A report revealed that at-risk patients are also not being referred by GPs early enough to detect if they have cancer. Many could be saved if they were tested and diagnosed earlier. However, the number of urgent GP referrals in England, where patients see a specialist within two weeks, has this year fallen below the NHS target of 93 per cent for the first time since 2003. This amounted to 122,835 patients between January and September not being referred within 14 days. Research led by Sir Mike Richards, the former director of National Cancer which is funded by the Department of Health, examined the last 20 years of cancer care in England.
He said: “Every year thousands of deaths could be avoided if we achieved these goals. This is the equivalent to a jumbo jet of people falling from the sky every two weeks.”
The first NHS Cancer Plan launched in 2000 promised that by 2010 “our five-year survival rates for cancer will compare with the best in Europe”. The study found that almost two decades later the UK still trailed far behind other countries in availability of diagnostic equipment – ranking 35 out of 37 countries for the number of CT scanners and 31 out of 36 for MRI equipment. The UK is also hit with staff shortages and constraints on the number of at-risk patients referred for testing by their GPs.
Sir Mike said: “The NHS Cancer Plan in 2000 and all subsequent cancer strategies have set ambitions for England to match the best in Europe or the world in relation to cancer survival.
Thousand of lives are lost because of a lack of scanners
The UK lags behind poorer countries in cancer survival rates
Although progress has been made on many aspects of cancer, these aims have not been achieved.” The study warned that increasing the number of referrals will also require investment across the healthcare system.
Study co-author Dr Rebecca Fisher added: “We need not only the facilities, we need more people to be able to operate the scanners and to interpret the results.”
The average UK survival rates for breast, lung, colon and rectum cancer from 2010 to 2014 were lower than Canada, Denmark, Norway, Sweden and Australia, according to the latest analysis of international variation in cancer survival. The survival rate for ovarian cancer was 10 per cent higher in Sweden than the UK for the same period – 46.5 percent compared to 36.2 per cent. In a report published by the Health Foundation, researchers warned more people suspected of having cancer needed to be referred for investigation by their GPs.
Nice guidelines recommend that patients with a three percent or higher risk should be given further testing. They have not yet been fully implemented and efforts are being made to increase GP awareness.
Early detection and diagnosis is critical to improving a person’s chances of survival, as early-stage cancer is more responsive to treatment. The five-year survival rate for bowel cancer is 90 percent if caught early, but less than 10 percent if diagnosed late. However, the proportion of people being diagnosed at an early stage remained almost static from 2015 to 2017. Disruption caused by reforms following the Health and Social Care Act in 2012 and recent cuts to funding for preventative measures – such as raising awareness of the dangers of obesity and smoking – have also had a negative impact on progress, Dr Richards’s study found.
It warned if the UK was to catch up in lowering survival rates a “whole-system” change was needed. It also called for the introduction of more Rapid Diagnostic and Assessment Centres and for more patients to undergo endoscopies and other tests to screen for bowel cancer.
Sir Mike said of the report’s recommendations: “The Prime Minister’s ambitious target to increase early detection of cancer from one in two people today, to three in four by 2028, is welcome, but setting targets and handing out money will not be enough. The NHS must change the way that care is currently organised to make it easier for people to be seen and diagnosed as quickly as possible, as we know this gives them the best chance of survival.”
Emma Greenwood, Cancer Research UK’s policy director, said the study showed “how far we still have to go in giving cancer patients the best chances of survival”. She added: “With the number of cases increasing it’s crucial we speed up progress.”
Professor Sir Mike Richards, Chief Inspector of Hospitals
Cancer accounts for more than a quarter of all deaths in the UK and kills around 164,000 people each year. Incidence of the disease has risen steadily, increasing by 40 per cent over 20 years to 2015.
An NHS England spokesman said: “The NHS is now seeing two million urgent GP referrals a year, half a million more than in 2015 when Nice updated their referral criteria, with a record numbers of people receiving treatment. Cancer survival rates are at their highest ever and further work to ensure faster and earlier diagnosis and treatment is underway and will be a cornerstone of the NHS’s long term plan for cancer to help save more lives.”
A Department of Health and Social Care spokesman said: “Improving early diagnosis of cancer is a key priority for this Government. That’s why from next year, patients with suspected cancer will receive a diagnosis or have cancer ruled out within 28 days. We also announced a package of cancer measures that will radically improve the system and ensure 55,000 more people survive cancer for five years from 2028.”
COMMENT by Ruth Thorlby
It’s rare to find someone who’s not been affected by cancer – either as a patient, or through family or friends. Better cancer services in the NHS regularly tops the list when people are asked what is important. Although there has been much progress in the past two decades with better access to drugs, more screening and speedier waiting times, outcomes still lag behind other countries. A promise was made by the Government in 2000 to have the fastest improving cancer services in Europe.
But other countries have also improved and the gap in survival rates between the UK and comparable countries is still there. Why? Part of the answer has taken several years to uncover. Research in several countries found there were no major differences in people’s knowledge of symptoms of possible cancer, but Britons were more worried about wasting their doctor’s time.
Doctors here were also less likely to refer people for tests. Getting patients diagnosed and treated earlier before their cancer has become advanced, is now seen as vital to closing the gap. Theresa May has recently said that early diagnosis should be a high priority and that the proportion of cancer patients diagnosed at an early stage should increase from one-in-two people to three-in-four by 2028.
Achieving this will require effort right across the NHS. At the moment, there are not enough staff to carry out investigations as both GPs and hospitals are under huge pressure. GPs need to be supported to refer more people for tests, and where possible do some of the tests locally. It is important to make sure there are enough diagnostic machines, such as CT and MRI scanners and enough staff to run them.
It is also vital people are better informed about the symptoms of cancer and feel confident they are not wasting the GP’s time.
Public awareness campaigns – which have been successful in the past – play a crucial role in this. Cancer caught earlier is easier to treat – often through surgery and radiotherapy – and often means less chemotherapy: better for patients and better for the NHS.
• Ruth Thorlby is Assistant Director (Policy) at The Health Foundation