Consent forms for SACT (Systemic Anti-Cancer Therapy)
We are working with Guy’s and St. Thomas’ NHS Foundation Trust to produce national standardised SACT regimen-specific consent forms.
We want to support clinicians in ensuring all patients are fully informed when consenting to SACT. These forms are endorsed by the UK Systemic Anti-Cancer Therapy Board (UK SACT Board).
Who has approved the content in these forms?
The programme is being led by a dedicated Cancer Research UK funded oncology pharmacist at Guys’ and St. Thomas’ NHS Foundation Trust.
All forms are independently checked by an oncology/haematology pharmacist, oncology/haematology consultant and member of the UK SACT Board.
The consent forms and guidance document are available to download in PDF format. Forms are grouped by tumour-site.
If you have specific queries or are looking for something not covered here, please email the pharmacist.
SACT Form update
SACT consent forms are currently being reviewed on a rolling schedule. Please see FAQs for order of roll-out. Republication dates may exceed the date of review indicated on each form. All forms are valid until new versions are available.
What's new?
- 29th October 2024: Myeloproliferative neoplasms (MPN) forms reviewed and updated.
- 21st October 2024: Melanoma skin cancer : New form added for Nivolumab with Relatlimab
- 10th October 2024: Lung cancer - New forms added and some forms updated
- 9th October 2024: Hepato Pancreato Biliary (HPB Cancers) – Forms updated
- 9th October 2024: Adult Welsh generic SACT and immunotherapy form reviewed and uploaded
- 18th September 2024: Multiple Myeloma – New consent forms uploaded.
- 2nd September 2024: Urology – Bladder cancer : Immunotherapy forms reviewed and uploaded
- 18th June 2024: : Guidance on consent for SACT reviewed and updated
- 11th June 2024: Urology – Germ cell cancer: Forms updated
- 14th May 2024: Neuroendocrine and adrenal cancers: Forms updated
- 13th May 2024: Urology Prostate cancer: New form added for Darolutamide -Docetaxel with ADT
Which tumour site group’s forms are available and when will they be reviewed?
The regimen-specific forms have been published for the following tumour site groups. Each group of forms will be reviewed on a rolling schedule every three years. The process by which each group of forms is revalidated may result in the republication dates exceeding the date of review indicated on each group of forms. All forms are valid until new versions are made available.
| Tumour site | Issue date | Review date |
| Acute Lymphoblastic Leukaemia (ALL) | In development | |
| Acute Myeloid Leukaemia | Apr-21 | Apr-24 |
| Brain & CNS | Apr-23 | Apr-26 |
| Breast | Mar-20 | Mar-23 |
| Children & Young Person ALL | Aug-23 | Aug-26 |
| Children & Young Person Generic | Sep-22 | Sep-25 |
| Chronic Lymphocytic Leukaemia (CLL) | Nov-23 | Nov-23 |
| Chronic Myeloid Leukaemia (CML) | Jul-23 | Jul-26 |
| Colorectal | Jun-22 | Jun-25 |
| Gastrointestinal Stromal Tumour (GIST) | Jul-23 | Jul-26 |
| Generic English SACT & Immunotherapy | Nov-23 | Nov-26 |
| Generic Welsh SACT & Immunotherapy | Dec-16 | Dec-19 |
| Gynaecological | Jan-21 | Jan-24 |
| Head & Neck | Aug-22 | Aug-25 |
| Hepatobiliary | Aug-17 | Aug-20 |
| Kaposi Sarcoma | Jul-23 | Jul-26 |
| Lung | Oct-22 | Oct-25 |
| Lymphoma | In development | |
| Multiple Myeloma | In development | |
| Myeloproliferative Neoplasms (MPN) | Jun-19 | Jun-21 |
| Neuroendocrine & Adrenal | Jan-19 | Jan-22 |
| Oesophagogastric | Aug-17 | Aug-20 |
| Sarcoma | In development | |
| Skin – Melanoma | Feb-21 | Feb-24 |
| Skin – Non-Melanoma | Nov-18 | Nov-21 |
| Supportive Medicines | Jul-20 | Jul-23 |
| Thyroid | Mar-22 | Mar-25 |
| Urology – Bladder | Mar-21 | Mar-24 |
| Urology – Germ Cell | Mar-21 | Mar-24 |
| Urology – Prostate | Aug-22 | Aug-25 |
| Urology – Renal Cell Carcinoma | Aug-22 | Aug-25 |
| Urology – Small Cell | Aug-22 | Aug-25 |
Please check the website regularly (e.g. once a month) for new forms and updates.
What happens when a new regimen is commissioned before the consent form group is due to be revalidated?
We are working to develop and publish consent forms in time with publication of positive NICE (England), AWMSG (Wales), SMC (Scotland) and HSCNI (Northern Ireland) determinations.
What should I do if I cannot find the regimen-specific form that I need?
We encourage Trusts to use the generic SACT or immunotherapy forms where a regimen-specific form is not available. Please get in touch with the project lead pharmacist so that this can be discussed with the tumour-specific lead consultant for development. Contact details for the project lead pharmacist are found at the end of this document.
When will consent forms for the haematology groups be available?
CML, CLL, MPN, and AML consent forms have now been published. ALL, lymphoma and myeloma consent forms are in development.
How have the forms been developed and what is the governance process?
The forms are based on the Department of Health consent form 1. The template form has been approved by the UK Systemic Anti-Cancer Therapy Board. Each hospital/Trust will need to ensure that the forms are approved for use locally by their governance or consent committee, whichever is most appropriate for the individual organisation. Please refer to the Guidance on Consent for SACT available on this website here.
Are the consent forms a legal document?
The consent form is not a legal document, but it represents best practice and conforms with and complements the guidance documents available to clinicians taking consent. Several guidance documents have described best practice in the area of consent with respect to law, ethics, training and experience required and the need for documentation that consent has taken place.
We explored informal counsel with a medico-legal advisor, in response to the issue of the Montgomery judgement. The following has been taken from their reply:
The most important aspect of the GMC guidance is that information about risk must be individualised for that patient. So for example, risk of cardiac events may be higher in a patient with pre-existing cardiac disease, or peripheral neuropathy may be more relevant if you are a concert pianist, as opposed to a patient who is not. These are probably the most comprehensive and patient friendly consent forms I have seen.”
The consent forms are developed to ensure a high level of consistency in the information giving and discussion with the patient. Your Trust Governance and/or consent committee must agree before you use these forms.
How do I give a copy of the completed form to the patient?
The patient can be given a photocopy or print out of the completed form. For trusts using electronic consent systems, there may be different mechanisms for providing the patient with a completed form depending on the system used, such as through secure email or a mobile application. We recommend retaining the original form in the patient’s records, or a scanned copy in the patient’s electronic records.
Will the consent forms be made available electronically?
Due to the complexity of the IT infrastructure, numerous electronic patient records and SACT prescription systems across the NHS, the project team cannot provide one single national electronic consent solution.
An electronic consent working group was subsequently formed as part of the project. The working group developed and published the ‘Guidance for the Implementation of CRUK SACT Consent Forms Electronically’. It is intended for use by NHS SACT providers wishing introduce electronic consent to decide which electronic consent solution would be the most appropriate for their individual needs. Guidance for the configuration and maintenance of electronic consent forms, including adoption of the CRUK consent forms electronically, is provided in this document. The document can be found on the CRUK SACT consent form webpage under the accordion ‘Guidance on Electronic Consent for SACT’ here.
Can I use the CRUK consent forms, branding and footer on our local electronic consent system?
The CRUK regimen-specific consent forms may be used within local electronic consent systems. As the forms have been through a robust governance process to ensure their consistency and quality, the following disclaimers should be used depending on the applicable scenario. The following disclaimers will be included in the next version of the Guidance on Electronic Consent along with CRUK brand guidelines for logo use.
Use of the consent forms without amendments:
The CRUK logo and consent form footer can be included in electronic consent forms where the content of the forms is used unamended in its entirety. The format, font or colours can be changed if necessary, but the text and CRUK logo should be unamended. The footer at the bottom of each page of the consent form includes the names of those who have prepared, checked and approved the forms, as well as the details of version and date.
In this instance, please include the following disclaimer:
When amendments are made to the consent form contents:
Where providers base their electronic consent forms on the CRUK consent forms but change some of the content for technical or clinical reasons, the CRUK logo and consent form footer should not be used.
The following disclaimer should be included within the e-consent system in a way that makes it clearly visible to both clinician and patient.
Will the consent forms be made available in Welsh and/or other languages?
The generic SACT and generic immunotherapy consent forms have been translated to Welsh. It is recommended that these forms are used to supplement the English regimen-specific consent forms when a Welsh language accompaniment is required. The project team continues to investigate avenues through which the translation of consent forms can be achieved.
Will chemo-radiotherapy consent forms be developed?
These forms are designed specifically for taking consent for SACT. For instances where the SACT is given in combination with radiotherapy, the radiation therapy will need to be consented for separately. The Royal College of Radiologists (RCR) have developed national site-specific radiotherapy consent forms. These can be found here. The RCR plan to develop chemo-radiotherapy consent forms, but this is an ongoing piece of work for which timelines have not yet been confirmed.
Do you have children and young people (CYP) SACT consent forms?
The Children and Young People Generic Form was published in 2021. The ALL in Children and Young People form was subsequently published in 2023. We subsequently plan to develop national SACT regimen-specific consent forms for TYA groups.
Where can I find more information about the regimen-specific consent forms?
Further information can be found on www.cruk.org/sact_consent. You can also email lucy.cox1@gstt.nhs.uk or alia.nizam@gstt.nhs.uk if you have any queries and with any comments.
Generic checkpoint inhibitor immunotherapy form
Welsh Generic Immunotherapy form
Last updated: 9th October 2024
ALL in Children and Young People
Children and Young people generic form
Last updated: 10th August 2023
Clofarabine, Cyclophosphamide and Etoposide
Nelarabine, Cyclophosphamide and Etoposide
UKALL14 Consolidation 1,2 and 4
UKALL 14 Intensification CNS Prophylaxis
UKALL 14 Intrathecal Systemic Anti-Cancer Therapy
UKALL 60+ Intensive (Philadelphia Negative)
UKALL 60+ Non-Intensive Intensive (Philadelphia Negative)
UKALL 60+ Philadelphia Positive
Last updated: 22 March 2024
AIDA (All- transretinoic acid and Idarubicin)
High dose cytarabine (ARA C) + Amsacrine
DA (Daunorubicin and Cytarabine)
Gemtuzumab ozogamicin with daunorubicin and cytarabine
Liposomal daunorubicin + Cytarabine ( Vyxeos)
Low dose cytarabine ( ARA C) + Venetoclax
Midostaurin + chemo (DA + HD Ara C)
Midostaurin (+/- chemotherapy)
Last updated: 17th August 2023
AC (Doxorubicin-Cyclophosphamide)
Atezolizumab - Paclitaxel albumin-bound
EC (Epirubicin-Cyclophosphamide)
FEC-PPH (Paclitaxel-Pertuzumab-Trastuzumab)
FEC-TPH (Docetaxel-Pertuzumab-Trastuzumab)
Kadcyla® (trastuzumab emtansine)
Liposomal doxorubicin (Myocet®)
Liposomal doxorubicin (Myocet®)-Cyclophosphamide
Paclitaxel albumin-bound - Carboplatin
Pembrolizumab – Carboplatin – Paclitaxel - EC
Pembrolizumab – Paclitaxel Albumin Bound
TC (Docetaxel-Cyclophosphamide)
TCarboH (Docetaxel-Carboplatin-Trastuzumab)
TCarboPH (Docetaxel-Carboplatin-Pertuzumab-Trastuzumab)
TPH (Docetaxel-Pertuzumab-Trastuzumab)
Tucatinib, trastuzumab and capecitabine
Last updated: 8 May 2024
Last updated: 10th August 2023
Last updated: 14 July 2022
Cisplatin-Fluorouracil + Radiotherapy
Liposomal doxorubicin (Caelyx®)
Liposomal doxorubicin (Caelyx®) - Carboplatin
Last updated: 16 February 2021
Atezolizumab, bevacizumab, carboplatin and paclitaxel
Atezolizumab, carboplatin and etoposide
CAP (cyclophosphamide-doxorubicin-cisplatin)
Carboplatin, pemetrexed and pembrolizumab
Carboplatin, paclitaxel and pembrolizumab
CAV (cyclophosphamide-doxorubicin-vincristine)
Cisplatin- pemetrexed - pembrolizumab
Nivolumab, Carboplatin and Pemetrexed
Nivolumab, Paclitaxel and Carboplatin
Last updated: 10th October 2024
CVD (cisplatin-vinblastine-dacarbazine)
Talimogene laherparepvec (Imlygic®)
Last updated: 21 October 2024
VCd (Bortezomib, Cyclophosphamide and Dexamethasone)
KRd (Carfilzomib, Lenalidomide and Dexamethasone)
Cyclophosphamide (Oral) +/- Dexamethasone
DVd (Daratumumab, Bortezomib and Dexamethasone)
DVTd (Daratumumab, Bortezomib, Thalidomide and Dexamethasone)
DRd (Daratumumab, Lenalidomide and Dexamethasone)
Isatuximab, Pomalidomide and Dexamethasone
IRd (Ixazomib, Lenalidomide and Dexamethasone)
Lenalidomide and Dexamethasone
PCd (Pomalidomide, Cyclophosphamide and Dexamethasone)
Pomalidomide and Dexamethasone
Given the substantial number of treatment regimens for Multiple Myeloma, consent forms for the commonly used regimens have been prioritised and uploaded. The remaining forms are in progress and will be accessible in due course,
Cyclophosphamide, Vincristine and Dacarbazine (CVD)
Etoposide, Doxorubicin, Cisplatin (EDP) +/- Mitotane
Fluorouracil, Carboplatin and Streptozocin (FCarboSt)
Fluorouracil, Cisplatin and Streptozocin (FCisSt)
Fluorouracil and Irinotecan (FOLFIRI)
Oxaliplatin, Irinotecan and Fluorouracil (FOLFOXIRI)
The published forms listed here are not exhaustive for neuroendocrine cancers. They reflect mostly (but not exclusively) those regimens for gastroenteropancreatic neuroendocrine tumours.
The regimen-specific consent forms for neuroendocrine cancers of other areas of the body can be found within their respective anatomical groups.
Last updated: 14 May 2024
Capecitabine-Cisplatin + Radiotherapy
Cisplatin-Capecitabine-Trastuzumab
Cisplatin-Fluorouracil (+/- Radiotherapy)
Cisplatin-Fluorouracil-Trastuzumab
Docetaxel-Oxaliplatin-Fluorouracil (FLOT)
ECarboF (epirubicin-carboplatin-fluorouracil)
ECarboX (epirubicin-carboplatin-capecitabine)
ECF (epirubicin-cisplatin-fluorouracil)
ECX (epirubicin-cisplatin-capecitabine
EOF (epirubicin-oxaliplatin-fluorouracil)
EOX (epirubicin-oxaliplatin-capecitabine)
Fluorouracil PVI + Radiotherapy
Irinotecan-Fluorouracil (FOLFIRI)
Oxaliplatin-Capecitabine (CAPOX)
Oxaliplatin-Fluorouracil (FOLFOX)
Paclitaxel-Carboplatin + Radiotherapy
Last updated: 5 April 2022
Publishing, additions and updates
We are publishing forms by tumour site, the first were for breast cancer in May 2016. We will publish new forms for other tumour sites regularly.
Recent additions and updates will be highlighted on the "What's new?" section on this page, and details of when forms have been last updated is stated in each section. Please check for updated versions and ensure that you use the latest version of each form.
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