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Four key ways to improve cancer patient care in Wales

by Leo Ewbank | Analysis

10 June 2016

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One in two people will develop cancer at some point in their lives. And over the coming years, healthcare services will have to diagnose and treat more people, and help more recover, than ever before.

Thankfully, we’re better informed than ever about how best to prevent, diagnose and treat the disease, and how to help patients have a better experience and quality of life . The challenge is to turn that knowledge into real improvements in care.

Wales, Northern Ireland, Scotland and England all have their own distinct health services. So it’s important to make sure that each country is planning its cancer services to meet its population’s needs.

With this in mind, and with the incoming Welsh government committed to drawing up a new cancer strategy we set out to look at how the Welsh NHS provides for people with cancer, how its services are performing, and how it could improve outcomes.

Yesterday we published our report, Where next for cancer services in Wales?, looking in detail at the challenges the nation faces. While there have been notable improvements in cancer care in Wales, with more people surviving than ever before, things are still a long way from where they should be.

Here’s what we found – and our recommendations for how the government can make improvements.

How patients fare

One of the first questions we asked was, how does cancer affect the population of Wales?

It’s a mixed bag. On one hand, we found that the chances of developing the disease are higher than the UK average, and so are the chances of dying from it.

And in Wales – like in other UK countries – cancer survival still lags behind the best in Europe.

But against these somewhat gloomy statistics, there is progress – overall cancer survival is improving. On average, 54 per cent of all patients survive for five years or more – compared to around 44 per cent of patients diagnosed in the mid-1990s.

And as in the other UK nations, there are big differences in survival between the different cancer types. For example, 80 per cent of people affected by testicular, prostate or breast cancer survive for five years or more after a diagnosis. In contrast, fewer than 10 per cent of people affected by three notoriously hard-to-treat cancers – pancreas, liver and lung – do likewise.

As well as this, cancer is affecting an increasing number of people in Wales. In 2005 around 16,800 people were diagnosed; in 2014 the number exceeded 19,000.

This increase is – like in the rest of the UK – due both to an ageing population and preventable risk factors, such as smoking and obesity. In fact, the number of cases diagnosed has increased by around 1.5 per cent a year for the last decade – and we expect this trend to continue.

Our projection, below, suggests it won’t be long before 20,000 people are diagnosed each year in Wales.

Wales cancer projection

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This presents a critical challenge for the Welsh NHS – one which other parts of the UK also face. As more people are diagnosed with cancer, demand on the health service will rise.

How patients are diagnosed?

As we know, early diagnosis makes a huge difference to cancer survival. Today, however, too many people in Wales – around a third of patients – are diagnosed at a late stage (i.e. stages three and four). This limits their options for successful treatment.

Other parts of the UK face similar challenges. As England’s own cancer strategy makes clear, late diagnosis is one of the main factors contributing to the UK’s outcomes being worse than other countries.

Diagnosing cancer early relies on several things: patients knowing that certain symptoms are likely to be cancer, visiting their GP, and – crucially – being sent for tests quickly if the doctor suspects cancer.

But the Welsh NHS is struggling to meet demands for investigative tests – resulting in patients starting treatment later.

The Welsh Government set a target for 95 per cent of cancer patients to start treatment within 62 days of being referred urgently by their GP, but this hasn’t been met since 2008 (see below). This failure to meet targets means that, since 2007, more than 5,000 patients are waiting more than two months to start treatment.

Wales cancer waiting times

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Availability of treatments

Finally, our report suggests patients across Wales aren’t getting widespread access to high-quality treatments – such as cutting edge surgery and radiotherapy, and the latest cancer drugs.

For example, radiotherapy contributes to an estimated four in 10 cancer cures. But the latest advanced techniques are only provided at three centres in Wales. Consequently, patients living in more rural areas face long journeys to receive treatment, and delaying some people starting it.

There are also problems over the availability of newer cancer drugs.

Wales generally follows the recommendations of the National Institute of Health and Care Excellence – NICE – on new drugs, but the nation’s local health boards have discretion over whether to fund those drugs NICE approves. This leads to variation in what’s available.

And patients with rare conditions, who need non-approved drugs, have to apply for the treatment using a system of Individual Patient Funding Requests (IPFRs). It’s then up to the local health board, which plans and provides healthcare in Wales, to decide whether or not to grant the request. This means patients in different parts of the country receive different levels of access.

An opportunity

So how can Wales improve? Over the coming months the Welsh Government will be developing a new strategy to tackle cancer. The previous strategy, Together for Health – Cancer Delivery Plan, was published in 2012 and comes to an end this year.

This is an opportunity to make substantial improvements, and we think there are a number of things that could make a real difference. Here are our four key recommendations:

  • The Welsh Government needs to review the state of diagnostics and invest money to make sure as many people as possible can be diagnosed quickly. An ageing population, and NICE’s recent decision to lower the threshold for referring patients with suspected cancer, is likely to mean more tests are needed. So it’s important that the Government plans for the rise in demand for diagnostics.
  • To remedy the inequalities in the availability of cutting-edge treatments, we think a nationwide approach is needed. We suggest a new organisation should be created, to take responsibility for planning and coordinating radiotherapy, and other specialist cancer treatments.
  • The Welsh Government should also introduce a national decision-making body so there is greater consistency in decisions for Individual Patient Funding Requests.
  • Lastly, the new strategy also needs to consider how the Welsh NHS will maintain access to cutting-edge drugs following reforms to the Cancer Drugs Fund and NICE in England.

Looking ahead

Cancer services in Wales have made important progress. More than half of cancer patients now live for five years or more after a diagnosis. But there is more to be done if Wales is to deliver the world-class results patients deserve.

Critically, more people will need cancer care in the coming years. The challenge for the Welsh Government, therefore, is to improve as quickly as possible while meeting rising demand. But we believe the recommendations in our report will help the Welsh NHS do this.

This new strategy is an opportunity to change cancer outcomes for the better and we hope the Welsh Government capitalises on this crucial moment.

Leo Ewbank is a policy adviser at Cancer Research UK