A post-code lottery still exists for cancer patients with “exceptional circumstances”

Between July 2006 and May 2008, 102 requests for funding for patients with “exceptional circumstances” were made to a total of 27 surrounding PCTs. The funding decision was gained for 98 patients (4 awaited) and of these, 73% had their applications approved. However, while some PCTs had approval rates of 100%, others had very high rejection rates, with three of the 27 PCTs accounting for over half of all rejections.

Dr Mark Saunders, one of the authors said, “Even though the application process is the same, each PCT interprets whether they feel that a patient’s circumstances are exceptional in a different way.” He goes on to add” some patients in a clinic may get the drug they applied for, but others, with similar circumstances, do not. This has created a lot of anxiety for patients and considerable extra work for clinicians, hospitals and PCTs.”

Furthermore there was found to be a stark variance in the time it took for the PCT to respond to the application, causing further distress for the patient and family. The average time taken was 37 days; however the range was from 0-231 days.

Although this study is concentrated in Manchester, Dr. Saunders points out, “A lack of national guidelines for the application process means that these problems are likely to be encountered across the country. These results underline patients’ anxiety regarding availability of new treatments and a post-code lottery”.

If a patient cannot gain funding via the PCT, there is now the option of top-up payments for the non-approved treatment. However for many this will be an unaffordable and unrealistic option.