professions education are poorly documented and understood.

Towards the Evidence-Based Integration of Complementary Medicines into Hospital Settings

The use of complementary medicine products offers potential benefits to hospital patients, yet very little is currently known about their use in Western hospitals or the extent of their potential risks and benefits. Hospital patients may be at higher risk from adverse events from complementary medicines than the general population because they take more pharmaceutical preparations, have poorer health and are at much higher risk of bleeding complications. The potential risks associated with complementary medicine use in hospital patients raises concerns for patient safety, yet it appears that hospital patients often fall into the divide created between community use of complementary medicines, which is widespread, and the hospital system, which does not support this use. Very few hospitals have well developed policies or guidelines on complementary medicine use, and few hospital staff have the necessary training to evaluate the use of complementary medicines and make appropriate recommendations to patients. This is compounded by the fact that complementary therapists generally do not have practice rights within most hospitals and patient disclosure of complementary medicine use to hospital staff appears to be poor. There are a number of recommendations that may minimise risks and facilitate the evidence-based use of complementary medicines in hospital settings. Recommendations include (a) all hospital medical staff and general practitioners should ask patients about their use of complementary medicines, and this use should be documented in the medical record and care plans; (b) complementary medicine use in hospitals should be recorded on the medication chart and included in discharge summaries; and (c) adequate training is required to ensure hospital staff have the appropriate skill to advise patients about the safe and appropriate use of complementary medicines, and appropriate resources should be available to all staff members. If hospital medical staff advise against the use of complementary medicine, reasons for this recommendation should be clearly communicated to the patient and their carers and documented in the patient’s medical record. Hospitals should appoint a dedicated staff member, ideally with both mainstream and complementary medicine qualifications, to take a leadership role regarding maintaining and disseminating information about complementary medicine use. Where appropriate, hospital staff should communicate with patients’ usual healthcare practitioners, including naturopaths and herbalists, at admission and discharge. In cases where patients want to continue or initiate use of complementary medicine while in hospital, they should have access to an appropriately trained practitioner who is able to ensure their needs are met in a safe and appropriate way.     

Use of complementary and alternative medicine among people living with diabetes: literature review

AIM: This paper is a report of a literature review to explore the prevalence of complementary and alternative medicine use amongst people with diabetes to inform nursing practice, education and research. BACKGROUND: Diabetes mellitus affects the entirety of a person's being and increasingly people use complementary and alternative medicine in conjunction with other medical treatments and lifestyle modifications to manage their condition and improve well-being. METHODS: The CINAHL, Medline, ProQuest nursing journals and Psych INFO databases were searched for the period 1990-2006 using identified keywords. RESULTS: A total of 18 studies from nine countries were found. The results suggest that the prevalence of complementary and alternative medicine use among people with diabetes ranges from 17% to 72.8%. The most widely used therapies among diabetic populations are nutritional supplements, herbal medicines, nutritional advice, spiritual healing and relaxation techniques. The characteristics which influence complementary and alternative medicine use are age, duration of diabetes, degree of complications and self-monitoring of blood glucose. CONCLUSION: Although inconsistency in the definition of complementary and alternative medicine and varying research designs make estimation of usage prevalence difficult, evidence suggests that a high proportion of people with diabetes use these therapies concurrently with conventional healthcare services. Healthcare professionals need to be aware of this issue and may need to incorporate complementary and alternative medicine information into patient assessment and intervention.     

Are interventions recommended by pharmacists during Home Medicines Review evidence‐based?

Introduction Over the past decade medication review services have been implemented in many countries, including Australia, UK and USA. Although, the attitudes and barriers to the implementation of evidence‐based medicine have been investigated, the extent to which medication review recommendations are evidence‐based is not known. Objective To determine (1) the extent to which pharmacist's recommendations during medication review services were consistent with the evidence‐based guides at the time of the review; and (2) the nature and extent of drug‐related problems (DRPs) and the actions recommended by pharmacists to resolve DRPs. Method A retrospective review of Home Medicines Review cases performed on 224 community‐dwelling older people (65 years or older). The chi‐squared test for categorical variables was used to compare the proportion of recommendations that were evidence‐based and recommendations for which no evidence could be identified in the most common Australian information sources. DRPs and the actions recommended to resolve the DRPs were classified according to previously employed criteria. Results Pharmacists made a total of 1114 therapeutic recommendations to general practitioners, of which 964 required supporting pharmacotherapeutic evidence. The majority (94%) of the pharmacists' recommendations were in accordance with the evidence‐based guides, as compared with the recommendations for which no evidence could be identified (P < 0.001). Pharmacists reported that 98% of the patients had at least one problem with use of their medication detected. Conclusion The majority of the actions recommended by pharmacists during the medication review process were consistent with the literature embedded in key Australian information sources. Medication management in older people is complex and challenging, as highlighted by the DRPs identified in 98% of our patients. A suitably trained pharmacist, with full access to the patient, medical record and supporting resources, can help to improve the quality use of medicines in this at‐risk population.     

Learning for heart failure patients (The L‐HF patient study)

Aim and objective. To investigate the learning style and preferences for information delivery of heart failure patients for the purpose of informing the design of educational resources. Background. Patient education is a vital component of heart failure management programmes however the content and delivery of education varies in each programme. Traditionally education programmes for patients have focussed on educational needs as identified by health care providers however research has shown there are discrepancies between patients’ and nurses’ perceptions of the learning needs of heart failure patients. There is no evidence that educational programmes for heart failure patients are based on identification of patients learning needs or their preferred learning style. Design. Qualitative. Method. A purposive sample of 12 participants, diagnosed with heart failure and enrolled in a heart failure management programme, participated in semi‐structured interviews. Results. Four themes emerged: knowledge quest (L‐loading), barriers to learning (L‐inhibitors), facilitators for learning (L‐agonists), and meeting educational needs (L‐titration). Integral to these themes was the participant’s relationship with health care professionals. Conclusion. This study provides unique information regarding the preferred learning modality of heart failure patients and, as such, serves to inform the development of appropriate education resources specifically tailored for this population. Relevance to clinical practice. The development of effective modes of education is likely to further enhance heart failure management programmes service organisation and delivery and improve health outcomes for heart failure patients.     

Attitudes towards, and information needs in relation to, supplementary nurse prescribing in the UK: an empirical study

Aims and objectives. The main aim of the study is to assess the views of people, who have not yet experienced nurse prescribing, to determine their level of confidence in nurse as opposed to doctor prescribing, effects on likely adherence and concerns that they might have. Additionally, the extent to which people would want nurses to provide an explanation for medicine choice and the type of information wanted was examined. Background. Nurse prescribing has been successfully implemented in the UK in a number of healthcare settings. Existing research has not addressed effects on people's confidence and likely adherence, nor have people's information needs been established. However, we know that inadequate medicines information provision by health professionals is one of the largest causes of patient dissatisfaction. Methods. A convenience sample of 74 members of the general population self‐completed a written questionnaire. Results. In general, people would have confidence in the nurse having prescribed the best medicine and say that they would be very likely to take the medicine. Concerns identified did not specifically relate to the nurses’ status. Support is provided for the importance of nurses providing a full explanation about medicines, and some indication about which categories of information should be included. Information about medication side effects was most wanted by participants. Conclusions. Independent and Supplementary Prescribing are pivotal to modernizing the NHS. The current study establishes people's initial views and concerns about nurse prescribing and assesses information needs. Support for initiating follow‐on studies with particular patient groups is also provided. Implications for clinical practice. People who have not yet experienced nurse prescribing are, in general, positive about nurses adopting this role. It is important that nurses provide appropriate information about the prescribed medicines, in a form that can be understood. This should include information about medication side effects.     

Evidence databases application: comparison of university faculties versus clinical residents in a developing country

Rationale, aims and objectives One of the main barriers against the implementation of evidence‐based medicine (EBM) is the lack of search skills, an element that affects the finding of the best available evidence. Faculty staff should be capable of using the best evidence in practice and of teaching students to implement EBM elements. They should be familiar with search strategies and evidence databases. The aim of this study is to compare the application of evidence databases by faculties and by residents with no training in this field. Methods Two hundred fifty‐seven faculties and first‐year residents of the Tabriz University of Medical Sciences filled out a valid self‐administered questionnaire on information‐seeking behaviour from August 2008 to June 2010. A chi‐square test was used to compare the variables. Results There were 52.1% of the respondents who were faculty members and 47.9% were residents. Only 8.7% used the Internet for their practice mostly. While Google was the most used resource, TRIP and Cochrane were less used. Significantly, the faculties used these resources more than the residents in both cases. Furthermore, two‐thirds of the participants were unfamiliar with medical subject headings (MeSH), and only 14.5% consulted a clinical librarian for help. Conclusion Significantly, clinicians used evidence databases and online resources minimally for their practice. Additionally, as the faculties used EBM resources more than the residents, this programme should be considered for inclusion in the curricula of medical schools.     

Medicines for chronic illness at school: experiences and concerns of young people and their parents

Background and objective: Access to medicines by young people with chronic conditions during the school day and suitable environments and support in the administration of a range of dosage forms may be required for optimal clinical management. Whilst Government policy emphasizes that children and young people with chronic illness should be able to lead as normal lives as possible, there is only limited evidence on the experiences and concerns of young people and their parents regarding the use of medicines at school and the impact on school life. The objective of this study was to examine the experiences and concerns of young people with chronic conditions, and their parents/carers, in managing medication at school. Methods: Data were gathered in audio‐recorded face‐to‐face semi‐structured interviews with 27 young people (5–18 years) and their parents attending out‐patient clinics at a major London teaching hospital. Open‐ended questions provided an opportunity for participants to describe experiences and views in the context of their activities, priorities and concerns and enabled a qualitative analysis. Results and discussion: The findings indicated that storage and access of medicines did not present major problems for young people receiving regular medication. However, those receiving medication on a ‘when required’ basis reported barriers to access. The most common concern regarding taking medication was lack of privacy, which sometimes led to non‐adherence. Adverse effects of medication were highlighted as a cause of both non‐adherence and poorer school performance. Extracurricular activities such as school trips were not viewed as presenting a problem by those who were interviewed. However, this was often because young people and their families devised their own strategies regarding the use of medicines that did not depend on the input of staff. There was wide variation in responses about the support young people received from school staff, with evidence of helpful and unhelpful practice. The potential benefits of liaison between schools and health professionals to assist schools in their support of students with their medicines were highlighted. Conclusion: This study has identified medication‐related issues from the perspective of young people and their parents, indicating ways in which their needs might be served more sensitively and effectively.     

四川省双流县永安中心卫生院基本情况现状调查

目的调查四川省双流县永安中心卫生院服务与经营现状,为乡镇卫生院卫生技术人员配置和国家基本药物目录实施提供基线数据。方法采用问卷调查加专题访谈的方式调查该中心卫生院基本情况,内容包括一般情况、人员、经营及业务状况、基本药物目录实施情况等。结果该中心乡镇卫生院硬件条件良好,服务人群的经济水平和健康状况较好。卫生院医护比、医药比高于全国平均水平。医院员工大专以上学历占61.6%,88%的员工为初级及以下职称,人员流失与流入基本持平。2009年药品收入占业务收入的53.6%,医药费用比2008年增加。医院于2010年4月1日起实行基本药物目录,尚无相关配套技术文件。结论四川省双流县永安中心卫生院基础条件较好,但作为西部小康型乡镇卫生院,存在卫生技术人员结构不合理、学历和资质不高及员工流动性大等问题,需制定相应政策和不断完善相应措施。完全实行基本药物零差价销售可能对医院经营造成较大影响,需及时足额补贴及政策配套才能维持现有卫生服务水平。     

成都市三圈七个乡镇和社区卫生服务机构药房管理和药品配送情况——三圈七院六站预调查报告之六

目的通过预调查了解成都市部分基层医疗卫生服务机构（三圈七院六站）药品管理、配送和监督网络情况,为循证建立成都市基层基本药物制度,保障药品供应提供证据。方法由经培训的研究人员采用访谈法调查成都市7个乡院／中心和6个村站药品配送情况和农村药品配送和监督网络（简称“两网”）建设情况。实地调查药房药品购销记录和药房环境;并与欧美发达国家药品分类管理、每千人药房数量和药剂师执业情况比较。结果①除人和卫生院因搬迁致药品管理资料遗失外,预调查的7个乡院／中心均有药品购销记录,并设有专人和设备养护在库药品。②仅3家药房使用电子药品数据库,数据库稳定性和功能有待加强。③预调查的5个乡院和5个村卫生站均通过农村药品配送和监督网络,实现药品每周1次的统一配送,保证了农村药品可及性。城市社区卫生服务中心药品配送基于传统的商业流通渠道,每周配送3次。村卫生站存在药品记录缺失,药品陈列不规范的问题。结论建议开发稳定可靠的药房电子信息管理系统,结合当地疾病负担和当前最佳证据制定乡院和村站的基本药物目录,加强乡院／中心对卫生站的指导、监督,规范卫生站药品管理,加强农村药品配送和监督网络建设,保障基本药物的供应。     

Attitudes of Australian pharmacists toward complementary and alternative medicines

BACKGROUND: The increase in the use of complementary and alternative medicine (CAM) by the general public has led to increasing interest in how health professionals view these therapies. OBJECTIVE: To determine the knowledge and attitudes of pharmacists toward CAM. METHODS: An anonymous, self-administered questionnaire was designed and mailed to 1500 randomly selected pharmacists in New South Wales, Australia. RESULTS: Four hundred eighty-four responses were received, with 77% of respondents indicating that they had personally used CAM and 60% correctly identifying that CAM was comprised of more than just botanicals and nutritional agents. The most commonly used CAMs were herbal and vitamin supplements (74%), which was significantly above use of the next most frequent CAM, massage therapy (6%). Most pharmacists (71%) reported offering CAM products for sale; however, 27% of these practices did not have access to CAM information for pharmacy staff or patients. Pharmacists generally viewed CAM positively and believed that they enhanced the customers' image of pharmacy (57%), increased customer numbers (87%), and could increase annual sales (72%). Ninety-one percent of respondents believed that it is necessary for pharmacists to have knowledge of both CAM and conventional medicine to be able to inform patients about their treatment options. Books and journal articles were their primary information sources, with the main reasons for recommending CAM evidence of efficacy and to maintain general health. CONCLUSIONS: CAM use is prevalent among Australian pharmacists. While pharmacists are aware of their role as educators about both CAM and conventional medicines, there is a need for greater access to CAM resources and education on these therapies.     

An international exploration of blended learning use in pre-registration nursing and midwifery education

AimTo explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy.BackgroundThe global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere.DesignCross-sectional, sequential, mixed methods studyParticipants/settingsNursing/nurse education leaders from across International Council of Nurses regionsMethodsExploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants’ knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes.ResultsParticipants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation.ConclusionsBlended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact.Tweetable abstractBlended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach.     

Counterfeit medicines in Poland: opinions of primary healthcare physicians,nurses and lay persons

Aims and objectives. To gain information concerning disparities in the understanding of the counterfeit medicines phenomenon between healthcare workers and lay persons. Background. Central‐eastern Europe is facing significant challenges in combating a multi‐billion euro, and often lethal, trade in counterfeit medicines. It is a major challenge especially for primary healthcare workers to expand the understanding of counterfeit medicines to the benefit of patients. Design. Use of questionnaires. Two separate questionnaires were distributed, one for healthcare professionals and the other for lay persons. Methods. Conducted between September 2009–May 2010. One thousand and seventy‐eight primary healthcare professionals and 377 lay persons were surveyed. Results. Findings revealed less awareness among healthcare professionals than lay persons about the danger of purchasing illegal medicines or dietary supplements outside pharmacies. Healthcare professionals have lower levels of awareness about the scale of counterfeit medicines as well as threats of counterfeit medicines to health than lay persons. The majority of medical workers do not know the procedure for reporting suspicious medicine and do not warn their patients against purchasing medicine from unknown sources. Conclusions. Primary healthcare workers have less awareness of the scale of the counterfeit medicines phenomenon than lay persons. Relevance to clinical practice. Nurses and physician need to become aware of the counterfeit medicines phenomenon. Nurses are well positioned to assume the active role in educating patients about the threat of the presence of counterfeit medicines so as to enhance safety for their patients. However, to accomplish that aim, these findings suggest that healthcare professionals need to become better educated about counterfeit medicines and need to be trained in skills to identify counterfeit medicines.     

A cross-sectional survey examining the extent to which interprofessional education is used to teach nursing,pharmacy and medical students in Australian and New Zealand Universities

The current status of interprofessional education (IPE) in Australian and New Zealand universities is largely unexamined despite its generally acknowledged benefit. Data are also limited about the use of IPE in teaching medication safety to nursing, pharmacy and medical students. For this reason a web-based cross-sectional survey was used to gather information from Australian and New Zealand universities offering nursing, pharmacy or medical programs. Responses were received from 31 of the 43 (72%) target universities. Eighty percent of the participants indicated that they currently offer IPE experiences, but only 24% of these experiences met the accepted definition of IPE. Of the participants who offer IPE as defined by Center for the Advancement of Interprofessional Education, only 50% use it to teach medication safety. Timetabling restrictions and lack of appropriate teaching and learning resources were identified as the main barriers to implementation of IPE. All participants reported that staff development, multi-media and e-learning resources would be beneficial to IPE initiatives and the teaching of medication safety. Innovative approaches will be needed to overcome the barriers and facilitate the uptake of quality IPE more broadly. Web-based and e-learning options promise a possible way forward, particularly in the teaching of medication safety to nursing, pharmacy and medical students.     

European Pain Federation (EFIC) position paper on appropriate use of cannabis‐based medicines and medical cannabis for chronic pain management

Cannabis‐based medicines are being approved for pain management in an increasing number of European countries. There are uncertainties and controversies on the role and appropriate use of cannabis‐based medicines for the management of chronic pain. EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper to empower and inform specialist and nonspecialist prescribers on appropriate use of cannabis‐based medicines for chronic pain. The expert panel reviewed the available literature and harnessed the clinical experience to produce these series of recommendations. Therapy with cannabis‐based medicines should only be considered by experienced clinicians as part of a multidisciplinary treatment and preferably as adjunctive medication if guideline‐recommended first‐ and second‐line therapies have not provided sufficient efficacy or tolerability. The quantity and quality of evidence are such that cannabis‐based medicines may be reasonably considered for chronic neuropathic pain. For all other chronic pain conditions (cancer, non‐neuropathic noncancer pain), the use of cannabis‐based medicines should be regarded as an individual therapeutic trial. Realistic goals of therapy have to be defined. All patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to reach the predefined goals and/or the patient is additionally burdened by an unacceptable level of adverse effects and/or there are signs of abuse and misuse of the drug by the patient, therapy with cannabis‐based medicines should be terminated.

Significance

This position paper provides expert recommendations for nonspecialist and specialist healthcare professionals in Europe, on the importance and the appropriate use of cannabis‐based medicines as part of a multidisciplinary approach to pain management, in properly selected and supervised patients.     

A cross-sectional survey examining the extent to which interprofessional education is used to teach nursing, pharmacy and medical students in Australian and New Zealand Universities

The current status of interprofessional education (IPE) in Australian and New Zealand universities is largely unexamined despite its generally acknowledged benefit. Data are also limited about the use of IPE in teaching medication safety to nursing, pharmacy and medical students. For this reason a web-based cross-sectional survey was used to gather information from Australian and New Zealand universities offering nursing, pharmacy or medical programs. Responses were received from 31 of the 43 (72%) target universities. Eighty percent of the participants indicated that they currently offer IPE experiences, but only 24% of these experiences met the accepted definition of IPE. Of the participants who offer IPE as defined by Center for the Advancement of Interprofessional Education, only 50% use it to teach medication safety. Timetabling restrictions and lack of appropriate teaching and learning resources were identified as the main barriers to implementation of IPE. All participants reported that staff development, multi-media and e-learning resources would be beneficial to IPE initiatives and the teaching of medication safety. Innovative approaches will be needed to overcome the barriers and facilitate the uptake of quality IPE more broadly. Web-based and e-learning options promise a possible way forward, particularly in the teaching of medication safety to nursing, pharmacy and medical students.     

Over-the-counter medicine abuse – a review of the literature

Background: The sale of over-the-counter (OTC) medicines from pharmacies can help individuals self-manage symptoms. However, some OTC medicines may be abused, with addiction and harms being increasingly recognised. This review describes the current knowledge and understanding of OTC medicine abuse.

Approach: Comprehensive search of international empirical and review literature between 1990 and 2011.

Findings: OTC medicine abuse was identified in many countries and although implicated products varied, five key groups emerged: codeine-based (especially compound analgesic) medicines, cough products (particularly dextromethorphan), sedative antihistamines, decongestants and laxatives. No clear patterns relating to those affected or their experiences were identified and they may represent a hard-to-reach group, which coupled with heterogeneous data, makes estimating the scale of abuse problematic. Associated harms included direct physiological or psychological harm (e.g. opiate addiction), harm from another ingredient (e.g. ibuprofen-related gastric bleeding) and associated social and economic problems. Strategies and interventions included limiting supplies, raising public and professional awareness and using existing services and Internet support groups, although associated evaluations were lacking. Terminological variations were identified.

Conclusions: OTC medicine abuse is a recognised problem internationally but is currently incompletely understood. Research is needed to quantify scale of abuse, evaluate interventions and capture individual experiences, to inform policy, regulation and interventions.     

Performance care practices in complementary and alternative medicine by Thai breast cancer survivors: An ethnonursing study

The purpose of this study was to explore how Thai breast cancer survivors perform care practices in complementary and alternative medicine to promote their health and well-being. Research was conducted using an ethnonursing method. Data were collected through semi-structured interviews with 17 Thai breast cancer survivors in Thailand. The transcribed interviews were analyzed using the ethnonursing analysis method. The findings showed Thai breast cancer survivors started their care practices in complementary and alternative medicine immediately following a diagnosis of breast cancer. They sought out and gathered alternative medicine information from several sources, such as the people around them, media resources, books, magazines, or newspapers. After gathering information, Thai breast cancer survivors would try out various types of complementary medicines rather than use only one type because of information from other people and their own evaluation. The findings of this study indicate the need for a conversation about complementary medicine use between healthcare providers and Thai breast cancer survivors as an on-going process throughout the cancer trajectory to ensure that safe and holistic care is provided.     

How much is the life of a cancer patient worth? A pharmaco‐economic perspective

What is known and Objective: Countries struggle to accommodate the introduction of new effective cancer medicines, while containing costs. Our objective is to comment on several pharmaco‐economic challenges involved in determining the value of cancer medicines by reviewing cost‐effectiveness thresholds for cancer medicines in several countries and by discussing the cost‐effectiveness of anti‐cancer biotechnology and orphan medicines. Comment: A literature search was carried out of PubMed, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews and EconLit up to August 2009. Health technology assessment agencies in England and Scotland are willing to incur a higher cost per quality‐adjusted life year for cancer medicines than for other medicines. Risk‐sharing arrangements have been implemented to optimize the value of cancer medicines. The cost‐effectiveness of biotechnology medicines in cancer care is challenged by their high price, and depends on the ability to identify the most responsive target population, through use of suitable biomarkers. The evaluation of orphan medicines in cancer care needs to balance the absence of an alternative therapy for a life‐threatening disease against the high cost‐effectiveness ratio, and usually weak clinical data. What is new and Conclusion: Current strategies used to inform decisions on the funding of expensive anti‐cancer medicines are commented on to highlight important issues and problems. Pharmaco‐economic evaluation is an important tool for assessing the value of cancer medicines and to inform evidence‐based decision making in cancer care. Value‐judgments such as preferential consideration of anti‐cancer medicines can then be made explicitly.