The views of patients and the general public about expensive anti-cancer drugs in the NHS: a questionnaire-based study.

OBJECTIVES: To determine the views of patients and members of the public about who should pay for expensive new cancer drugs not recommended by the National Institute for Health and Clinical Excellence (NICE). DESIGN: A study-specific questionnaire was used to elicit the views of patients and the general public between April and June 2010. It examined whether participants thought patients should be told about all possible cancer treatments, if the NHS should always fund non-NICE recommended drugs and attitudes towards self-funding/co-payments. The influence of sociodemographic factors on responses was also examined. SETTING: Oncology clinics in Sussex and various locations including old persons' lunch clubs, parks, sports venues and support groups. PARTICIPANTS: Two hundred and 10 patients with common solid tumours, and 416 members of the general public MAIN OUTCOME MEASURES: Frequencies of responses to items regarding payments for expensive anti-cancer drugs stratified by sociodemographic factors and comparison of responses between patients and members of the public. RESULTS: Most respondents (70% [147/210] of patients and 64% [266/416] of the general public) had heard of NICE. Both groups believed that doctors should tell patients about all available cancer treatments even if the NHS cannot pay (94%, 196/208; 93%, 388/415). However, only 49% (101/207) of patients and 36% (146/409) of the public believed that the NHS should always fund all new cancer drugs that have failed health technology assessments. Strong predictors of willingness to purchase expensive new cancer drugs included younger age (<45 years), sex (female) and higher educational level. CONCLUSION: The general population appear realistic about the difficulties of providing funding for expensive new drugs. A communication skills training course has been developed to help clinicians with these difficult consultations.

The (mis)classification of chemo-fog--methodological inconsistencies in the investigation of cognitive impairment after chemotherapy.

BACKGROUND: A growing number of studies report cognitive impairment after chemotherapy; indeed the phenomenon of chemo-fog is now almost universally accepted. We are concerned however that there is little if any consistency in the way in which patients are classified as showing cognitive impairment or not. We aim to demonstrate that different methods of analysis produce markedly different results, making the true extent of impairment unclear. METHODS: We analysed data from 92 breast cancer patients 4 weeks post-chemotherapy and from 42 healthy controls using 7 different methods, each taken from a different research paper in the area of cognitive impairment post-chemotherapy. FINDINGS: The extent of impairment was dependent on the method of analysis. Impairment ranged from 12 to 68.5% in the chemotherapy group and from 4.8 to 64.3% in the healthy control group. INTERPRETATION: This brief report highlights the contrasting degrees of cognitive impairment calculated by using legitimate statistical methods and demonstrates the need for a collaborative effort to standardise our methods that we might better understand the phenomenon of chemo-fog.