The UK has come far over the last 40 years in reducing mortality from cancer, but we should be doing better. We do not yet have world-class outcomes and the incidence of cancer is rising rapidly: more than 320,000 people get cancer every year and this will rise to more than 430,000 by 2030.
Survival rates have improved since the first NHS cancer plan was launched in 2000, services were reorganised and greater transparency introduced.
However, the challenges ahead are significant - we have an NHS in transition and a difficult financial climate.
Patients should continue to demand service improvement at least until we can demonstrate that our outcomes are no worse than comparable countries. We need to dispel the myth that cancer services have had disproportionate attention and funding over the last 10-15 years. Cancer budgets have grown, but no more than the overall NHS budget, despite rapidly growing incidence and cancer being the biggest cause of premature mortality in almost every age group.
Outcomes continue to lag behind the best performing countries, even though British research has developed many innovations that have improved cancer survival here and elsewhere. We need to diagnose more patients earlier and provide better access to optimal treatment, particularly for patients with advanced disease.
Responsibility for early diagnosis will be split between Public Health England, local authorities and the NHS, and there is a risk of fragmentation. These bodies need to work together effectively. Around a quarter of cancer patients are only diagnosed through an emergency presentation, and they do much worse than patients diagnosed through other routes. Many patients report visiting a GP several times with symptoms before being referred for further investigation.
The NHS must be a service that encourages people to get problems checked early rather than one that is perceived by some as being “too busy” for anything other than an emergency. Earlier diagnosis must be prioritised in the new system to meet the government’s commitment of saving 5,000 additional lives annually.
Cancer care is complex. We need high quality services throughout the patient journey - in communities and in primary care - through to survivorship and end of life care. A typical cancer patient will interface with many different clinical specialties, so well designed, integrated pathways are essential to avoid delay and frustration. The indications are that many aspects of treatment will be commissioned nationally but there is a concern that, as the NHS reforms are implemented, we will lose the integrated expertise currently within cancer networks. Since the reforms began, networks have suffered instability through staff losses and funding uncertainties. Addressing this instability must be a priority.
Clinical studies in the NHS are vital in cancer, supporting many breakthroughs in treatment and service design. The only way to make further leaps in outcomes is through research. To achieve the best survival rates in Europe, the NHS must promote a culture where research and adoption of innovation are routine.
The Health Act has laid down the gauntlet, committing all parts of the NHS to promoting and supporting research. The NHS leadership now needs to demonstrate how it will deliver. UK research has often changed clinical practice much faster elsewhere, not just with new drugs, but with radiotherapy, surgery and diagnosis.
Adoption of evidence-based innovation needs to be much faster here. A study in 2010 estimated that around 3,000 lives a year could be saved in the UK through prevention and early detection of bowel cancers using flexible sigmoidoscopy. Pilots are now under way, but every week of delay equates to 50 avoidable deaths.
Looking forward, the NHS Commissioning Board will set the framework for cancer diagnosis, services, treatment and research, and there has already been a very welcome announcement on provision of radiotherapy. Patient choice may or may not become a driving force in a disease as complex and traumatic for patients as cancer. What must be delivered though is greater transparency - the sort that exposes a six-fold variation in patients’ access to radical treatment for lung cancer.
With the NHS in transition, there are great opportunities to improve cancer services but also considerable risks. We have a unique opportunity to take our research strengths and our NHS expertise and deliver better results for patients.
Dr Harpal Kumar is chief executive of Cancer Research UK.