Yesterday (Sunday 19th July) The Independent Cancer Taskforce published a new cancer strategy for England for the years 2015-2020. Entitled Achieving World-Class Cancer Outcomes, the strategy makes a number of recommendations designed to increase cancer survival and improve patient diagnosis, treatment and care over the next five years.
The Taskforce was led by Harpal Kumar, CEO of Cancer Research UK - and included representatives from across the cancer charity, NHS and health professional sectors. We were pleased that our own Deputy CEO, Clara Mackay, was one of the Taskforce members, in her capacity as former Chair of Cancer 52. The Taskforce produced its work after consulting with hundreds of individuals and organisations, including us. We took part in workshops as part of that process and also provided a written response, details of which we set out in a previous blog post.
In summary, the new cancer strategy for England says the six main priorities for the NHS over the next five years should be:
- To spearhead a radical upgrade in prevention and public health
- Drive a national ambition to achieve earlier diagnosis
- Establish patient experience as being on a par with clinical effectiveness and safety
- Transform our approach to support people living with and beyond cancer
- Make the necessary investments required to deliver a modern, high quality service
- Overhaul processes for commissioning, accountability and provision
If the recommendations in the document are followed it is estimated that an extra 30,000 cancer patients a year in England could survive cancer for ten years or more by 2020, with 11,000 of those patients surviving due to being diagnosed earlier.
Overall, we find the strategy very encouraging and particularly welcome the initiatives for early diagnosis, improving patient care and end of life care. We have picked out a few key points below.
Early diagnosis - The report builds on the new NICE Referral Guidelines for suspected cancer, introduced in June. We did not feel the referral guidelines went far enough for pancreatic cancer (see our blog post here) and so are pleased to see the strategy making a series of recommendations which should further improve GP referrals and lead to earlier diagnosis. In particular, the report recommends that: GPs should be able to urgently refer patients for diagnostic tests even if a patient does not specifically meet the criteria set out in the NICE referral guidelines; that GPs should have direct access to key investigative tests like CT scans by the end of 2015, which should cut down on the time taken to achieve a diagnosis; and that new, innovative ways of ensuring faster diagnosis, including Multi-disciplinary Diagnostic Centres (MDC) for when patients present with recurring vague symptoms, like abdominal pain should be introduced.
To try and make sure more patients are diagnosed more quickly, the strategy also recommends a new target for the NHS to meet. It sets out that once a GP has made a referral a definitive diagnosis of cancer, or a diagnosis that excludes cancer, should have been made within 4 weeks. This target will be reported on at a local commissioning level and results will be made public on a regular basis. Given that pancreatic cancer too often takes far too long to diagnose – our online symptoms and diagnosis survey suggested that over 40% of patients had to wait three months or longer for a diagnosis - this new target could be of great significance.
Access to innovative drugs - The strategy rightly identifies the need for a long-term replacement for the Cancer Drugs Fund (CDF) that will still ensure patients have greater access to new and innovative treatments. It makes reference to an ongoing review process, which Pancreatic Cancer UK is feeding into, and we agree that a long-term solution to drug access needs to be found. However, in the short-term, we also need to ensure that pancreatic cancer patients can continue to access drugs currently available on the CDF, like Abraxane, until that new system is put in place. At the moment, the CDF is set to review whether Abraxane should be removed from the list at the end of July and we sincerely hope that those who make the decisions will listen to the points raised in our Two More Months Campaign and continue to make Abraxane available to eligible pancreatic cancer patients for the foreseeable future.
Quality of life and end of life care– In our written submission we urged the Taskforce to include in the strategy measures to improve a patient’s quality of life and we are glad to see that there is a strong section on this in the final document. We know from various surveys, and from what patients tell us, that care is improved when patients have access to a Clinical Nurse Specialist (CNS). We are pleased to see that the strategy calls for all patients to have access to a CNS and we will continue to press for more nurses with pancreatic specialist training.
There is also a robust recommendation designed to ensure that local commissioning groups provide proper integrated services for end of life care. This will include giving patients and their families greater support if they choose to die at home, together with more substantial practical and emotional support throughout.
However, there are some areas where we feel the strategy could and should have gone further for people with pancreatic cancer. For instance, in our written submission as part of the Taskforce’s consultation process we stressed the importance of ensuring that there were specific measures included in the strategy for tackling cancers of unmet need – i.e. those with the lowest survival rates, like pancreatic cancer. The document does recognise that whilst survival has improved for some types of cancer ‘in lung, pancreas and oesophageal cancers, and most brain tumours, survival has remained stubbornly low to date.’ Despite that acknowledgement there is no section of the strategy that goes on to address how to tackle this disparity, unlike for other groups where a disparity in care or outcomes was recognised, such as older people or for children and young adults. We feel this was a missed opportunity.
We believe that this strategy can only be deemed a success if, by 2020, all cancer types, including those with them most stubbornly low survival rates, such as pancreatic cancer, have seen an improvement in outcomes for patients. So we will be watching closely to make sure that the series of generally very good recommendations contained in the new strategy deliver just that.