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Anti-depressant Drugs

Tim Loughton: To ask the Secretary of State for Health on what basis he recommended an optimal dose for selective serotonin reuptake inhibitors and related anti-depressant drugs. [178695]

Ms Rosie Winterton: As with all medicines, the recommendations for dosing of selective serotonin reuptake inhibitors (SSRIs) were made on the basis of the dose finding studies provided at the time of licensing and the outcome of clinical trials.

On 11 March 2004 the committee on safety of medicines issued advice reminding prescribers of the recommended starting dose of one SSRI: paroxetine (Seroxat). This followed re-review of the original dose finding studies for paroxetine and consideration of prescribing data which suggested a proportion of patients were being started on doses of paroxetine above those recommended for depression.

Tim Loughton: To ask the Secretary of State for Health what assessment he has made of the results of clinical trials of paroxetine (Seroxat) which showed that patients treated with placebos experienced withdrawal reactions comparable in character and severity to those experienced by patients on the active drug. [178340]

Ms Rosie Winterton: Assessment of clinical trials with paroxetine indicate that 25 per cent. of patients experienced symptoms on stopping treatment and 15 per cent. of those experienced symptoms described as severe. In the same trials, 15 per cent. of patients experienced symptoms on stopping placebo and 9 per cent. of those experienced symptoms described as severe. The most common events reported in clinical trials as occurring on stopping both paroxetine and placebo include dizziness, nausea, insomnia, anxiety and headache. The incidence and character of the
 
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symptoms experienced on withdrawal are reflected in the product information for prescribers (the summary of product characteristics) and the patient information leaflet.

Ann Clwyd: To ask the Secretary of State for Health if he will request the Medicines and Health Care Regulatory Agency to undertake a full, detailed, and publicly available review of the evidence on the suicide risk posed by selective seratonin re-uptake inhibitor antidepressant drugs for (a) adults and (b) children. [180520]

Ms Rosie Winterton: The safety of the selective serotonin reuptake inhibitors (SSRIs) and in particular, any link to an increased risk of suicide is currently undergoing intensive review by an expert working group of the committee on safety of medicines (CSM).

The Medicines and Healthcare products Regulatory Agency (MHRA) has communicated advice to doctors and patients as each stage of the review has been completed. An interim report, which sets out the group's advice and the action that has been taken as a result, was published on the MHRA/CSM website in September 2003. In December 2003, the CSM issued advice on the use of SSRIs that paroxetine, venlafaxine, sertraline, citalopram and escitalopram should not be used in children and young people under 18 years because of a lack of benefit in this patient population and an increased risk of adverse events, including suicidal behaviour.

The focus of the expert working group is now to complete its review of the available data relating to the safety of SSRIs, including that relating the risk of suicidal behaviour in adults. It expects to complete its work later this year, at which point its final report will be published.

Anti-TNF Alpha Therapy

Mr. Viggers: To ask the Secretary of State for Health if he will make a statement on the funding of anti-TNF alpha therapy in the Portsmouth Hospitals Trust area. [181366]

Ms Rosie Winterton [holding answer 29 June 2004]: Portsmouth Primary Care Trust (PCT) has agreed to fund anti-TNF therapy in accordance with National Institute for Clinical Excellence guidance. Demand for anti-TNF therapy locally has been higher than the PCT anticipated and the PCT is now working closely with Portsmouth Hospitals National Health Service Trust to ensure that anti-TNF therapy is available to all for whom it is clinically appropriate.

Brain Tumours

Charles Hendry: To ask the Secretary of State for Health (1) what plans his Department has to increase the number of hospitals with facilities to treat brain tumour patients, with particular reference to specialist facilities for treating children with brain tumours; [181316]

(2) what steps are being taken by his Department to improve the prognosis for children diagnosed with a brain tumour; and if he will make a statement. [181365]

 
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Miss Melanie Johnson [holding answer 29 June 2004]: It is for local health communities to decide how best to provide services for their local populations.

The Department has commissioned the National Institute for Clinical Excellence (NICE) to develop service guidance on tumours of the brain and central nervous system for use in the national health service in England and Wales. The guidance will address services for the diagnosis, staging and treatment, follow up, rehabilitation and specific elements of supportive and palliative care that meet the particular needs of patients with brain and central nervous system tumours and of their families and carers. NICE expects to publish the guidance in August 2005.

The distinct needs of children with cancer have been increasingly recognised over recent years. That is why we have also commissioned NICE to produce service guidance for the NHS on child and adolescent cancers. The guidance will include recommendations on optimal forms of diagnostic services, treatment, support services and palliative care. It will also include advice on research, the transition from paediatric to adult services and specialist follow up for late effects of treatment. We expect the guidance to be published in February next year.

Both sets of guidance will support the planning, organisation and commissioning of services to ensure the best possible outcomes for cancer patients.

The Department issued Referral "Guidelines for Suspected Cancer" in 2000 to help general practitioners identify those patients who are most likely to have cancer and who therefore require urgent assessment by a specialist. These guidelines include a section on brain tumours in children.

The guidelines are currently being updated by NICE and are due to be published next year. The Department provides specific funding for a specialised research network on paediatric oncology. This network is led by the United Kingdom children's cancer study group (UKCCSG). The brain tumour group of the UKCCSG is currently running eight trials. In addition, several other trials are under development and a number of recent studies are being analysed.

Charles Hendry: To ask the Secretary of State for Health what steps he is taking to reduce treatment waiting times for (a) children suffering from brain tumours and (b) all brain tumour patients; and if he will make a statement. [181318]

Miss Melanie Johnson: The NHS Cancer Plan sets out our strategy to reduce waiting times for cancer patients. A two week outpatient waiting time standard was introduced in 2000 for all urgent general practitioner referrals of suspected cancer. In the last quarter—January to March 2004—99.5 per cent, of urgent GP referrals for suspected brain and central nervous system cancers were seen by a specialist within two weeks. From 2001, a maximum waiting time of one month from urgent referral to first treatment was introduced for all children with cancer, including brain cancer. In the last quarter, all children who were urgently referred and subsequently diagnosed with cancer were treated within one month. By 2005, there will be a maximum wait of one month from diagnosis to first treatment and two
 
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months from urgent referral to first treatment for all patients with cancer. Progress towards these targets is being achieved through increased investment, additional staffing levels, installing new and replacement radiotherapy and diagnostic facilities and streamlining care processes through the cancer services collaborative—improvement partnership.

Charles Hendry: To ask the Secretary of State for Health (1) what steps his Department is taking to provide a central information resource on brain tumours, for use by patients and carers; [181319]

(2) what steps his Department is taking to provide information to (a) patients, (b) parents and (c) carers on the support available to brain tumour patients. [181321]

Miss Melanie Johnson: The Government established a coalition for cancer information (CCI) in June 2002. The CCI brings together producers and consumers of cancer information from national voluntary organisations, the National Cancer Research Institute, the national health service and the Department. It has been established to oversee the development, delivery and dissemination of high quality information materials for those affected by cancer, including those with brain tumours, and their carers.

Recently published guidance from the National Institute for Clinical Excellence (NICE) on improving supportive and palliative care for adults with cancer will benefit all patients with cancer, including those with brain tumours, and their carers. The Government have also commissioned NICE to develop service guidance on tumours of the brain and central nervous system for use in the NHS in England and Wales. Both pieces of guidance cover aspects of care such as communication and information. NICE has also been commissioned to produce service guidance for the NHS on child and adolescent cancers. The guidance will look at the interface with services provided by non NHS providers, including those providing support for families, carers and siblings, including bereavement support.

The Department also recently awarded a Section 64 core grant to the United Kingdom Brain Tumour Society of £34,000 spread over the three years beginning 2004–05.

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