A journey through the cancer pathway

A road to longer, better lives

By Amy Warnock

Nearly 1 in 2 of us will get cancer in our lifetimes.  

And that statistic applies to Alex too - our fictional character in this story.  

Alex is 47 years old and lives in Sheffield. Alex loves playing tennis, catching up on the latest tv series, and meeting up with friends for a drink and a board game at their local pub. 

Like many of us, Alex has had family members affected by cancer and knows first-hand how cancer can impact on someone’s life.  

While we have made huge progress on cancer in the past 50 years, we still have a long way to go.  

At the moment, the UK lags behind other comparable countries when it comes to cancer survival. And the challenge is only growing.   

So let’s follow Alex’s journey through their cancer diagnosis and treatment and look at some of the barriers they encounter along the way.  

But while these barriers might exist for now, they can be overcome. So we’ll also look at how government action could transform the cancer pathway and lead to more people living longer, better lives.  

Prioritising prevention

As with everyone, Alex’s cancer journey actually starts before their cancer diagnosis. It starts with how Alex goes about living their everyday life.  

And that’s because around 4 in 10 UK cancers are preventable.  

So, if we can prevent cancers from developing in the first place, we can avoid the need to begin a journey on the cancer pathway.  

A doctor holding a sign that says 'Cancer Prevention'

Image source: Shutterstock/Markus Mainka

Image source: Shutterstock/Markus Mainka

The picture now

Let’s take lung cancer as an example. It’s the third most common cancer in the UK, and every year around 49,200 people are diagnosed with the disease.  

The majority of lung cancer cases are caused by smoking, which means they are preventable.  

And it’s not just lung cancer. Smoking causes at least 15 types of cancer, as well as numerous other health conditions. Around 125,000 people in the UK are killed by tobacco each year - this includes smoking, second-hand smoke and chewing tobacco. 

Smoking is also the biggest driver of the difference in life expectancy between the least and most affluent populations in the UK.  

Alex has smoked since the age of 17, and like most people who smoke they want to give up. But because of the addictive nicotine in cigarettes, Alex has struggled.  

But it’s not just smoking. Obesity and overweight is the second biggest cause of cancer in the UK and is linked to 13 types of cancer. Obesity and overweight prevalence in the UK is increasing, affecting more than 6 in 10 adults.  

Drinking alcohol also increases cancer risk and the UK Chief Medical Officer's drinking guidelines advise against regularly exceeding more than 14 units of alcohol spread over a week. But there is no completely safe level of drinking, so the less you drink the better for your health.  

The good news is that we can do something about these risk factors. And if we want to reduce the burden of cancer in the UK, that begins with trying to prevent it.  

What can change

Put simply. if we can prevent more cancers we can save more lives. 

And to do this we need strong government action.  

Tackling smoking alone, to ensure that England meets its Smokefree target (that’s 5% or less of the adult population smoking) across all socio-economic groups, would prevent around 26,600 cancer cases by 2040.  

And fortunately we could already be on our way to making this a reality. Recently, the UK Government announced that it will introduce legislation to raise the age of sale for tobacco, ensuring no one currently aged 14 or under can ever be legally sold cigarettes or other tobacco products. But we’re not done yet, we need to see this legislation passed, and adequate funding for services to help people stop smoking. 

It’s changes like this that could prevent people like Alex ever taking up smoking in the first place, and maybe also prevent their cancer.  

But this alone won’t be enough. To prevent even more cancer cases, we need to see more measures introduced to reduce the prevalence of smoking, overweight and obesity, and drinking alcohol above recommended limits in the UK.  

A non-smoking sign

Image source: Shutterstock/Variety beauty background

Image source: Shutterstock/Variety beauty background

Optimising screening

If we can’t prevent cancer, the next best thing is diagnosing it early.  

That’s because by diagnosing cancers earlier we can ensure that people have more treatment options and the best chance of survival. 

Scientist preparing microscope slides with liquid based cytology method

Image source: Shutterstock/Anamaria Meija

Image source: Shutterstock/Anamaria Meija

The picture now

The UK has been focusing on early diagnosis for some time, and the NHS have a target of diagnosing 75% of cancer patients early (at stage 1 or 2) by 2028, but it is currently not on track to achieve this.  

As it stands, far too many cancers are still diagnosed at stage 4, when there are limited treatment options and prognosis is often poor.  

Around 1 in 5 cancer cases in England are diagnosed through emergency routes, which is associated with worse outcomes and worse patient experience. This needs to change.  

A key way in which we can diagnose cancers earlier is through screening programmes, where people without symptoms are tested for early signs of cancer. The UK currently has three cancer screening programmes, for bowel, breast and cervical cancer.  

But at present only 6% of cancers are diagnosed through screening, so we need to optimise and expand on these programmes to ensure that the screening programmes are working as hard as they can to help save lives.

An empty corridor in a hospital

Image source: Shutterstock/Xdbzxy

Image source: Shutterstock/Xdbzxy

What can change

We know there isn’t a silver bullet to achieving earlier diagnosis across all cancer types. But there is a big potential for innovation in cancer screening.   

The UK breast, cervical and bowel screening programmes save over 5,000 lives every year. But if we increase the uptake of these programmes across England to around 80%, we estimate that we can diagnose an extra 4,000 cases of cancer per year. 

And there are also exciting new developments on the horizon.  

In June this year, the UK Government announced the roll out of a new targeted lung cancer screening programme for people in England aged 55-74 who either smoke or used to smoke. 

By delivering this national lung cancer screening programme we estimate that, with a 50% take up, around 1,900 lives could be saved in the UK each year.

Having smoked for a long time, a screening programme like this could have had a big impact for Alex, as it could have led to their cancer being diagnosed earlier, when there are more treatment options available.  

The UK Government now need to ensure that the lung cancer screening programme is quickly implemented across England, and relevant ministers in the devolved nations should also commit to rolling out lung screening in their countries as quickly as possible. 

A woman undergoing a mammogram

Image credit: Rhoda Baer/National Cancer Institute

Image credit: Rhoda Baer/National Cancer Institute

Waiting for a diagnosis

Lung cancer screening wasn’t available for Alex yet, so instead their journey to receiving a diagnosis starts when they notice some changes. 

Alex first suspects that something isn’t quite right when they notice a new cough that won’t go away. So Alex goes to their GP, who gives them an urgent referral for a chest X ray.  

After the X ray, Alex is referred for further tests. 

And this is where we run into one of the biggest hurdles on the pathway. Cancer waiting times.  

An image of a chest x ray

Image credit: National Cancer Institute

Image credit: National Cancer Institute

The picture now

Getting an urgent suspected cancer referral is an incredibly stressful time, both for Alex, and their friends and family. So it should be a priority to make sure that this experience is as quick as possible.  

But at the moment this isn’t happening. Performance related to cancer waiting times are at a near all-time low. 

NHS England has set cancer waiting times targets, but over the past few years, these have consistently been missed.  

In England, 85% of patients should start their treatment within 62 days of an urgent cancer referral. But the 62-day standard has been missed since 2015, meaning over 141,000 patients waited longer to start treatment than if the target had been met consistently. 

In 2021, the new Faster Diagnosis Standard (FDS) was introduced in England, which stipulates that patients should have their cancer ruled out or receive a diagnosis within 28 days. Although the implemented target of 75% is well below the original target of 95%, this target has still not been met since its introduction.  

So what can we do to make sure that people like Alex are diagnosed and treated as quickly as possible? 

What can change

The main problem facing the NHS when it comes to cancer waiting times is resource, particularly when it comes to diagnosing cancer.

Fixing the cancer workforce isn’t easy, but it’s doable.

The UK Government made a good start this year by publishing their Long-Term Workforce Plan. But they need to build on this plan and commit funding to ensure that it delivers the cancer workforce that the country needs.

Importantly, as well as addressing staff and resource shortages, action needs to be taken to improve NHS workforce retention. There are proven interventions to boost retention, including access to training and professional development opportunities, flexible working and wellbeing support. Using interventions such as these, the UK Government need to fully commit to turning the tide on the numbers of experienced staff leaving the workforce. 

If we can improve NHS resource and retention, and begin to meet cancer wait time targets, this could have a huge impact on patients. 

By meeting the FDS target at 95%, rather than the current target of 75%, we estimate that around 49,000 extra people per month could receive a cancer diagnosis or have cancer ruled out within the proposed 28-day FDS window. Not only does that mean that cancers can be treated faster, it means less time spent worrying for people and their families.

But it’s not just cancer waits that can be fixed. With new challenges on the horizon, such as an ageing population and more complex treatments, by addressing NHS staffing shortfalls across the cancer workforce, the government can ensure that the UK have a workforce fit for the future of cancer care. 

Hospital staff in a hospital corridor

Image source: Shutterstock/Altrendo Images

Image source: Shutterstock/Altrendo Images

Innovating new treatments

Because of staff shortages, Alex has had to wait longer than 28 days to receive a diagnosis of lung cancer. And now they are about to begin treatment.  

Alex’s treatment plan involves treatment with gefitinib. This is because Alex’s cancer has a mutation in a gene called EGFR, which is involved in helping cells grow and divide.  

Gefitinib can specifically target and block EGFR activity in cancer cells 

Targeted cancer treatments, such as gefitinib, have made a huge difference to people with cancer over the last 50 years. They work by targeting specific differences between cancer cells and healthy cells which help the cancer to survive and grow. This means they’re less likely to damage healthy tissue. 

But the journey of developing new treatments and getting them to patients is a long one. 

An box of Iressa (getfitinib)

Image source: Shutterstock/Syazwani Pardi

Image source: Shutterstock/Syazwani Pardi

The picture now

The path to new treatments begins with a strong research workforce. But there are concerns over the sustainability of the biomedical research funding landscape over the next decade.  

With current government levels of funding and charity income remaining static, we estimate there will be a shortfall of between £1-2bn in cancer research investment over the next decade.  

But it’s not just a problem of research funding. We also need to tackle system-wide issues to ensure that research careers are attractive and accessible for everyone, remove the barriers that may stop international talent coming to the UK to do their research, and build a diverse research community. 

We’re also facing barriers when it comes to translation – getting new discoveries from the lab to a place where they can benefit patients. All stages of the UK translation pipeline, from the early stages of clinical research to test safety and effectiveness through to adoption and implementation, need to be strengthened to ensure that patients can see the impact of new tests and treatments.   

What can change 

Of all publicly funded cancer research in the UK, around 38% comes from the government and around 62% comes from charities.

The US Government funds over 5 times more cancer research per capita than the UK Government...

...and the Norwegian Government funds over 2.5 times more.

The government needs to commit to making research and development (R&D) spending a priority. 

The UK can remain at the forefront of cancer research, but it will take sustained, long-term investment across the research sector.  

Investment in research not only has huge benefits for patients, but also for our economy. In 2020/21 there was £1.8bn invested into cancer research. This generated more than £5bn of economic impact.  

As well as committing to prioritising funding, the government also need to ensure that barriers to cross-border research are minimised, as well as reducing potential barriers, such as high upfront visa costs, to encourage an international and diverse research workforce in the UK. Collaboration across the globe is key to solving cancers biggest problems.  

The government also needs to facilitate translation in the UK, streamlining the process of bringing innovations to the health system and encouraging investment to fund the early stages of translation. 

With a world-leading research sector, and a streamlined translation process, we can ensure that we continue to make groundbreaking discoveries and develop new cancer treatments for patients just like Alex.  

A picture of the world with lines joining different countries across the globe

Image source: Shutterstock/Nico El Nino

Image source: Shutterstock/Nico El Nino

Leading on cancer

Thanks to getfitinib, Alex is able to live a longer, better life. But that’s not the case for everyone with cancer.  

As we can see from Alex’s journey, the cancer pathway for a patient can be long, complex and fraught with obstacles. These obstacles will vary widely depending on the patient, but importantly many of them are fixable. 

Fixing them won’t be easy, but it is possible. Cancer survival in the UK has doubled over the last 50 years, and with the right leadership we can make sure that the next 50 years are just as impactful.  

The upcoming general election needs to be a turning point for people affected by cancer.  

We need to see strong leadership on cancer in the UK, to ensure a long-term focus on cancer. This approach needs to bring together discovery, translation, cancer prevention, detection, diagnosis and treatment, health system investment and reform, to ensure that more of us are able to live longer, better lives.  

And that’s why we’ve launching Longer, better lives: A manifesto for cancer research and care. Our manifesto outlines the steps the next UK Government must take to make transforming cancer outcomes a reality. And if you agree, you can join us in telling party leaders to back our calls for longer, better lives.

An image of Longer, better, lives: a manifesto for cancer research and care being held outside Westminster
TopBuilt with Shorthand