improving cancer outcomes at a national level - the story from england professor sir mike richards...
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Improving Cancer Outcomes
at a national level
- The story from England
Professor Sir Mike Richards
National 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)
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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
DEN
UK
CAN
AUS
1995-99 2000-02 2005-076
8
10
12
14
16
18
20
CAN
NOR
DEN
UK
SWE
AUS
1995-99 2000-02 2005-0745
50
55
60
65
70
AUS CAN SWE NOR DEN UK
CAN
NOR
DEN
UK
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
NOR
DEN
UK
AUSCAN
1995-99 2000-02 2005-0790
92
94
96
98
100
AUS CAN SWE NOR DEN UK
SWE
NOR
DEN
UK
AUS
CAN
1995-99 2000-02 2005-0765
70
75
80
85
90
AUS CAN SWE NOR DEN UK
AUS
NOR
DEN
UK
CAN
SWE
1995-99 2000-02 2005-0720
25
30
35
40
45SWE
NOR
DEN
UK
AUS
CAN
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 250
Colorectal ~ 1700 Endometrial 250
Lung ~ 1300 Leukaemia 240
Kidney/Bladder ~ 990 Brain 225
Oesophagogastric ~ 950 Melanoma 190
Ovary ~ 500 Cervix 180
NHL/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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