The sustainability of cancer care in the UK was a key theme at LaingBuisson’s Private Acute Healthcare Conference on 11 October. Prior to the event, Check4Cancer chief medical officer and visiting professor of cancer surgery at Anglia Ruskin University Professor Gordon Wishart looked at how the UK stacks up in terms of survival rates and whether increased focus on prevention will be enough to deliver the much-needed improvements
It was reported by the OECD in 2019 that the UK had one of the worst cancer survival rates among developed countries At the time, Cancer Research UK (CRUK) attributed this to inadequate early cancer detection and a lack of access to optimal cancer treatment.
Now, a new report from the Institute for Public Policy Research (IPPR) has confirmed the findings. Analysts estimated that, among the 240,000 preventable deaths in the UK in the decade following 2010, there were 180,000 cancer deaths that could have been avoided if UK cancer mortality had matched the European average.
The report is yet to be considered by the IPPR Commission on Health & Prosperity ahead of a final blueprint in 2024, but the authors have identified common themes across multiple disease processes, including lack of access to timely diagnosis and treatment, poor user experience and poor quality outcomes when measured against comparable countries.
Their solution is a ten-point plan to transform the NHS from a disease and treatment service by putting primary and community care at the centre of a national disease prevention service. Key solutions to deliver this plan include retention and motivation of the workforce, improved user experience and increased innovation to redesign clinical services delivered by a 3.6% increase in funding over the next five years alongside an Infrastructure Restoration Fund worth £33bn over the next ten years.
The question is, will this strategic approach improve cancer survival in the UK?
There are currently 375,000 new cancer patients diagnosed each year in the UK, and 175,00 deaths. Based on a report by The Health Foundation, CRUK has predicted that by 2040, there will be more than 500,000 new cases per annum and more than 200,000 cancer deaths in the UK. Some of this is due to an increasing and ageing population, but there is growing evidence of the increased cancer risk associated with a Western lifestyle and Western diet.
A recent study reported that the global number of early-onset cancer cases diagnosed in patients under 50 years of age rose from 1.82 million in 1990 to 3.26 million in 2019, with the highest incidence rates in North America, Australasia and Western Europe. The most common risk factors associated with early-onset cancer in this study were alcohol, smoking, obesity and several dietary factors including diets high in red meat or sodium, and diets low in fruit or milk. The finding that a high fasting blood glucose was also a risk factor provides another potentially treatable risk factor in young adults.
The key to improving cancer survival is by promoting early cancer detection, through increased awareness of cancer risk factors and specific cancer signs and symptoms, expansion of the national cancer screening programmes and rapid access to streamlined cancer diagnostic pathways. As such, there is some overlap with the IPPR proposal to refocus investment on cancer prevention, but we still await national screening programmes for lung and prostate cancer.
NHS screening services need to be updated to take account of personal rather than population risk by using family history and lifestyle risk scores, and simple tests that detect tiny errors (SNPs) in DNA. Furthermore, having identified a considerable number of reversable cancer risk factors, it will be a major public health challenge to persuade those at higher risk to enter behavioural change programmes.
The July cancer waiting times data from NHS England reports continued delays to cancer diagnosis and treatment, with only 77.5% of urgent referrals seen within two weeks and only 62.6% of patients starting treatment within 62 days of urgent referral. In May 2021, a cross party Cancer Summit Report recommended ring-fenced cancer funding to develop both short and long-term workforce planning, invest in diagnostic and treatment equipment such as radiotherapy, overhaul the outdated IT infrastructure and digitalise services where appropriate. Without this urgent investment, we will be unable to develop streamlined diagnostic pathways that harness recent innovations in AI and new technologies. In my opinion, it has been a huge mistake to abandon the ten-year cancer plan and include cancer in a new Major Conditions Strategy. And, as a result, the IPPR proposal is unlikely to close the significant gap in cancer survival compared to the rest of Europe.
For a country that has contributed so much to cancer research and development in recent decades, it is unforgivable that we have one of the worst cancer survival rates among OECD countries, and the worst in the G7. In 2019, the NHS published a Long Term Cancer Plan with a goal to increase early cancer detection (Stage 1 or 2) from 50% to 75% by 2028. To show how big the gap is to match the best in Europe, the UK early cancer detection rate was only 54% in 2019 and 52% in 2020. Furthermore, with a 4% shift to later-stage presentation during the first year of lockdown, and the probability that this will increase to 10% over the two-year lockdown period, this target currently looks untenable.
If we are serious about tackling these unavoidable cancer deaths reported by the IPPR, we need a dedicated cancer plan, with oversight by a government minister supported by an independent advisory group of knowledgeable cancer experts, to deliver a radical new cancer strategy. Without this commitment I fear we will continue to languish near the bottom of the cancer survival league tables.
Professor Gordon Wishart will be taking part in a panel session on the cost of cancer care at LaingBuisson’s Private Acute Healthcare Conference in London on 11 October.