Improving Cancer Outcomesat a national level

- The story from England

Professor Sir Mike RichardsNational Cancer Director

June 2012

1

Improving Cancer Outcomes in England

● What were the problems?

● What have we done?

● Where next?

2

Cancer in England 20 years ago

● High incidence (like other developed countries)

● Poor survival (most cancers)

● High mortality (especially lung cancer and breast cancer)

3

Cancer in England 20 years ago● Why were outcomes so poor?

England had particularly high smoking rates in the 1950s and 1960s

Our services were very fragmented, both within hospitals and between hospitals and the community, with long waiting times

We were complacent – we believed our National Health service was amongst the best in the world

We chose to ignore emerging findings from the EUROCARE studies as unreliable

Our services were ‘doctor-centred’ not ‘patient-centred’

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Cancer in England: What changed? (1)

● The evidence of poor outcomes became more difficult to dismiss

● The voice of cancer experts, charities and patient groups started to be heard by the media by politicians

● The Chief Medical officers for England and Wales published a report highlighting problems – The Calman-Hine report (1995)

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Five year period survival profiles from 1991 to 2002 for colorectal and breast cancer: The EUROCARE Studies

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Cancer in England: What changed? (2)

● Tony Blair calls a “Cancer summit” in May 1999 and declares cancer ‘a top priority’

● National Cancer Director appointed – November 1999

● First comprehensive Cancer strategy published September 2000: The NHS Cancer Plan

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What was achieved? 2000 - 2007● Reduced smoking rates (from around 28% to around 21%)

– through concerted efforts (taxation; ban on smoking in public places; stop smoking services, etc)

● Improved cancer screening programmes for cervical, breast and colorectal cancer

● Reduced waiting times

● Improved services – with almost all patients being assessed by a multidisciplinary specialist team

● Centralisation of complex surgery

● Improved radiotherapy and chemotherapy services

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How was this achieved? 2000 – 2007● “Community building” – nationally and regionally

clinicians ▪ patients academics ▪ politicians managers ▪ charities civil servants ▪ industry

● 28 cancer networks – each serving on average 1.8m population (range 1-3m)

● National Cancer Action Team – to support change

● Clearly defined targets/commitments

● Additional funding – but no more than for the rest of the NHS

● New cancer standards – and peer review assessment of individual services

● Rigorous monitoring and reporting

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The position in 2007

● Much better services

● Much shorter waits

● Better patient experience/satisfaction

but…

● Survival rates still lagged behind other countries

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1995-99 2000-02 2005-0730

35

40

45

AUS CAN NOR DEN UK

CAN

UK

DEN

AUS

NOR

1995-99 2000-02 2005-0770

75

80

85

90

AUS CAN SWE NOR DEN UK

SWE

NOR

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UK

CAN

AUS

1995-99 2000-02 2005-076

8

10

12

14

16

18

20CAN

NOR

DEN

UK

SWE

AUS

1995-99 2000-02 2005-0745

50

55

60

65

70

AUS CAN SWE NOR DEN UK

CAN

NOR

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SWE

Colorectal Cancer 5yr RS Lung Cancer 5yr RS

Breast Cancer 5yr RS Ovarian Cancer 5yr RS

ICBP: 5 year relative survival. Coleman et al, Lancet 2011

AUS

1995-99 2000-02 2005-0750

55

60

65

70

75

80

AUS CAN NOR DEN UK

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AUSCAN

1995-99 2000-02 2005-0790

92

94

96

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100

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1995-99 2000-02 2005-0765

70

75

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AUS CAN SWE NOR DEN UKAUS

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1995-99 2000-02 2005-0720

25

30

35

40

45SWE

NOR

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AUS

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Colorectal Cancer 1yr RS Lung Cancer 1yr RS

Breast Cancer 1yr RS Ovarian Cancer 1yr RS

ICBP: 1 year relative survival. Coleman et al, Lancet 2011

Cancer Reform Strategy: 2007

● Second cancer strategy – with a new emphasis on:

A National Awareness and Early Diagnosis Initiative (NAEDI)

A National Cancer Survivorship Initiative (NCSI) – “living with and beyond cancer”

A National Cancer Intelligence Network (NCIN) – to provide better data on all aspects of cancer

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National Awareness and Early Diagnosis Initiative

● 4 components

Public awareness campaigns to promote earlier presentation

Support for GPs

Better diagnostic services

Research and evaluation

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How many deaths might be avoided if cancer survival in England matched the best in Europe?

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[NB Prostate has been excluded as survival ‘gap’ is likely to be due to differences in PSA testing rates.]Data derived from Abdel-Rahman et al, BJC Supplement December 2009

Breast ~ 2000 Myeloma 250Colorectal ~ 1700 Endometrial 250Lung ~ 1300 Leukaemia 240Kidney/Bladder ~ 990 Brain 225Oesophagogastric ~ 950 Melanoma 190Ovary ~ 500 Cervix 180NHL/HD 370 Oral/Larynx 170

Pancreas 75

Total around 10,000 pa

Lung cancer – cough campaign

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Be clear on cancer: Bowel cancer

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Improving Outcomes: A Strategy for Cancer

● Third cancer strategy – with a new focus on outcomes Survival Quality of life (PROMs) Recovery from treatment Patient experience (survey) Safety

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Patient experience survey

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National Cancer Intelligence Network

● We aspire to having the “best cancer intelligence network in the world”

Cancer registration as the foundation

Linking datasets (primary care, screening, radiotherapy, chemotherapy, hospital administrative systems, etc)

Bringing together the relevant expertise

Producing useful outputs for hospitals, commissioners, patients, etc

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Summary

● We have definitely made progress over the past 12 years

● Even with a national focus it has not been easy

● We know we still have a long way to go

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