Sir John Bourn, head of the National Audit Office, reported today that cancer patients are increasingly surviving the disease as a result of the new initiatives launched by the Department of Health and the NHS over the last decade. But the NHS needs to continue to do more to ensure all patients are treated swiftly and appropriately.
The incidence of cancer has grown by 31 per cent since 1971, in part owing to lifestyle factors such as the trend up to the late 1960s for a greater number of women to smoke and the trend for increased exposure to sunlight. However, survival rates are up and death rates have fallen by 12 per cent in the last 30 years. Progress varies by type of cancer. Detection and treatment of breast cancer have improved strongly with survival rates now approaching 80 per cent. However, in the absence of means of detecting lung cancer in its early stages, patients diagnosed with lung cancer then live on average for only four months, highlighting the importance of effective prevention measures for this cancer.
Cancer mortality rates for men in England and Wales now compare very favourably with other countries (for example, France, Spain and Germany), but have further to go for women, in part a reflection of the timing of the take up of smoking in different countries. Comparison of survival rates is less straightforward but indicates that England has not been doing as well as the best in Europe, such as Sweden or the Netherlands. Improvements in survival rates for the most deprived people are increasing more slowly than for the most affluent.
People in England with cancer have tended to be diagnosed at a more advanced stage than people with cancer in countries with better survival rates. Today’s report call for more action to tackle the delay on the part of some patients to come forward for medical advice when they have suspicious symptoms Those most strongly suspected by GPs of having cancer are now assessed promptly, but a significant proportion of those with cancer have not been referred urgently and have therefore had to wait a number of weeks longer for assessment by a consultant. Today’s report recommends that GPs should have better guidance on referring patients with suspected cancer and that the Department of Health should develop a mechanism for assessing the time taken for patients who are referred routinely and subsequently diagnosed with cancer to be assessed and treated.
Delays in diagnosis are a continuing problem. This is chiefly due to shortages of endoscopists, pathologists and radiographers. The Department is taking action to address this.
More patients are receiving appropriate treatment but there are still inequalities in the availability of some treatments, such as approved drugs, and timely access to other interventions, such as radiotherapy. Survival rates for cancers consistently favour London and the south of England, whereas the North East of England suffers the lowest survival rates.
Today’s report highlights the fact that the most effective way of preventing cancer is for people to stop smoking. One contribution to this is that the NHS has encouraged hundreds of thousands of people to stop at least for a short period. An evaluation is underway to find out how many of those remain non-smokers in the long term. Strategic Health Authorities vary substantially in referral rates to stop smoking services and the number of patients quitting for at least four weeks. The NAO recommends that strenuous efforts be made to bring all services up to the level of the best.