Collaboration across UK cancer community vital to restoring and improving NHS cancer services

Reversing the impact of the coronavirus pandemic and improving long-term cancer outcomes is only possible if the entire UK cancer community comes together in partnership and the government make it a priority funding focus, says a new report published by the ABPI.

The report says that the UK must be more ambitious with its cancer strategy if it is to compete with the leading nations across Europe – from improving early diagnosis, reducing variations in care to using the latest medicines and treatments.

While cancer incidence has been rising in the UK, deaths have been declining and survival rates increasing pre-pandemic. However, COVID-19 is widely thought to have significantly impacted every aspect of cancer care – from diagnosis and patients' willingness to present for treatment through to service delivery and follow-up care.

The report – Cancer in 2020 and beyond: Cross-sector insights into improving outcomes for cancer patients – is based on interviews with 14 high-profile UK cancer stakeholders from across NHS, academia, industry, and patient-facing charities.

It makes a number of recommendations which, if implemented, the contributors say, would lead to meaningful improvements for NHS cancer patients far beyond pandemic recovery. 

Also published today alongside the report is an updated data set of useful cancer-related statistics, charts, and evidence, all online here. This data set draws on research first carried out by the Swedish Institute for Health Economics (IHE).

The report looks at four different areas of cancer care and among the recommendations for putting cancer at the heart of the post-pandemic health service recovery plan are:

1. Demonstrate ambition in cancer strategy and funding:
   • The Department of Health and Social Care (DHSC) should set ambitious timelines with appropriate funding to deliver care on a par with other European and G7 countries and work with the cancer community on a strategy to deliver this goal.
2. Improve early diagnosis and treatment:
   • By delivering targeted public awareness programmes – both cancer screening and awareness of symptoms targeted at those at high risk.
   • By funding dedicated community diagnostics hubs to accelerate diagnosis and provide quick turnaround so that cancer patients can be at reduced risk of COVID-19.
3. Reduce variation in care:
   • NICE and NHS England and Improvement (NHSE&I) to work with the cancer community – Independent Cancer Taskforce and Clinical Expert Groups, charity, industry, and academia – to implement end-to-end pathway guidelines for doctors and nurses and to develop holistic and optimised treatment and wellbeing pathways.
   • NHSE&I to strengthen the role of centres of excellence and ‘hub and spoke’ models of cancer care as well as working with national cancer alliances to ensure consistency of care and reduce variation across the UK.
4. Speeding up of adoption and innovation:
   • NHSE&I to invest in IT infrastructure to improve medical research and real-world data collection.
   • NHSE&I to work closely with the research community to learn lessons from the pandemic on how to improve and speed up clinical trials.
   • Changes that lead to faster and wider access to treatments, including for rare cancers should be adopted.

Dr Paul Catchpole, Director Value and Access Policy, ABPI, said:

“There seems to be overwhelming agreement from those working in cancer services that we need to look at how to improve patient pathways and bring these more in line with other countries. As we look to cautiously and safely restart services that were restricted due to COVID-19, there is an opportunity to now do things differently.

“It will take the combined effort of every person in the cancer community working together to deliver high-quality, consistent care to NHS patients.”

According to IHE, despite cancer incidence rising in the UK, cancer care in the UK was improving with deaths declining and survival increasing pre-pandemic.

However, for some cancers – including lung and colorectal – the UK still falls well short of many similar EU countries on survival, with UK five-year survival rates ranked below the European average for five out of seven tumour types analysed.

The majority of stakeholders interviewed recognised the findings of the IHE report as an accurate reflection of the UK’s cancer environment and highlighted the urgent need for action by policymakers.

All 14 of those interviewed recognised highlighted the importance of improving early detection and diagnosis and screening as key to closing the gap.

Emma Greenwood, Director of Policy at Cancer Research UK, said:

“The biggest barrier to improving cancer outcomes is the stage at which we’re diagnosing cancers in the UK. The British public tend to be more reluctant to go to the GP with symptoms than in other comparable countries, GPs are less likely to send patients for diagnostic tests, and we have significant issues around capacity to deliver diagnostics.”

Despite the UK having some of the world’s leading universities, some interviewees said that collection, analysis, and review of real-world health data could be improved if we are to turn world-class research into tangible benefits and pioneer new treatments at pace and scale.

Baroness Delyth Morgan, Chief Executive of Breast Cancer Now, said:

“When it comes to research and development, we’re good at the ‘R’ but not at the ‘D’ in the UK and a large part of the reason for that is due to workforce and funding restraints. The Government needs to have the ambition to improve cancer outcomes through the implementation of research innovations.”

And, while the UK provides fast access to some innovative cancer treatments in line with comparator countries like France and Germany, the actual use of some medicines by clinicians in the UK remains relatively low. There is variation in cancer care between – and even within – regions of the UK. 

A shared concern among interviewees was the greater need for investment in the health service if the UK is to achieve better quality care for people with cancer. In 2018, the UK spent £159 per person per year on cancer care, which is below the European average of £176 and considerably less than countries of comparable size and wealth such as Germany and France.

Many of the existing challenges identified by the interviewees will further be exacerbated by the COVID-19 pandemic. However, the health system response to the pandemic has also paved the way for the acceleration of a number of innovations in cancer care.

Remote consultations and virtual consultant triage services for example have the potential to improve turnaround times, increase NHS capacity, reduce waiting times, and clear patient backlogs.

Dr Paul Catchpole said:

“COVID-19 has presented many challenges, but we are also learning from the experience. The pandemic has seen some service improvements – mooted for years – implemented in weeks. We must now work together to adopt these new ways of working for the benefit of all patients, including cancer patients – the pharmaceutical industry stands ready to play its part in this.”