Lives depend on it

Our cancer survival must match EurOpE’s bEst

Everyone should have the best possible chance to survive cancer. But UK survival rates are among the worst in Europe. And 1 in 3 of us diagnosed with cancer will die within a year. This must change.

Ahead of the General Election, Macmillan is calling on all political parties to commit to delivering cancer outcomes that match the best in Europe by the end of the next parliament.

Almost 1 in 2 people will receive a cancer diagnosis in their lifetime by the time the next parliament ends. A recent major study of 29 European countries found survival rates for almost all common cancers in the UK are worse than the overall European average.1 Urgent action is needed so that more people survive cancer and are able to live well after treatment.

There is also significant variation in cancer outcomes across the country. Recent Macmillan analysis has shown that the proportion of people dying within a year of being diagnosed with cancer is 61% higher in the worst-performing local healthcare area in England than the best. 38% of people with cancer die within 12 months in the worst area, Barking and Dagenham, compared to 24% in the best, Hampshire and Farnham.2

This variation is not explained by some areas having an older population, higher levels of deprivation or higher rates of certain types of cancer which have a particularly poor prognosis. The difference could be down to how quickly patients are being diagnosed and treated.

To make sure that cancer outcomes in the UK match the very best in Europe, it’s crucial that they are:

• diagnosed at the earliest opportunity

• able to access the best treatment that is right for them, irrespective of their age or where they live, and

• properly supported to live well once treatment has finished.

Barking and Dagenham

North East Hampshire and Farnham

Die within a year

Survive at least a year

almOst 1 in 4 people with cancer in England are diagnosed as an emergency4, for example in A&E. Those diagnosed in this way are likely to have a worse survival rate.

they are twice as likEly tO die within a year of diagnosis as those diagnosed through an urgent GP referral.5

We need to improve early diagnosis

People have a better chance of surviving cancer and having fewer long-term consequences if their cancer is caught early. However, cancer services in this country perform poorly on early diagnosis compared with many other developed countries.

We need to ensure everyone has access to the most appropriate treatment

Too many people with cancer in the UK are not receiving the best possible treatment. Treatment rates vary depending on where people live and how old they are.

For example, for people with early-stage non-small cell lung cancer, surgery often offers the best chance of a cure. But in the UK we carry out less surgery for lung cancer than in other European countries. What’s more, the proportion of people who receive surgery varies widely across the country.7

There are three main ways of improving early diagnosis and reducing the proportion of people diagnosed via an emergency route. They are:

• improving awareness of signs and symptoms of cancer and making sure people visit their GP if they are concerned

• supporting GPs to make timely referrals for diagnostic tests if they suspect cancer, and

• making sure that once a referral has been made, the person is tested as quickly as possible.

In work for the Department of Health, the economics consultancy Frontier Economics estimated that diagnosing cancer earlier could be very cost-effective.6 This estimate is based on the cost of additional diagnostic tests and changes to treatment costs if patients are diagnosed at an earlier stage.

‘ I went to the GP with weight loss and serious stomach problems a number of times but it wasn’t until I collapsed and went back to the doctor again that I was diagnosed with Stage 3 bowel cancer.’

Sonia, Manchester

Variation in proportion of people with non-small cell lung cancer who receive surgery, based on 2012 cancer networks in England and Wales8

There are currently 2 million people in the UK living with and beyond cancer. Although people with cancer are living longer that does not necessarily mean they are living well. At least 1 in 4 of them face poor health or disability after treatment.12

The physical consequences of treatment range from general fatigue to more severe issues such as incontinence, osteoporosis and chronic pain. There are also emotional consequences of cancer and its treatment to consider, such as anxiety and depression.

To help improve the support that people receive, Macmillan has developed the Recovery Package. This is a combination of different interventions that, when delivered together, will improve outcomes and, consequently, lives.

The components of the package include:

• a holistic assessment of the patients’ needs, and a tailored care plan to meet these

• a treatment summary explaining both the treatment received and the next steps to the patient and their GP

• a cancer care review, completed by a GP or practice nurse, allowing the patient to discuss their needs and monitor progress, and

• a health and wellbeing event to prepare the person for the transition to supported self management, which helps educate and empower the patient to manage their condition and keep themselves fit and healthy.

We need to invest in care after treatment for people living with and beyond cancer

However, the UK has some of the worst survival rates for older people in Europe and rates of surgery decline sharply with age.

The reasons for poorer outcomes in older people are complex. They may include delays in diagnosis and treatment, cancer being diagnosed at a more advanced stage and the increased likelihood of other health issues in addition to cancer. However, there is also a growing body of evidence to suggest that many older people are not being offered optimal treatment.11

In assessing suitability for and providing appropriate advice on treatment, cancer care teams should take mental and physical considerations into account. They should avoid making decisions based on chronological age alone.

By addressing inequalities associated with age we have the potential to drastically improve outcomes for older people with cancer.

‘ I’m sure if I was 65 I’d be on a different treatment. I’ve always been really active; I’m not necessarily a typical 85-year old.’ Barbara, Coventry*

Over 1.3 million older people (aged 65 and over) are living with cancer in the UK9 and that number is set to

treble by 204010

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Health and wellbeing

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Treatment summary and cancer care

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Managing consequences of treatment

What is Macmillan calling for?

The next government should deliver cancer outcomes that match the best in Europe by the end of the next parliament. Macmillan is calling on all political parties to:

1 dramatically decrease the number of people diagnosed with cancer via an emergency route

2 reduce variations and inequalities in access to treatment, particularly for older people. This includes:

i. Publishing an action plan to tackle the reasons why older people have some of the worst survival rates in Europe

ii. Ensuring that every cancer care team uses a comprehensive assessment of the needs of older people and is able to provide appropriate advice to inform the best possible treatment for them

3 make sure all people with cancer are better supported after treatment has ended

This includes ensuring that everyone diagnosed with cancer receives a Recovery Package.

People living with and beyond cancer must be properly supported in their recovery once their treatment ends. This will help to minimise the impact of their illness on their health and their life. An individual Recovery Package is an important part of that support. It will help people to prepare for the future, identify their individual needs and return to work, should they wish to, and as near to a normal lifestyle as possible.

Copyright © Macmillan Cancer Support 2013.Permission granted for use as seen, this notice must remain intact in all cases. All rights reserved.

Help us makE cancer a priOrityCall on your manifesto leads to make matching the best cancer outcomes in Europe an election pledge and make it a priority for the next government.

Ahead of next year’s General Election, Macmillan is also calling on political parties to commit to ensuring that:

· all people with cancer are treated with the highest levels of dignity and respect, and for NHS staff to be supported to do this; and

· everyone at the end of their life is given free social care, so that they can spend their final days in the place of their choosing.

References 1 De Angelis et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5-a population-based study. Lancet

Oncology 2014: 15: 23-34

2 ONS and London School of Hygiene and Tropical Medicine. 2013. Cancer Survival Index for Clinical Commissioning Groups, Adults Diagnosed 1996-2011 and Followed up to 2012 http://www.ons.gov.uk/ons/rel/cancer-unit/a-cancer-survival-index-for-clinical-commissioning-groups/adults-diagnosed-1996-2011-and-followed-up-to-2012/index.html (accessed April 2014)

3 One-year survival for people diagnosed with lung cancer during 2005-2007 is 29.7% in the UK and 43.6% in Sweden. UK figure refers to people diagnosed with lung cancer in England, Wales or Northern Ireland. Source: Coleman MP et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 2011; 377: 127–138 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62231-3/ fulltext?_eventId=login#tbl2

4 Public Health England’s National Cancer Intelligence Network. Routes to diagnosis 2006-2010 workbook (a): http://www.ncin.org.uk/publications/routes_to_diagnosis (accessed July 2014)

5 Elliss-Brookes L et al. Routes to diagnosis for cancer – determining the patient journey using multiple routine data sets. Br J Cancer 2012; 107: 1220-1226

6 Department of Health. The likely impact of earlier diagnosis of cancer on costs and benefits to the NHS, January 2011 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213788/dh_123576.pdf

7 Health and Social Care Information Centre. National Lung Cancer Audit 2013. Variations persist after adjusting for age, sex, socioeconomic status, stage of disease and general health

8 Health and Social Care Information Centre. National Lung Cancer Audit: 2013. http://www.hscic.gov.uk/searchcatalogue?productid=13406&q=title%3a%22Lung+cancer%22&infotype=0%2fAudit&sort=Relevance&size=10&page=1#top (accessed February 2014) Variations persist after adjusting for age, sex, socioeconomic status, stage of disease and general health (performance status)

9 Macmillan Cancer Support. The rich picture on older people with cancer. 2013 http://be.macmillan.org.uk/Downloads/CancerInformation/RichPicture/OlderPeopleRichPicture2013MAC136681113-FINAL.pdf

10 Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202

11 Age UK, Department for Health and Macmillan Cancer Support. Cancer Services Coming of Age: Learning from the Improving Cancer Treatment Assessment and Support for Older People Project. 2012 http://www.macmillan.org.uk/Documents/AboutUs/Health_professionals/OlderPeoplesProject/CancerServicesComingofAge.pdf

12 Macmillan Cancer Support. Throwing light on the consequences of cancer and its treatment. 2013

*Names and locations have been changed as requested to protect anonymity

The UK is facing a cancer crisis. By the end of the next government’s term in 2020, almost half of us will have to face cancer sometime during our lives. And while the majority of us will receive a good standard of care, this sadly isn’t the case for everyone.

We urgently need to change this.

Our survival rates are among the worst in Europe – not least because thousands of us are diagnosed too late. And many thousands more are treated with a lack of compassion or denied the right to die where we want, with dignity. If we’re struggling to ensure everyone receives a good standard of care now, how will we cope as the number of us diagnosed with cancer grows?

Next year’s General Election is our chance to make sure the new government tackles this looming crisis. Without urgent action, not everyone with cancer will get the care that’s right for them.

No one should face cancer alone.

Help us raise standards of cancer care and make sure it is a priority for the next government.

Find out more at macmillan.org.uk/GeneralElection2015

Macmillan Cancer Support, registered charity in England and Wales (261017),Scotland (SC039907) and the Isle of Man (604). MAC15065_LFT

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