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Effect of the UK Postcode Lottery on Survival of Patients with Metastatic Renal Cancer: an Audit of Outcomes in Patients with Metastatic Renal Cancer Suitable for Treatment with Tyrosine Kinase Inhibitors |
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| Authors: | N. James J. Pascoe A. Zachariah D. Ray A. Oldroyd H. Parry H. Benghiat M. Karina S. Collins E. Porfiri |
| Affiliation: | 2. Cancer Research UK Institute for Cancer Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;3. Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;4. Quality Outcomes Research Unit, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK;1. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK;1. Department of Molecular Microbiology and Biotechnology, The George Wise Faculty of Life Sciences, Tel-Aviv University, Tel Aviv 69978, Israel;2. Department of Food Science, Institute of Technology and Storage of Agricultural Products, A.R.O., The Volcani Center, P.O. Box. 6, Bet Dagan 50250, Israel;3. Biology of Lactation Laboratory, Institute of Animal Science, A.R.O., The Volcani Center, P.O. Box 6, Bet Dagan 50250, Israel;4. National Mastitis Reference Center, Kimron Veterinary Institute, P.O. Box 12, Bet Dagan 50250, Israel;1. Laboratorio de Nocicepción y Dolor Neuropático, Instituto de Biología y Medicina Experimental, CONICET, Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina;2. Laboratorio de Bioquímica Neuroendócrina, Instituto de Biología y Medicina Experimental, CONICET, Vuelta de Obligado 2490, C1428ADN, Buenos Aires, Argentina;3. Departamento de Bioquímica Humana, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121ABG, Buenos Aires, Argentina;1. Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois;2. Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri;3. Department of Medicine, Washington University School of Medicine, St. Louis, Missouri;4. Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri;5. Division of Cardiac Surgery, University of Massachusetts Medical School, Worcester, Massachusetts;1. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana;3. Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;4. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan;6. Duke Clinical Research Institute, Durham, North Carolina;5. Liver Disease Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland |
| Abstract: | AimsTo determine whether primary care trusts’ agreement or refusal to fund sorafenib or sunitinib affects outcomes for patients with metastatic renal cell carcinoma.Materials and methodsThis retrospective audit was conducted in a tertiary referral centre for urological cancer. Requests to prescribe drugs not approved by the National Institute for Health and Clinical Excellence are recorded on a trust database. We obtained details of all requests made for sunitinib and sorafenib for patients with renal cell carcinoma since licence in 2006. Outcome measures analysed were overall survival measured from the date of request for funding and hospital resource use as measured from Payment by Results data. Known prognostic factors and the patient's Index of Multiple Deprivation score were assessed at baseline as potential confounders of survival difference.ResultsSeventy-nine patients were identified. The groups were similar with respect to prognostic factors and Index of Multiple Deprivation scores. Thirty-seven and eight patients had funding approved for sunitinib and sorafenib, respectively; 21 and 13 were turned down. Seven patients who were denied funding received one or other of these drugs by self-funding treatment. Survival was longer for patients who received treatment with a drug for which they had applied for funding than for those who did not (hazards ratio 0.46; 95% confidence interval 0.21–1.01; χ2 = 3.80; 1 d.f.; P = 0.05); the advantage was similar for patients receiving sunitinib (hazards ratio = 0.49; 95% confidence interval 0.18–1.36; χ2 = 1.86; 1 d.f.; P = 0.17) and sorafenib (hazard ratio = 0.44; 95% confidence interval 0.11–1.69; χ2 = 1.58; 1 d.f.; P = 0.21). Overall National Health Service resource use apart from funding for the renal cancer drugs was similar for both groups.ConclusionsCompared with patients receiving treatment, patients denied access to sunitinib and sorafenib had substantially worse survival outcomes, despite receiving treatment from the same clinical team. Access to the new drugs did not have an effect on overall use of National Health Service resources by funded patients. Modern treatments for advanced renal cancer should be available to all National Health Service patients with the disease. |
| Keywords: | Renal cell carcinoma sorafenib sunitinib tyrosine kinase inhibitors |
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