NHS uptake of NICE-approved medicines varies according to location and disease area, according to the Health and Social Care Information Centre (HSCIC).

The HSCIC report shows that for 13 disease areas where comparison was possible, use of NICE-approved drugs was above the expected level in six and below it in six.

Roche’s cancer drug Herceptin (trastuzumab) was among several medicines whose prescription level was lower than expected.

Comparisons between NHS organisations indicate regional variation.

However, HSCIC Chief Executive Tim Straughan said: “Anyone interpreting the figures needs to be clear about the limitations of what the data show and it would certainly be wrong to think they definitively show drugs are being either ‘under’ or ‘over’ prescribed.”

Medicines whose uptake was higher than expected included carmustine implants and temozolomide (for brain cancer), varenicline (for smoking cessation), insulin glargine and detemir (for type 1 diabetes), statins (for high cholesterol) and drugs for osteoporosis.

Medicines whose uptake was lower than expected included riluzole (for MND), naltrexone (for heroin addiction), trastuzumab (for breast and gastric cancer), prucalopride (for chronic constipation), febuxostat (for gout) and drugs for acute coronary syndrome.

Steve Oldfield, Managing Director UK & Ireland of Sanofi, commented: “Many of the medicines appraised by NICE which are absent from the report are not reaching patients as quickly as they should, as local funding pressures in the NHS start to bite.

“More worryingly still, the very latest medicines launched in the last two years are being used significantly less than expected.”

Over two-thirds of brain cancers, and a third of all cancers, in NHS patients aged over 70 are only diagnosed following emergency hospital admissions.

A study by the National Cancer Intelligence Network found that elderly patients made up two-thirds of the patients whose cancers were diagnosed by that route.

Importantly, it found that patients were far less likely to survive a year if their diagnosis came through A&E rather than an outpatient referral.

According to the study, which looked at 750,000 patients in England, 70% of brain cancers, 55% of pancreatic cancers and 52% of liver cancers in patients aged over 70 were diagnosed via emergency admissions in 2006–8.

Also, 39% of all lung cancers were only diagnosed after an A&E admission.

Study co-author Sara Hiom, Director of Information at Cancer Research UK, said: “We don’t yet know the reasons that lie behind these stark figures, but we urgently need to understand why there is such a great proportion.”

Possible explanations were that elderly patients were “reluctant to bother their doctor,” she said, or that doctors were dismissing symptoms as ‘old age’. In some cases the A&E admissions were emergency GP referrals.

According to Professor Sir Mike Richards, the National Cancer Director, improved awareness of the symptoms of hard-to-detect cancers could reduce the need for emergency diagnoses.

“A public awareness campaign run in Leeds showed that the proportion of emergency presentations can be reduced,” he noted. “Correspondingly more patients were diagnosed through the urgent outpatient route.”

Siemens Healthcare Diagnostics has partnered with two pharmaceutical companies, ViiV Healthcare and Tocagen, to develop diagnostic tests alongside targeted drugs for HIV and cerebral cancer.

As ViiV Healthcare is a joint venture of Pfizer and GSK focused on HIV treatment, the partnership represents a collaboration of leading pharma and medtech companies.

It also signals major company investment in ‘stratified medicine’, where drugs targeting narrow patient groups are developed alongside ‘companion diagnostics’ to identify suitable patients.

Siemens CEO Michael Reitermann said the new projects would “align Siemens with new classes of therapies tailored to the individual”.

ViiV Healthcare will partner with Siemens for clinical trials of its first-in-class CCR5 co-receptor antagonist Celsentri (maraviroc) and investigate the commercial prospects of a diagnostic test to assist in patient selection.

Celsentri was licensed in 2007 in Europe and the US as a treatment for CCR5-tropic HIV. It is currently in a phase III study to establish its efficacy in combination with darunavir/ritonavir.

The planned trials will put the combination head-to-head with the combination of Gilead’s Truvada and darunavir/ritonavir.

US company Tocagen will partner with Siemens to produce diagnostic tests to support clinical trials of Tocagen’s viral gene therapy Toca in two forms, injectable Toca 511 and extended-release Toca FC tablets, in treating primary brain cancer.

For diagnostics companies such as Siemens, gaining access to the companion diagnostics market – which is already worth $1.5bn – depends on collaboration with pharma companies.

A 37-year-old army veteran denied access to a potentially life-prolonging cancer drug has protested against the ‘postcode lottery’ in NHS access to drugs.

Father of two Mark Bannister, who has terminal cancer of the brain, was told by his consultant that the drug Avastin (tamoxifen) could extend his life by two years.

However, while Avastin is available on the NHS in his consultant’s town, it is not available in his own town 15 miles away – across the divide between NHS Yorkshire and the Humber (where Mr Bannister is treated) and NHS East Midlands (where he lives).

Avastin can ‘starve’ a tumour by preventing blood vessels from reaching it. The drug is not ‘readily approved’ by NICE, and so decisions about its allocation are made by the Cancer Drugs Fund on a regional basis.

The case has highlighted concern about health inequalities and the ‘postcode lottery’ that differentiates access to therapies by location.

Mr Bannister commented: “I’m just so angry that people can play with your life by saying who can and can’t have treatment.”

The likely impact of NHS reforms on the ‘postcode lottery’ remains uncertain, with many GPs claiming that local budget constraints will prevent them from prescribing according to need.

While the Government has announced plans to improve the implementation of NICE guidance, it is likely that drugs not recommended by NICE will become less available in the near future.

A new study of 350,000 mobile phone users has found no link between mobile use and incidence of brain cancer.

The Danish study, which follows months of argument over the possible risks of wireless communication devices, does not include people who use mobile phones in their work.

The National Radiological Protection Board (NRPB) in the UK has said the study “lacks statistical precision” and is not conclusive, though Cancer Research UK has noted that it provides “the strongest evidence yet” for the safety of mobile phones.

Mobile healthcare or mHealth is one of the fastest-growing areas of medical technology, and experts such as health consultant David Lee Scher have recognised its potential to enable ‘participatory medicine’.

Led by the Institute of Cancer Epidemiology in Denmark, the new study looked at 350,000 mobile phone users over 18 years. It found no increased incidence of gliomas and other brain cancers.

The researchers said their study could not rule out potential risks to children and to people whose work includes heavy mobile phone usage.

Hazel Nunn, Head of Evidence and Health Information at Cancer Research UK, said the Danish study provided “the strongest evidence yet that using a mobile phone does not seem to increase the risk of cancers of the brain in adults.”

However, the NRPB, which advises the government on radiation safety, said the study was not large enough to be conclusive.

Two specialists interviewed in a recent Panorama programme said their own studies indicated cause for concern. Dr Lennart Hardell (Sweden) reported finding a strong correlation between location of brain tumours and the side of the head used for mobile phone calls. Dr George Carlo (USA) said his study indicated an increased risk of a rare type of brain cancer.

Dr Carlo commented: “This is not black and white... we have moved now into a grey area that needs to be looked into very, very carefully.”

In May 2011, a Council of Europe committee declared mobile phone usage to be “potentially harmful” and called on governments to “take all reasonable measures” to reduce their use, particularly in schools.

Shortly afterwards, the World Health Organisation included mobile phones in the same “possibly carcinogenic” category as lead and car exhaust fumes, and called for further research. The Danish study is a major step in that process.

A new imaging technique enables scientists to trace individual cancer cells as the growth of a tumour spreads through the brain.

Researchers at the Case Western Reserve University School of Medicine used cryo-imaging to look at a mouse model of glioblastoma multiforme, an aggressive cancer with no treatments to stop it spreading.

Susann M. Brady-Kalnay, Professor of Molecular Biology and Microbiology at the Case Western Reserve School of Medicine said: “We're able to see things we couldn't before, and we can use these images to understand how tumour cells invade and disperse”.

The cryoimaging system consisted of a fluorescence microscope, robotic imaging positioner, customized cryostat, PC-based control system, and visualization/analysis software. The technique alternates between sectioning and imaging, collecting colour brightfield and fluorescent blockface image volumes.

The scientists used a model that included four different cell lines of brain cancers at various stages of tumor development and dispersion. The cancer cells were modified with fluorescent markers and implanted in the model's brain.

Researchers found that two cell lines, a human brain cancer LN229, and a rodent cancer CNS-1, best resembled the actions of glioblastoma multiforme in human patients.

The ability to produce clear and detailed images will be invaluable when evaluating the potency of drugs and other therapies designed to block dispersal of glioblastoma multiforme cells.