There are nearly 43,000 new bowel cancer cases in the UK every year, making it the fourth most common cancer in the UK and the second leading cause of cancer deaths, with more than 16,500 patients per year dying of the disease.

When bowel cancer can’t be completely removed by surgery, patients may be offered chemotherapy to shrink the tumour. Cetuximab may also be offered alongside the less toxic chemotherapy. Cetuximab works by targeting tumours with a defect in a particular pathway in the tumour cell.

When patients have a break from chemotherapy, they will continue to receive cetuximab alone. Despite a previous clinical trial that showed intermittent cetuximab to be a safe alternative to continuous cetuximab, treatment breaks beyond six weeks were prohibited in England. In other words, patients were required to continue to take cetuximab when on a break from chemotherapy, despite evidence that a break in cetuximab does not have any negative impact on patient outcome but can potentially benefit the patient’s quality of life.

This new research, led by Queen’s University Belfast in collaboration with Bowel Cancer UK and a series of investigators across the UK, involved a historical analysis of both intermittent and continuous cetuximab approaches to determine their impact on both quality-of-life and treatment costs. The research has been published in the Journal of Cancer Policy, the key policy journal for cancer

Using a health economic modelling and analysis approach, the researchers found that employing a treatment break approach with cetuximab would not have any negative impact on a patient’s quality-of-life and outcome, but could potentially save up to £1.2 billion for the health service. This work formed part of the crucial evidence that Bowel Cancer UK presented to NHS England to justify a change in bowel cancer treatment policy.  This led to a temporary policy change by NHS England, removing the treatment break restrictions during the COVID-19 pandemic.

Dr Lisa Wilde, Director of Research and External Affairs at Bowel Cancer UK, comments: “Bowel cancer is the fourth most common cancer in the UK. We’ve been campaigning for several years to remove the treatment breaks policy in England, so we warmly welcome this scientifically-validated new evidence. It is clear that allowing people with advanced bowel cancer to take a break from their treatment benefits patients and saves the NHS money.

“At the beginning of the COVID-19 pandemic, NICE produced interim treatment guidance to maximise the safety of patients with cancer and make the best use of NHS resources, including allowing some patients to take breaks from their treatment. We’ve been working with NHS England to develop new guidance and hope to see this evidence reflected within the new recommendations.”

Professor Mark Lawler, Chair in Translational Cancer Genomics, Professor of Digital Health at Queen’s University Belfast, and senior author on the study, said: “This study is the first of its kind to use a cost minimization approach to look at the real costs of cancer therapies in the clinical trial setting. It highlights how substantial cost savings can potentially be achieved by reducing treatment, while also reinforcing the importance of therapy breaks to potentially increase tumour responsiveness to treatment once the therapy is reintroduced.

“Our study highlights how precise health economic evidence can influence health policy, championing reduced treatment intensity approaches without compromising patient outcomes, which is of particular relevance when addressing the reduced capacity and severe treatment backlogs experienced during the COVID pandemic.”

Dr Raymond Henderson, Senior Health Technology Assessment Manager at Salutem Insights Ltd and lead author on the paper, said: “Allowing patients to avail of treatment breaks not only can provide good value but also can enhance their quality of life and outcome.”

The study involved researchers from Queen’s University Belfast, Cardiff University, Imperial College London, University Hospital Leeds, University of Oxford, King’s College London, Bowel Cancer UK, Salutem Insights Ltd and Mount Vernon Centre for Cancer Treatment. Funding was through a Medical Research Council – Cancer Research UK Stratified Medicine Grant, a Health Data Research UK (HDR UK) grant, a grant from Cancer Focus Northern Ireland and through the Queen’s University Belfast Foundation.

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