Putting cancer surgery under the spotlight

When was the last time you saw a headline about cancer surgery?

You’d be forgiven if you couldn’t remember. While the latest ‘wonder drug’ often hits the headlines, the backbone of cancer treatment for many – surgery – hardly gets a look in.

That’s despite that fact that nearly half of all people who are cured of their cancer have surgery as part of their treatment. What’s more, surgery can be used to prevent and diagnose cancer, as well as to manage symptoms.

We think it’s time to put surgery back in the spotlight.

That’s why we asked a team of independent academics at the University of Birmingham and the consultancy ICF-GHK to assess how surgery services are doing across the UK.

Mixed findings

The result is our first major report on cancer surgery, which we hope could be a valuable first step towards improving this crucial treatment in the future.

The researchers interviewed over 50 UK surgeons about their experiences and carried out an international survey on cancer surgery outside the UK, which received 138 responses from surgeons across the world.

Their findings were mixed.

On the one hand, newer techniques such as keyhole surgery and improved approaches to care mean that some patients spend less time in hospital and recover faster.

But there’s also some evidence that services are being stretched, and that research to improve surgery needs far more support.

Access to surgery

The researchers looked at how the NHS can make sure patients are getting access to high-quality surgery. They found that there’s no easy way to organise surgery services across hospitals – what’s best depends on the type of cancer.

For example, some rare cancers require specialist care that can only be given by a small numbers of experts across the country and so, inevitably, this means there are fewer hospitals able to provide the surgery.

The NHS has a challenge on its hands to make sure that patients are getting the surgery they need but without having to travel too far from home.

We know that patients in the UK seem to have fewer operations than patients in some other countries, and that numbers of operations for different cancers vary across our country.

The researchers explored possible reasons for these differences, including travel costs, age-related issues, ethnicity and gender.

They found that, although there is no strong evidence that any of these factors affected access to surgery, we really need more research to better understand variations in access and whether these differences contribute to differences in survival.

Making sure we have the best surgeons available

The surgeons interviewed for the report were also asked whether they thought current medical training programmes are up to scratch. Their answers weren’t encouraging – some were worried that these programmes aren’t producing the experienced surgeons our health system needs – in particular, those who can handle general surgery (especially emergency surgery) as well as complex, more specialised types.

The quality and performance of qualified surgeons was also discussed in the interviews. Since last year there have been publicly available data on the performance of individual surgeons across the country, which in theory helps you hold your surgeon to account.

Those who were interviewed for the report agreed that this is great news, but cautioned that it takes a team of people to perform good surgery – so patients need better, more sophisticated data if they are really to hold NHS staff to account.

Developing surgical research

Another issue the report looks at, and which is particularly close to our hearts, is research.

Broadly speaking, there are two main types of surgical cancer research. The first looks at surgery alone and tries to improve techniques or develop new ones. The second considers how to use surgery most effectively alongside radiotherapy or drugs to treat – and hopefully cure – patients with minimal side effects.

There’s a small pool of surgeons who are extremely engaged in research in the UK, and they’ve brought about major advances in recent years. But our report suggests that we need many more surgeons to lead research in the future to create further advances in cancer treatment.

This is not simply an issue with how much money is available for research, but making sure that hard-working surgeons have the time and support they need to get involved.

Next steps

The report covers a number of issues, and the findings are complex.

We’re now trawling through the findings with a fine-toothed comb and thinking hard about how we might support improvements in cancer surgery in the future.

We’ll no doubt be talking more about surgery in the coming months as we think how best to respond to the report, and about how to push surgery higher up the political agenda – so watch this space.

Further information

• Download the full report