In January 2015, NHS England announced that it was putting together a ‘Taskforce’ to work out how the country can best tackle the challenges that cancer will bring over the next five years, and pull together a ‘cancer strategy’ to improve survival.
Cancer strategies are a good thing. They set ambitious goals and provide resources across the health system to improve cancer outcomes. So we were really pleased by the announcement.
As former National Cancer Director, Professor Sir Mike Richards, wrote on this blog a few weeks ago, the improvements in survival over recent decades have been due in no small part to the previous strategies that he and his team developed and put into practice.
Our chief executive, Harpal Kumar, is chairing the new Taskforce.
But because he is doing so independently, it’s important that we as a charity submit our own view on what we think will have the most impact in years to come, and will bring us closer to achieving our 20 year goal to see three-quarters of patients survive their cancer for 10 or more years.
Last Friday was the deadline to submit evidence to the Cancer Taskforce – and we, like many others, put in a response. The Taskforce asked for three key commitments that we want to see included.
For us this broadly falls into these categories:
- Prevent more cancers;
- Diagnose cancers at an earlier stage;
- Ensure that the most effective treatments are available to all patients who need them.
But there is a lot more to it than these broad points, and there are so many things we want to see happen over the next five years.
So we thought we would share a bit more about what we want to see in the strategy, and what we put in our submission.
A shared ambition to prevent more cancers
More than four in 10 cancers diagnosed in the UK are linked to lifestyle or environmental factors – in other words they are preventable.
So we want the strategy to aim to reduce the incidence of preventable cancers. And that means action on smoking, alcohol and obesity. But we also need a greater focus on drugs that can prevent certain types of cancer in people at higher risk. And an NHS that uses these ‘chemopreventative’ drugs when the evidence around patient benefit is strong enough.
While the number of people smoking is declining, it remains the leading cause of preventable disease and death in England.
We want the strategy to commit to implementing a five year tobacco control plan, which will work towards an overall vision of a ‘tobacco-free’ society (less than 5 per cent of adults smoking) in the next 20 years. We also want to see a focus on tackling smoking-related health inequalities and greater support for high quality smoking cessation services.
Alcohol consumption is also a major risk factor for cancer. Regardless of the level of alcohol consumption, there is an associated cancer risk. We believe a specific alcohol harm reduction strategy is required to improve public awareness of the risks and introduce measures to tackle the availability, price and marketing of alcohol.
And we need action on obesity too. We are used to being hit with headlines about the nation’s growing waistline in the media. And evidence shows that obesity is associated with more than 18,000 cases of cancer in the UK each year.
With more than half of adults in the UK being overweight or obese, it is vital that the Government develops an obesity strategy that focuses on:
- tackling marketing of unhealthy foods,
- improving accessibility and prices of healthy foods,
- encouraging physical activity.
Substantial improvements in early diagnosis
In England, we often diagnose cancer later than in other comparable countries, which is one reason survival in the UK is poorer than those countries. We need to diagnose cancer as early as possible to give patients the best possible chance of survival. So we think that addressing this should be a focus of the new cancer strategy.
Here are a few ways we think earlier diagnosis can be achieved:
- Increasing bowel screening rates across England, subject to people having all the information they need to decide to take part. Uptake of bowel screening still varies across the country and is generally poor compared to other screening programmes. We also want to see new screening programmes introduced where evidence has shown their benefit.
- Improving public awareness of various cancers and symptoms is an important way to promote early diagnosis. Research is showing that the Be Clear on Cancer campaigns have been successful in boosting symptom awareness, and we want to see more evidence-based public awareness campaigns such as these.
- A major issue is that thousands of patients are waiting too long to receive their test results. The NHS needs to find better ways to get patients into and through the health system quicker to diagnose cancer. GPs need greater support, but the lack of capacity in diagnostic services needs urgently addressing as more people are referred for tests.
Providing all patients with the best treatment
We know that different treatments get used at different rates in different areas of the country. This means some patients are missing out on treatments that could benefit them.
So we want the strategy to reduce this variation, and ensure all patients receive the most effective treatments for their cancer.
For many cancer patients, surgery offers the greatest potential for cure. Yet it can be difficult for doctors to offer some patients certain types of surgery.
Recent research has shown that this is a particular problem for older people, who are less likely to be offered surgery as a treatment option. But we also know that surgery rates in England are lower than comparable countries, and access varies across the country. We want the strategy to address this variation in surgery, and identify better ways for the NHS to adopt new and innovative techniques that could improve the outlook for patients.
Availability of radiotherapy – which we have been campaigning to improve for years now – is also an issue, with levels below those recommended, and access rates varying across the country.
In particular, we know that patients are missing out on more advanced types of radiotherapy – and urgent action is needed to replace outdated equipment to help ensure all suitable patients can receive the treatment they need.
Ultimately, we want the strategy to put improvements in radiotherapy at its heart – building on the Vision for Radiotherapy report we published last year. We need to address this variation in access to provide patients with truly world-class treatment.
Chemotherapy and drugs
Chemotherapy and other drug treatments play a vital role in the treatment of cancer. We have blogged before about the need to have a system of funding cancer drugs that works for all patients, and we want to see that happen, and happen soon.
We are now in the world of personalised medicine, and the NHS must be in a position to capitalise on that, to get the right medicines to the right patients. A key way to do this is for patients to be offered molecular diagnostic tests to show which drug is best for their cancer. We have aired our disappointment about progress in this area and we want to see the NHS make ground here.
There is so much more….
There is a lot we want to see in the new strategy – such as commitments to research, better data on NHS performance, and more tailored information for patients. You can read our response here to find out more.
But for the time being, we hope this gives you a flavour of what we want to see over the next five years to improve things for people with cancer. It’s now up to the Taskforce to produce an ambitious strategy that will meet the cancer community’s expectations.
We await its response.
Emlyn Samuel and Ifewumi Fagunwa are part of Cancer Research UK’s policy department