How cancer treatments are made available

Cancer treatments, including drugs, are usually developed over years of careful research. This helps to show:

  • how the treatment works
  • which cancers it can be used to treat
  • what the side effects are
  • how it compares to current treatments.

This research is used to work out whether a treatment is effective and safe enough to be made widely available. Every treatment has side effects, but the research should show that the benefits of the treatment usually outweigh the risks. Drugs are licensed to show this.

In the UK, the two organisations that license drugs are:

Most new cancer drugs are licensed by the European Medicines Agency. Until a new drug has a licence, it can't usually be prescribed in the NHS.

A drug is licensed to be used in a particular way. For example, a drug that is licensed to treat breast cancer should not be used to treat any other type of cancer. If new research shows that the drug is also helpful in treating another type of cancer, the drug’s developer has to apply for another licence.

How the NHS decides about cancer treatments

Several organisations give advice about cancer treatments to the NHS:

  • In England and Wales, the National Institute for Health and Care Excellence (NICE) advises the NHS. NICE is an independent organisation. It gives advice on which new and existing treatments should be available in the NHS. It also advises on how illnesses like cancer should be treated.
  • In Wales, the All Wales Medicines Strategy Group (AWMSG) gives advice about drugs that haven’t been assessed by NICE.
  • In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) gives advice about treatment. The Scottish Medicines Consortium (SMC) advises about new drugs. Sometimes, the NHS in Scotland will also choose to follow NICE guidance on certain treatments.
  • In Northern Ireland, the Department of Health, Social Services and Public Safety (DHSSPS) reviews guidance produced by NICE. If it decides the advice can be applied to Northern Ireland, it will support it.

These organisations give advice based on how a new treatment compares to treatments that are already available and whether it is good value for money. The NHS is usually expected to follow the advice given. If the advice is to provide a treatment, the NHS should do this within a number of months. The timeframe is different across the UK and can depend on the treatment.

However, these organisations don't make decisions about all treatments used in the NHS. If they haven’t given advice, each NHS area makes their own decisions about whether to provide a treatment.

Despite this, it is still the doctor’s decision whether to use a treatment or prescribe a drug. If a treatment is not usually available, doctors may still be able to access it for some patients in some situations.

Why some cancer treatments are difficult to access

Across the UK, the NHS is split into smaller areas called local health bodies. Each nation has a different name for local health bodies:

  • In England, they are called Clinical Commissioning Groups (CCGs).
  • In Scotland and Wales, they are called health boards.
  • In Northern Ireland, they are called health and social care trusts.

Local health bodies must make sure the treatments they provide:

  • will benefit the people in their area
  • are a good use of their money.

This means that they may decide not to provide or pay for some treatments.

Local health bodies will often follow any advice from NICE or the other organisations in their area. If no advice has been given, the local health body make their own decision. If there is not enough evidence to show that a treatment is effective and safe, they may decide not to provide it.

Local health bodies keep a list of the treatments and drugs that they do not usually provide or pay for. But in some situations they will override this. Each local health body must have a process in place to make decisions about individual situations.

Back to Coming to your decision

Finding out your treatment options

Knowing basic information about your type of cancer and different treatments options can help you to make an informed treatment decision.

Making your decision

If  you’re struggling to come to a decision about treatment, try following these five steps.