The government must act now to stamp out staggering inequalities in cancer care. Its first steps should be a one year survival target and changing how NICE works, writes John Baron
People don’t choose which cancer they get, yet people with rarer cancers often have to fight to get the drugs they need during a period when they are often ill, tired and weak
Much needed progress has been made in cancer treatment and care over the last few decades, leading to improvements in survival rates across the population as a whole. NHS managers and staff have worked hard to implement the recommendations of the cancer reform strategy, and the cancer plan before that, to improve outcomes for cancer patients.
However, despite these improvements, it is still the case in England that if you are from certain social, ethnic or age groups, you are more likely to get cancer, and less likely to survive it. This has been confirmed by a recent health committee inquiry which concluded that health inequalities have widened in the last decade.
Over the last eight months, I have chaired an inquiry looking into why these inequalities exist. The all party parliamentary group on cancer has taken evidence from people across the health sector - clinicians, PCTs, the voluntary sector and patients - and found appalling inequalities in the care, treatment and survival rates of different groups of cancer patients.
We now believe the government could make a real commitment to stamping out inequalities in cancer by introducing a new one year survival rate target. Current mortality and five year survival rate targets are not providing the NHS with the tools it needs to make a difference in cancer inequality. A one year indicator would shift attention to the vital first year after cancer is suspected and help sharpen the focus on measuring outcomes.
The new target would provide an impetus within the NHS to raise awareness of the early symptoms of cancer, promote early presentation and diagnosis, and speed up the referral system.
During our inquiry we learned that in general, older people with cancer receive less intensive and less radical treatment than younger people. It is true that some older people will present later, have co-morbidities or be too frail for treatment, but age should never be the sole reason for treatment decisions.
Over the last decade, little progress on survival rates has been made for patients aged 75 or over, despite significant improvements for the population as a whole. Earlier this year, the National Cancer Intelligence Network estimated that around 15,000 people aged 75 or over were dying prematurely from cancer in the UK each year.
The new one year survival rate target would apply to patients of all ages, including, for the first time, patients aged 75 or over. This would be a significant step towards stamping out ageism in the health service and providing real encouragement for the NHS to properly diagnose and treat older cancer patients.
We were also shocked to hear how much worse the experience and chances of survival could be if a patient has a rarer cancer, such as pancreatic or liver. There are fewer drugs - sometimes none - available for rarer cancers on the NHS. People don’t choose which cancer they get, yet people with rarer cancers often have to fight to get the drugs they need during a period when they are often ill, tired and weak.
There needs to be a radical overhaul in the way the National Institute for Health and Clinical Excellence decides which drugs should be available on the NHS. Drugs are turned down by NICE because of their relatively high treatment costs per patient. But this does not take into account the fact that, due to the small numbers of patients affected, there would actually be modest overall costs to the NHS. We think the Department of Health should continue to encourage NICE to take a more flexible approach to appraising these drugs. And we want to see the National Specialised Commissioning Group take responsibility for commissioning drugs for cancers that affect fewer than one in 50,000 people.
Our report makes a number of other key recommendations to tackle cancer inequalities:
- new legislation to ban the use of sunbeds for under 18s;
- better enforcement of the Ofcom code on smoking;
- a national cancer patient experience survey programme;
- regular care needs assessments for cancer patients;
- better cancer patient data collection.
So this is the challenge we are laying down for the government - set a one year survival rate indicator for cancer patients, improve drug appraisal processes, and show a real commitment to stamping out cancer inequalities for good.
The inquiry report is available at www.appg-cancer.org.uk