Systemic Anti-Cancer Therapy Regimen Library
Frequently asked questions
What is the ACT-NOW programme?
The ACT-NOW (Anti-Cancer Therapy - Nationally Organised Workstreams) programme is about the best possible cancer care for patients in New Zealand. We want to ensure high quality, evidence-based and resource efficient care is delivered in New Zealand cancer centres. To achieve this we have developed consensus definitions and guidance regarding chemotherapy treatment regimens for the ‘big four’ cancer types – bowel, lung, breast and prostate. We’ve developed a process for development, oversight and implementation of new treatment regimens and are applying this process to the remaining cancer types.
This work has involved doctors, nurses, pharmacists and Te Aho o Te Kahu Cancer Control Agency working together to achieve comprehensive chemotherapy definitions.
This programme is the key quality improvement tool for medical oncology and malignant haematology. We will collate the most useful information about cancer treatments, access and outcomes from around the country. This will help us understand the best balance between resource use, efficiency, treatment side effects and outcomes. We understand that sometimes treatments are different because of patient factors or factors like geographical access to treatment. We expect this is a normal part of treatment. We will be able to identify unexplained variations in care that could be impacting on best treatment or outcomes.
What is SACT?
SACT or Systemic Anti-Cancer Therapy refers to a group of chemotherapy agents (cancer medicines) used to treat cancer. SACT also includes targeted therapies designed to act on specific molecular targets, immunotherapy to help the immune system, and supportive care medicines to reduce the side effects of treatment, such as nausea. SACT is delivered in regimens often containing combinations of multiple anti-cancer agents and supportive medications given according to a specific schedule.
What are regimens?
Regimens define the combinations of chemotherapy agents, targeted therapies, immunotherapy and supportive care medicines to be given to a person with cancer according to a specific schedule. Regimens will usually specify the treatment agents (or combination of treatment agents) to be used, their dosage, the frequency and duration, and how they should be administered (eg, intravenous infusion or oral tablets).
Why do we need to define regimens?
The SACT Regimen Library (SRL) has been designed to reflect current practice, not to constrain it. We need to understand variations in care that are necessary to support the needs of New Zealand communities and to identify variations in care that help meet the needs of communities and those that don’t. Defining regimens ensures that all providers are describing cancer treatments in the same way, so that they can be accurately counted and analysed.
What is the SACT Regimen Library (SRL)?
The SACT Regimen Library is a national database of chemotherapy treatment definitions that have been developed and endorsed by the clinical community. The objective of the SACT Regimen Library is to identify the range of chemotherapy treatment regimens in use and give each a clear name. Previously, cancer centres have used different names for similar treatments, and this has limited our ability to track these and improve care. Clinicians have agreed to a standard naming convention as part of working together to better understand how chemotherapy is being delivered in New Zealand and how we can improve treatment and outcomes for people with cancer.
What is the New Zealand Formulary?
The New Zealand Formulary is an expert and reliable source of information about medicines, funded by the Ministry of Health. The New Zealand Formulary hosts the SACT Regimen Library and manages its daily operation on behalf of Te Aho o Te Kahu Cancer Control Agency.
Why are paediatric cancers and clinical trials not included in the SACT Regimen Library?
We would like all cancer types for all cancer patients to be included in the Library. Pragmatically, we need to start somewhere and grow. We are focused on the most common adult cancers as our starting point, with a focus on equity first. We are absolutely committed to collaborating with the whole cancer sector. Our vision and hope is for all cancers and all people to be included in future.
How are SACT Regimen Library regimens developed?
The ACT-NOW programme brings representatives from New Zealand cancer centres across all cancer types together in the most ambitious and collaborative chemotherapy project to date. Under the umbrella of Te Aho o Te Kahu Cancer Control Agency these groups work together to identify current practice within NZ, to review the clinical evidence and to agree common naming conventions. All chemotherapy regimens currently in common use in public and private are included. Any discrepancies are resolved by consensus. Definitions are published in draft and consulted upon prior to publication. Expert technical review is undertaken by specialist pharmacists, nurse specialists, oncologists and haematologists.
How are regimens prioritised for development?
Regimen development is prioritised by cancer type, specifically:
- cancers that disproportionately affect Māori and other priority populations.
- cancers that have a significant disease burden in New Zealand
Secondary criteria will consider the availability of working group members to participate in national regimen development workshops and the need to balance the workload for these members.
What is the scope of the SACT Regimen Library (SRL)?
The SRL currently provides agreed regimens for the ‘big four’ cancers: bowel, lung, breast and prostate. During 2021/2022 the SRL aims to provide regimens for all cancer types within adult medical oncology and malignant haematology, including the key supportive care medicine components of these regimens.
Who is the ACT-NOW project for?
Ultimately the ACT-NOW project is for people affected by cancer to make sure they have the safest and the best treatment. Initially this means focusing on technical information about the components of chemotherapy regimens, which will be of most use to doctors, nurses and pharmacists involved in the delivery of care. ACT-NOW aims to grow to include patient information about cancer treatments.
I would like the ACT-NOW programme to do more…
So would we! This is very much a project in evolution, and this is the beginning of a long journey to improve patient care and outcomes. Every journey has first steps. We have tried to develop initial steps that meet core needs in common areas for common cancer types that address equity issues, and will continue to work with our sector to expand the benefits of the programme.
Why don’t we just use the Australian eviQ regimen library?
EviQ, a similar Australian regimen library, has been used by many clinicians in NZ for many years, but is an Australian standard governed by Australian clinicians and cannot meet all the needs of New Zealanders. EviQ have been strong supporters and collaborators helping us to develop the SACT Regimen Library. EviQ provides information but cannot collect information about treatments given in New Zealand. Our goal is to both provide and collect information to inform and improve care.
Are private chemotherapy providers included?
Private chemotherapy providers are invited to participate in the development of regimen definitions. So far participation from private providers has been strong. The SACT Regimen Library provides coverage of regimens given in the private sector and for this reason some of the regimens will contain medicines that are not funded by Pharmac, the agency that manages New Zealand’s medicine budget.
Who is involved?
Regimens are developed by cancer type working groups, containing doctors, pharmacists and nurses from across the country who specialise in giving chemotherapy for a particular cancer type. These groups examine the body of evidence supporting the use of each regimen during the development process. All treatment regimens go through a comprehensive peer review and approval process prior to publication.
How is SRL kept up to date?
Working groups meet once a year to review and update existing regimens, taking into consideration new evidence, medicine availability or patient need. Working groups will meet more regularly for cancer types where regimens evolve more rapidly. Meetings can also be arranged at short notice to respond to issues requiring a rapid response such as new announcements from Pharmac, medicine supply issues or recalls.
Does the ACT-NOW programme have any influence over which medicines are funded or available within New Zealand?
No. Pharmac is the crown entity responsible for determining which medicine treatments are funded within New Zealand. However, some chemotherapy drugs are given in the private sector and not in the public sector and oncologists have committed to having a comprehensive regimen library, including all medicines used commonly in public and private. This will help us better understand the gap between public and private care.
Why does the SRL Library usually name drugs by their generic name rather than their trade name?
Cancer drugs often have two names – the scientific name (often called the generic name) and the name the drug company uses to market the drug (the trade name). The SRL library names drugs according to their generic (scientific) title, not according to the drug company’s marketing name. Although some people are more familiar with trade names than generics, the generic (scientific) name is more precise and accurate. There are rare occasions where it may be more appropriate to use the trade names but this will be rare, and will be done after discussion with the clinical advisory group.
How does my clinician decide which regimen is best for me?
The best treatment for you is always decided by you and your doctor in partnership. It takes into consideration your health, your cancer, the stage of cancer, other treatments you may have had, other medicines you are on, and other health conditions that you have. Every person has an individual health care plan, and the chemo regimen is one part of this plan.
Myself / my family member / my friend is receiving chemotherapy, but the regimen is not on the SRL. Why is this the case and does it mean my/their doctor is not following best practice?
Sometimes people’s unique circumstances mean they might need to receive a treatment not on the SRL. This should be discussed with your oncologist. In no way does SRL intend to replace clinical judgement or individualised care.
Is the use of the SRL regimens mandatory for all providers?
No, the use of the SRL regimens is voluntary. However, all cancer centres have committed to developing national consistency and national standards. While this will never replace cancer centre autonomy, having standardised regimen definitions helps everyone.
Some regimens show medicines that are S29 or * … what does this mean?
Sometimes medicines used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe at the time of prescription and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed provided sections 25 and 29 of the Medicines Act 1981 are complied with, and by obtaining informed consent from patients. Some SRL regimens contain such medicines. These are identified within the SRL viewer with either a * or ‘S29’ flag. Please note that some of these medications may have already gone through a review process and been approved for use by regulatory authorities in other jurisdictions e.g. Food and Drug Administration (FDA) in the United States. All treatment regimens listed by NZF have been through robust peer review, including review of all the most recently published clinical trial data and international guidelines, and are considered an accepted standard of care by clinicians and Te Aho o Te Kahu, Cancer Control Agency, whether prescribed through sections 25 or 29 or with formal Medsafe approval.
Should we be focusing more on prevention and screening?
We (Te Aho o Te Kahu) are doing that too! Our work is guided by the New Zealand Cancer Action Plan 2019-2029, and the ACT-NOW project is part of this.
Where can I go for more information?
info@teaho.govt.nz
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