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How does cancer treatment in the UK measure up to other countries?

Jacob Smith
by Jacob Smith | Analysis

27 February 2024

4 comments 4 comments

A close up of the UK on a globe, with a red pin marking its location
Shutterstock - Laura Reyero

For more than a decade, a multidisciplinary group of experts, including academics, clinicians and data experts, from the International Cancer Benchmarking Partnership (ICBP) have been reporting on the variation in cancer survival between countries.  

The partnership, which is hosted by Cancer Research UK, is a unique collaboration that explores what factors are driving differences in cancer survival so that it can identify changes to policy and practice that could make an impact for patients. 

We already know that, for some cancer sites, the UK lags behind other, comparable countries when it comes to survival, and research from the ICBP has given us insight into some of the reasons why. 

These range from how quickly GPs refer patients for tests, to each of the UK nations lacking consistent cancer policies, and a variation in the rate of early detection for many cancers. 

Survival by stage at diagnosis is also a crucial indicator for assessing the quality of cancer treatment and care between countries, which the ICBP uniquely investigates. 

Some previous ICBP studies show that stage for stage, patients in the UK have poorer survival than patients in other countries, this is especially true for the most advanced cancers and our older patients. 

But those reasons alone leave the puzzle incomplete. The full picture is complex, multifactorial and likely to span the whole cancer pathway, and to complete it, we need to explore some other possible causes. 

Now, new research from the ICBP, published today in Lancet Oncology, is giving us new pieces to slot into our puzzle. 

A striking picture

The research looked at differences in how countries use chemotherapy and radiotherapy, two of the most widely used cancer treatments, to see if that could be a factor in why survival differs. 

It’s the most comprehensive study of how chemotherapy and radiotherapy use varies to date, exploring the treatment of over 780,000 people diagnosed across countries in 3 continents between 2012 and 2017. 

And the results were striking: people in the UK were treated with chemotherapy and radiotherapy less often, and faced longer waits to start treatment. 

“For many aggressive cancers – such as ovarian, lung and pancreatic cancer, it’s vital that people are diagnosed and start treatment as soon as possible,” said Dr John Butler, clinical lead for the ICBP. 

“Lower use of chemotherapy and radiotherapy in the UK could impact people’s chances of survival, especially for older patients.  

“Although we have made progress, the last benchmark showed that cancer survival in the UK is still around 10 to 15 years behind leading countries. This study captures missed opportunities for patients in the UK to receive life-prolonging treatment.”

The findings 

Along with the 4 nations of the UK, the research examined treatment data from three comparable countries, Norway, and some jurisdictions of both Australia and Canada. It included 8 cancer types: oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian. 

Icons representing the 8 cancer types investigated in this study: oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancers
The 8 cancer types investigated in these studies were oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian. Based on a graphic created by the International Cancer Benchmarking Partnership and Cancer Research UK

And between those countries, there was variation in the treatment of all 8 cancer types, but some key differences were clear. 

Overall, people in the UK were treated with chemotherapy and radiotherapy  less often than in comparable countries, and patients 85 and over were the least likely group to receive these treatments. 

Countries with better cancer outcomes typically had higher use of chemotherapy and radiotherapy and shorter waits to start treatment. 

For example, people living in Norway and Australia started chemotherapy and radiotherapy in the quickest time and had the highest 5-year net survival for stage 3 colon cancer. Survival was in 70.7% in Norway, and 70.1% in Australia, compared to 63.3% in the UK.* 

Graphs showing the overall average use of radiotherapy (top) and chemotherapy (bottom) in the 4 UK nations
Graphs showing the overall average use of radiotherapy (top) and chemotherapy (bottom) in the 4 UK nations compared to the overall average of the analyses. Data from Wales was not used in the meta-analyses to calculate the overall average, and as such is marked with an asterisk. Based on a graphic created by the International Cancer Benchmarking Partnership and Cancer Research UK.

Patients in the UK also faced long waits for treatment, although this varied depending on where they live.  

The average time to start chemotherapy in the study period was shortest in England (48 days) and longest in Scotland (65 days). Northern Ireland had the shortest average time to start radiotherapy (53 days). Wales (81 days) and Scotland (79 days) had the longest. 

“This study builds on over a decade of ICBP research into how cancer diagnosis and care varies internationally,” says Professor Georgios Lyratzopoulos, lead researcher from University College London.  

“We already know that the cancer survival in the UK has fallen behind countries like Australia and Canada, and this analysis of two key cancer treatments highlights one of the likely reasons.  

“With cancer cases projected to rise in the UK, the NHS must be equipped to deliver the best care for patients. The cancer treatment landscape is changing at pace, but capacity issues and system pressures mean that not all patients can feel the benefit of specialist cancer treatments.   

“To improve the UK’s cancer outcomes, we need to continue to investigate what is driving international variation in treatment – better data collection is key to this.” 

What do we do about it? 

Although not every patient will require them, chemotherapy and radiotherapy are key cancer treatments. It’s estimated around 4 in 10 people with cancer in the UK should receive radiotherapy as part of their care. 

While some cancer patients need time to prepare for treatment, waiting too long can   exacerbate their stress and anxiety levels, and for some patients mean their cancer can keep growing. 

But if we’re to address these differences in treatment use between countries, we need to understand what’s causing them. 

For example, concerning delays to begin treatment in the UK are partly a result of the UK Government’s lack of long-term planning on cancer in recent decades. Workforce and capacity pressures across the UK health system, a result of the lack of long-term planning, are another barrier to delivering world-class treatment for patients.   

Workforce will be one of the research themes covered by the next phase of the ICBP’s research, with the partnership hoping to discover how the best performing jurisdictions are mitigating this issue.  

However, the UK’s urgent crisis in cancer care could be turned around with a long-term plan to deliver the investment and reform needed in the NHS.  

Longer, better lives

Cancer Research UK’s manifesto, ‘Longer, better lives’ is calling on the UK Government to dramatically improve cancer survival in the UK.  

A key part of this is taking a strategic approach to addressing treatment variation. If implemented, the manifesto’s policies could help to prevent 20,000 cancer deaths every year by 2040.    

In addition, we’re calling for a strategic approach to addressing treatment variation. Better data collection and investment in clinical audit and quality improvement would help us understand and tackle why access to timely, quality treatment differs.    

With cancer cases projected to rise in the UK, demand for treatments like chemotherapy and radiotherapy will substantially increase. And a wider range of people, including older people with more complex healthcare needs, are likely to require cancer treatment.   

“The UK should be striving for world-leading outcomes,” says Michelle Mitchell, our chief executive.  

“All cancer patients, no matter where they live, deserve to receive the highest quality care. But this research shows that UK patients are treated with chemotherapy and radiotherapy less often than comparable countries.  

“When it comes to treating cancer, timing really matters. Behind these statistics are people waiting anxiously to begin treatment that is key to boosting their chances of survival.   

“We can learn a great deal from other countries who have stepped up and substantially improved cancer services. With a general election on the horizon, the UK Government has a real opportunity to buck the trends we see in this research and do better for people affected by cancer.” 

 Jacob

* ICBP SURVMARK-2 data, Age-standardised 5-year net survival, both sexes, age 15-99, colon cancer, 2010-2014. 

    Comments

  • Tom Hatton
    23 June 2024

    If we are talking about cancer survival rates in the UK compared with say Norway for example it would be interesting to compare how many early cancer screening tests are available to the public in these two different countries.
    And indeed what percentage of the two populations are aware how vital to your survival taking the opportunity to get tested is.

  • Michael Baker
    19 June 2024

    With a general election taking place in 2 weeks ; and Labour, the party that is underpinned by the success – until recently- of the Welfare State and a belief across its membership that public services are key to our civilised country, due to take charge, we should all celebrate the final end of post Thatcher greed and rabid “small state” privatisation. Getting UK back up on its feet and working with the EU – a large and successful marketplace for the best in medical solutions – will certainly help close the gap between us and other European countries.

  • Malcolm Turner
    6 March 2024

    Governments and people who are responsible should be ashamed of themselves ,

  • Dr.Chitra Ray ,FRCOG
    27 February 2024

    As a retired Gynaecologist I find these findings extremely worrying and disappointing. However, with all the problems the NHS is going through ,at the moment, somebody has to take a strong controle over the whole situation as soon as possible. Delay in diagnosis and start of treatment of cancer cannot be taken as inevitable. May be the whole structure needs changing and Cancer care given a priority.

    Comments

  • Tom Hatton
    23 June 2024

    If we are talking about cancer survival rates in the UK compared with say Norway for example it would be interesting to compare how many early cancer screening tests are available to the public in these two different countries.
    And indeed what percentage of the two populations are aware how vital to your survival taking the opportunity to get tested is.

  • Michael Baker
    19 June 2024

    With a general election taking place in 2 weeks ; and Labour, the party that is underpinned by the success – until recently- of the Welfare State and a belief across its membership that public services are key to our civilised country, due to take charge, we should all celebrate the final end of post Thatcher greed and rabid “small state” privatisation. Getting UK back up on its feet and working with the EU – a large and successful marketplace for the best in medical solutions – will certainly help close the gap between us and other European countries.

  • Malcolm Turner
    6 March 2024

    Governments and people who are responsible should be ashamed of themselves ,

  • Dr.Chitra Ray ,FRCOG
    27 February 2024

    As a retired Gynaecologist I find these findings extremely worrying and disappointing. However, with all the problems the NHS is going through ,at the moment, somebody has to take a strong controle over the whole situation as soon as possible. Delay in diagnosis and start of treatment of cancer cannot be taken as inevitable. May be the whole structure needs changing and Cancer care given a priority.