Analysis

Cancer care improves, but still falls short of targets

Health Foundation report finds that 10,000 lives in England could be saved each year if cancer services were improved

Health Foundation report finds that 10,000 lives in England could be saved each year if cancer services were improved

Health_Foundation
Picture: iStock

Over recent years, cancer care in England has undergone significant improvements in mortality, treatments and patient experience.

But despite the ambitions set out in successive national strategies, cancer survival still lags behind that of other comparable countries.

90%

Five-year survival for bowel cancer diagnosed early; 10% if diagnosed late

Source: The Health Foundation (2018)

Those were the headline findings of the Health Foundation report, Unfinished Business, published in November. This states that 10,000 lives in England could be saved each year if cancer services, particularly early diagnosis, were improved.

The authors of the report, led by former Department of Health national cancer director Sir Mike Richards, assessed changes to cancer services during the 20 years to 2015.

In the absence of any other formal evaluation, they collated data, and interviewed nearly 70 people involved in creating, implementing and reporting on cancer policy.

Launching The Health Foundation report, Professor Richards said: ‘The NHS Cancer Plan in 2000 and all subsequent cancer strategies have set ambitions for England to match the best in Europe or the world in relation to cancer survival.

‘Although progress has been made on many aspects of cancer, these aims have not been achieved.’

If they had, many deaths could have been avoided, Professor Richards argued, adding that the mortality rate is equivalent to ‘a jumbo jet of people falling from the sky every two weeks’.

Nurse specialists

Advances in cancer care have come in multiple forms, his report says.

As well as improved mortality and survival rates, progress has been made in technology and legislation, such as the smoking ban, as well as better organisation of services.

35th

UK’s ranking out of 37 countries for availability of CT scanners

Source: The Health Foundation (2018)

Expansion of the cancer workforce and the delivery of care through multidisciplinary teams, now standard practice, have also contributed to progress.

And cancer nurse specialists (CNSs), now integral members of such teams, have ‘become the norm’.

The rise in the number of CNSs is linked by the report’s authors to the enhanced patient experience today compared with that of 20 years ago.

The 2011-12 National Cancer Patient Experience Survey, referenced in the report, shows that patients who receive support from a CNS have a better experience. Yet even now, not all patients with cancer have access to a CNS.

Carole Farrell, lecturer in clinical practice at the University of Bolton, and consultant editor of Cancer Nursing Practice, says specialist nurses contribute hugely to improvements in cancer care, before and after diagnosis.

‘In the UK, there are numerous examples where CNSs have transformed services to benefit patients, streamlined service delivery and produced cost savings.

Red flags

‘Their work has had a positive impact on promoting early detection of cancers by encouraging screening attendance; educating patients and the public about signs, symptoms and red flags; and signposting many to early interventions.

‘And after diagnosis, specialist nurses play a key role in educating, and supporting patients pre-, during and post-treatment.’

But, she argues, their contribution is still not fully recognised by key stakeholders and commissioners.

While acknowledging how much cancer care has improved over the last two decades, the Health Foundation also finds plenty of areas where England lags behind other countries, and early diagnosis is one example.

As recently as the late 1990s, some experts doubted that delaying diagnosis even by several months could affect outcomes. But because cancer data can now be linked with hospital and screening data, both the extent and impact of late diagnosis have been demonstrated.

‘There is now almost universal consensus on the importance of early diagnosis of symptomatic patients,’ the report says.

Other areas where progress has been limited include:

  • Insufficient focus in cancer strategies on the role of primary care
  • Slow implementation of new models of access to diagnosis
  • Consistent difficulties in delivering required increases in the cancer workforce
  • Persistent variation in the quality of cancer services

Cancer networks

To compound those issues, reforms introduced under the Health and Social Care Act 2012 caused significant disruption to cancer care, Professor Richards and his co-authors state, with national leadership and support for cancer networks ‘significantly downgraded’.

1 in 5

of all cancers are diagnosed after emergency presentation

Source: The Health Foundation (2018)

Cancer Research UK’s description of the impact of the reforms is quoted in the report as like being blindfolded in a fog, ‘groping around, trying to find bits of the old world and bring them back together again’.

The loss of momentum that followed the reforms has still not been regained, the report says.

Looking ahead, plans announced by prime minister Theresa May for a new cancer strategy as part of a long-term NHS plan, are an ‘extremely welcome’ move, Professor Richards says.

His report calls for action in a number of areas including bowel screening, early detection of lung cancer, which is too often diagnosed as an emergency presentation, and full implementation of the National Institute for Health and Care Excellence’s Guideline 12. This recommends that GPs should investigate patients whose symptoms indicate a 3% or higher risk of cancer.

Dr Farrell would like to see more specialist nurses for certain cancer groups and in some geographical locations.

‘Clinical demand is rising year on year, yet business cases for new specialist nurses are often rejected, and some roles downgraded,’ she says.

‘They are seen as too expensive for the organisation to maintain and expand in the current financial climate, and this needs to be addressed urgently, alongside succession planning.’

Diagnostic workforce

Cancer charities have echoed the report’s call for a much larger diagnostic workforce.

Cancer Research UK director of policy Emma Greenwood says: ‘Significant shortages in staff qualified to diagnose cancer remain a major barrier to progress and we must, as a matter of urgency, see a clear plan to boost the cancer workforce – backed up by vital investment – as part of the NHS long-term plan.’

Macmillan Cancer Support director of policy, campaigns and influence Moira Fraser-Pearce says: ‘Investment in staff to secure a growing, diverse and sustainable workforce is crucial to tackling these issues and making sure patients not only live longer but live well.’

In response to the report, NHS England said record numbers of people were now receiving cancer treatment.

A spokesperson said: ‘Cancer survival rates are now at their highest ever and further work to ensure faster and earlier diagnosis and treatment is already underway, and will be a cornerstone of the NHS’s long-term plan for cancer to help save more lives.’

Cancer then and now

The Health Foundation’s report, Unfinished Business, states that in the mid-1990s there were 214,000 new diagnoses of cancer per year in England. By 2016, there were nearly 300,000, representing a 40% increase.

Health Foundation policy fellow and one of the report’s authors Rebecca Fisher says: ‘There are many more cases of cancer but the complexity of managing those cases has also increased.’

New scans, pathways and treatment options have contributed to improved survival rates. ‘But that’s not all of the story,’ says Dr Fisher.

CONCORD-3, the most recent analysis of international variation in cancer survival, shows that, breast cancer aside, survival rates for many cancer types remains lower in the UK than in comparable countries. ‘We remain at the bottom and we are not narrowing the gap,’ says Dr Fisher. 

 

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About the author

Daniel Allen is a freelance health writer

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