Analysis

Improving quality of life during and after cancer treatment

Cancer survival rates are rising, but should more be done to improve the quality of survival?
Falling off a cliff

Cancer survival rates are rising, but should more be done to improve the quality of survival?

Cancer diagnoses in England continue to rise with an average of 822 new cases per day in 2015, the latest government figures have revealed. But alongside this rise, the general trends for all childhood cancers combined show increasing five-year survival rates.

Adult survival rates across a range of measures are also showing general improvements.

299,923

new cancer diagnoses were registered in 2015

On the face of it this is good news, but what more needs to be done to improve the quality of survival?

The Office for National Statistics reported this February that 299,923 new cancer diagnoses were registered in

...

Cancer survival rates are rising, but should more be done to improve the quality of survival?

Falling off a cliff
Macmillan Cancer Support's Dany Bell: ‘After treatment ends, some patients say it’s like falling off the edge of a cliff’
Picture: iStock

Cancer diagnoses in England continue to rise with an average of 822 new cases per day in 2015, the latest government figures have revealed. But alongside this rise, the general trends for all childhood cancers combined show increasing five-year survival rates.

Adult survival rates across a range of measures are also showing general improvements.

299,923

new cancer diagnoses were registered in 2015

On the face of it this is good news, but what more needs to be done to improve the quality of survival?

The Office for National Statistics reported this February that 299,923 new cancer diagnoses were registered in 2015. Among the 24 most common cancers examined, one and five-year survival rates were highest for testicular cancer in men and melanoma of the skin in women. Survival for pancreatic cancer was lowest for both genders.

‘Survival rates vary by cancer type for several reasons,’ says Macmillan Cancer Support’s treatment programme manager Dany Bell, who is also a registered nurse.

‘Some types of cancer are more aggressive, while some are likely to be diagnosed later than others. Survival rates are particularly poor for pancreatic cancer, in part because its signs and symptoms are hard to spot,’ she adds.

Outcomes

Compared with cancer outcomes in other European countries, the UK continues to lag behind, says Ms Bell. The reasons for this are complex, with difference in outcomes often being due to variations in rates of surgery, chemotherapy and radiotherapy, as well as in funding or resources.

‘While there are always challenges in improving survival rates, it isn’t unachievable,’ says Ms Bell. ‘If countries such as Sweden, France, Finland and Austria can achieve higher rates, then the UK can – and should – bridge the gap.’

Late diagnosis is a significant factor. When Public Health England’s (PHE) National Cancer Registration and Analysis Service (NCRAS) established its Routes to Diagnosis project – which now includes data from 2006 to 2013 – it found that one in four people were being diagnosed with cancer as an emergency.

‘Those diagnosed at an early stage have a much better chance of survival,’ says PHE’s director of disease registration, Jem Rashbass. Now the proportion has fallen to one in five, although there are still wide variations in age, gender, deprivation and type of cancer.

‘It’s notable that even lung cancer, which is thought of as a lethal disease, showed net survival in excess of 80% when diagnosed at the earliest stage. Unfortunately, about half of all cases are diagnosed at the most advanced stage,’ Dr Rashbass says.

Transformation

Survivorship also means living with the ill-effects of cancer or its treatment, including chronic fatigue, incontinence and sexual difficulties. ‘There needs to be a complete transformation in how cancer patients are supported,’ says Ms Bell. ‘Early detection and good treatment are vital, but it’s not good enough to treat the illness and then fail to address what the person needs. After treatment ends, some patients say it’s like falling off the edge of a cliff.’ 

< 1%

Of all UK cancer diagnoses are for childhood cancers

While Macmillan has been at the forefront in shifting understanding, Ms Bell argues that addressing patients’ needs should not be the sole domain of charities: ‘The NHS must change to make sure cancer patients and their loved ones don’t feel they have been left high and dry after treatment.’

For children, survival rates continue to rise. The rate is now more than 80%, up from around 63% 25 years ago. Although childhood cancers account for less than 1% of all cancer diagnoses in the UK, patients are likely to be living with the effects of treatment for much longer.

‘The quality of survival becomes more important,’ says Rachel Hollis, lead nurse for children’s cancer at Leeds Children’s Hospital and a trustee of the charity CLIC Sargent.

‘We know much more about the long-term effects now because we’ve followed-up children and seen what has happened down the line. This means we can modify the treatments they get today, in some cases reducing its intensity and toxicity, to decrease the long-term effects tomorrow,’ says Ms Hollis.

She believes that nursing can play an important role in improving the quality of children’s lives during and after cancer treatment, with follow-up and survivorship programmes increasingly being nurse-led. But to make real improvements, she would like to see children and young people’s views included in cancer patient experience surveys.

‘This is critical because the adults’ survey has brought forward improvements,’ says Ms Hollis. ‘We’ve been lobbying for it for many years and I hope that work is going to happen soon.’ 

Survival rates at a glance
  • More than 90% of cancer registrations in England are in only 24 sites in the body, with more than half being in the breast, prostate, lung or colorectal.
  • Five-year survival is above 80% for breast cancer in women, testis and prostate cancer, thyroid cancer, Hodgkin lymphoma and melanoma of the skin in both genders.
  • Five-year survival remains below 25% for cancers of the brain, liver, lung, mesothelioma, oesophagus, pancreas and stomach.
  • Ten-year survival for children diagnosed in 2015 is predicted to be 82.4%, rising from 63.7% in those diagnosed in 1990.

Source: Office for National Statistics (2016, 2017a, 2017b)

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