OBJECTIVES:  Since its inception in 2010, the National Cancer Drugs Fund (NCDF) has become an important market access route for cancer medicines in England and became fully established in April 2011. The objective of this analysis was to review the decisions made by the NCDF to date, in the context of NICE decisions, and identify how recent and proposed changes to the NCDF might impact on future decisions and the evaluation process for oncology products. METHODS: The NCDF list was analysed and compared against those appraised by NICE to obtain the percentage that are rejected by NICE as well as those that are never assessed by NICE. Trends across indications and the number of drugs represented on the NCDF were also analysed. Policy documents and consultations on proposed process changes to the NCDF were also reviewed. RESULTS: As of May 2015 there are 38 drugs covering 67 indications approved on the NCDF list, many of which have been rejected by NICE. Recently implemented and proposed changes such as a change to the definition of rarity when scoring the median drug cost per patient, and the appeal process, could have significant implications for pharmaceutical companies and patients on gaining reimbursement for oncology products. CONCLUSIONS:  The existence of the NCDF suggests that NHS England sees cancer as having more value than other diseases. Evidence suggests that the NCDF has been a success in providing access to medicines for patients but could be seen as undermining the NICE evaluation process. Recent changes in the NCDF appear to try and close this gap.