How can the NHS break the negative cycle of cancer care caused by a focus on containing short term costs? That was the issue under discussion by a panel of experts in an event sponsored by Bristol-Myers Squibb
Bristol-Myers Squibb developed and funded the Transforming the Cycle in Cancer Care meeting, on which this article’s conclusions are based.
Job bag: ONCUK1700314-01 Date of preparation: April 2017
Cancer prevalence in the UK is increasing1; current estimates show that one in two of us born after 1960 will be diagnosed with a form of cancer at some point in their lives.1 But the NHS is struggling to cope.
The UK allocates much less of its health spending to cancer (3.8%) than the EU average (5%) and survival lags behind much of Europe.2
It’s increasingly evident that a negative cycle of cancer care exists, where too often a short term approach that focuses on immediate pressures can often lead to longer term costs, resulting in fewer resources being available.2
With no additional funding immediately available, the NHS needs to start delivering more for less. To help break the cycle, a group of experts have helped compile a report – Transforming the Cycle of Cancer Care. Below, Katherine Murphy, Chief Executive of The Patients Association, examines its findings.
Breaking the cycle
Ms Murphy states the need for change: “Britain’s NHS system is widely admired, and its nurses, doctors and support staff should be commended for the time and effort they put into running cancer services, from diagnosis to treatment.
“But as the NHS crisis deepens, patient care is at risk, as emergency care for discharged patients, limited availability of new treatments and late diagnoses are exacerbating an increasingly stretched budget.2 This can result in a less effective cancer service being provided to patients, with shortages of oncologists, radiologists and cancer nurse specialists in England.2
“A number of truly innovative and effective pilot schemes are demonstrably improving patient outcomes and reducing financial pressures on services. The task to the NHS going forward should be how it can take the best of these pilots and replicate them across the UK to the benefit of all patients.”
Best practice solutions
The report found that the NHS needs to be more pioneering; actively seeking out and recommending programmes that are instigating wide-scale change.
Social media campaigns,3 primary care solutions3 and even a Danish stratifying system4 have all shown very promising results in improving the route to diagnosis, with the potential to provide vital improvements for England where late cancer diagnoses cost the NHS an extra £210 million each year.5
Anna Jewell, Director of Operations at Pancreatic Cancer UK, agrees: “As a charity, we are providing grants to support practical interventions that improve diagnosis, treatment and care.
“Pancreatic cancer is the 11th most common cancer in the UK,6 but has the lowest survival rate of the most common types of cancer.7 Delays in surgery taking place can result in patients needing treatment for jaundice, which involves biliary stenting, a procedure which can be distressing and put patients at risk of developing complications.8
“But early surgery for pancreatic cancer is not yet routine in the NHS8; our £50,000 grant helped the University of Birmingham to develop and review a fast-track pathway to avoid stenting, with patients being reviewed within seven days of referral and surgery being delivered on average 16 days from CT scan. The review of this pathway showed that it had a clear and measurable effect on patient outcomes and NHS costs.”8
The report calls on the NHS to ensure that existing structures that incentivise uptake of new practices are rewarding best practices in cancer care such as the above, rather than practices that have become sub-optimal over time.
In addition, it calls for a system to identify such best practice and disseminate that knowledge across the health service.7 A focus on ensuring uptake and dissemination of data would establish a new network of collaboration between NHS clinicians UK-wide.
Ms Murphy argues that any new incentive structures would prove cost neutral, with the cost of establishing and maintaining any new system offset by the benefits of implementing successful and innovative schemes.7
Ms Murphy is hopeful about the futures of the NHS cancer service. “The NHS Cancer Strategy highlighted the necessity of ‘pathway redesign and changing clinical behaviour’ in order to radically improve cancer care.9
“With new treatments and scientific advances, improving cancer care for patients is within our grasp so the NHS needs to follow the example of clinicians and charities and start investing in long-term solutions.”
The full report can be found on The Patients Association’s website.
Transforming the Cycle of Cancer Care recommendations
Ms Murphy chaired the Working Group that made the following recommendations
1. The NHS must prioritise the improvement of cancer care and treatment.
2. Commissioners must take a long term view and urgently implement innovative examples of best practice from our European counterparts that can provide ‘quick wins’ for the NHS by improving patient outcomes and reducing financial pressures.
3. NHS Improvement should establish a system to oversee the identification and roll-out of best practice in cancer care across the NHS.
4. The NHS should offer financial incentives to NHS providers who introduce best practice care and remove incentives for outdated and more expensive models.
5. Commissioners of cancer services must work across the NHS to prioritise health promotion and disease prevention strategies.
6. The NHS must improve the availability of molecular testing and referrals to diagnostic services to improve the rates of early diagnosis.
7. Once diagnosed, it is essential that patients access treatment as quickly as possible. The savings from introducing best practice care should be used to improve patient access to treatment.
8. Patients and staff must be fully engaged in the process of service change to drive the uptake and adherence of best practice.
9. Patients with less common cancers cannot not be left behind. The NHS must ensure that best practice is disseminated across a broad range of tumour types.
1. Ms Katherine Murphy (Chair) – Chief Executive, The Patients Association
2. Charlotte Dawson – Head of Nurse Advisory, Beating Bowel Cancer
3. Dr Sam Hare – Consultant Chest Radiologist, Barnet Hospital
4. Anna Jewell – Director of Operations, Pancreatic Cancer UK
5. Professor Trevor Powles CBE – Emeritus Professor of Breast Oncology, Institute of Cancer Research, and Trustee, Breast Cancer Now
6. Kathy-Pritchard Jones – Chief Medical Officer, London Cancer
7. Anita Ralli – National Policy and Access Manager, Bristol Myers-Squibb
8. Mr David Ryner – Head of Policy, Cancer 52 and Chair, Chronic Myeloid Leukaemia Support Group
9. Professor Peter Selby – President, European Cancer Concord and President of the Association of Cancer Physicians
10. Dr Philip Webb – Associate Director of Planning & Performance, Velindre NHS Trust
1. Ahmad AS, Ormiston-Smith N, Sasieni PD. Trends in the lifetime risk of developing cancer in Great Britain: Comparison of risk for those born in 1930 to 1960. Br J Cancer 2015; 112: 943-947
2. Cole, A, Lundqvist A, Lorgelly P, et al. 2016. Office of Health Economic and Swedish Institute for Health Economics, Improving Efficiency and Resource Allocation in Future Cancer Care. Available here. (Accessed: September 2016).
3. Hinde S. 2012. Policy Research Unit in Economic Evaluation of Health and Social care Interventions. Available here. (Accessed: March 2017)
4. Vedsted, P, Olesen, F. A differentiated approach to referrals from general practice to support early cancer diagnosis – the Danish three-legged strategy. Br J Cancer 2015; 112: S65-S69
5. Birtwistle, M, Earnshaw, A. Incisive Health and Cancer Research UK, 2014. Saving lives, averting costs: An analysis of the financial implications of achieving earlier diagnosis of colorectal, lung and ovarian cancer. Available here. (Accessed: September 2016).
6.Cancer Research UK. 2014. Pancreatic cancer statistics. Available here. (Accessed: March 2017)
7. Cancer Research UK. 2014. Cancer survival for common cancers. Available here. (Accessed: March 2017)
8. Roberts, K. 2016 Fast track pancreatoduodenectomy: Using evidence based medicine to improve the care and outcomes for patients with resectable pancreatic cancer (presentation to Pancreatic Society 2016).
9. National Health Service, 2016. Achieving World-Class Cancer Outcomes: Taking the Strategy Forward. Available here. (Accessed: November 2016)
10. Bristol-Myers Squibb, 2017. Transforming the Cycle in Cancer Care report. Job Bag: ONCUK1700193-01. Date of prep: March 2017