Why consistent and funded cancer policies are key to improving cancer survival

The House of Parliament in London

Overall, cancer survival is improving in the UK and has doubled in the last 40 years. However, survival varies between cancer types, ranging from 98% for testicular cancer to just 1% for pancreatic cancer.

But it isn’t only between cancer types that survival varies. There are also differences between countries in survival for several types of cancer.

International differences in how likely people are to survive cancer can be the result of a variety of factors, from late-stage diagnosis to patients not having access to the most effective treatment.

It has also been suggested that differences in policy between countries may explain some of the international variation in cancer outcomes, in this case cancer survival, but evidence to support this claim has been difficult to collect.

Now, for the first time, research from the International Cancer Benchmarking Partnership (ICBP) has found a link between cancer policy consistency over time and cancer survival for six of the seven cancer types included in the analysis (stomach, colon, rectal, pancreatic, lung and ovarian cancer).

The ICBP has been reporting international variation in cancer survival for over 10 years, giving us insight into how the nations of the UK compare internationally.

The partnership, which is hosted by Cancer Research UK, is a unique collaboration that explores what factors are driving differences in cancer survival, so that it can identify changes to policy and practice that could make an impact for patients.

How do we measure up?

The study examined the evolution of cancer policies between 1995 and 2014 across high-income countries to develop an index of cancer policy consistency over time to score each country’s cancer plans against.

They then compared this with previous cancer survival data for oesophageal, stomach, colon, rectal, pancreatic, lung and ovarian cancers over the twenty-year period.

It found that countries that set out consistent cancer policies over the analysis period had the greatest improvements in cancer survival. Critically, the countries with the best improvements published policies that were supported by robust implementation and funding plans.

So, where does the UK fall in that ranking?

The four devolved nations of the UK were analysed separately, as they each publish different cancer plans.

1- and 5-year survival was broadly similar between devolved nations, with the largest ranges in survival observed for pancreatic and colon cancer.

However, like previously published ICBP research, it showed that cancer survival in the UK lags many other comparable countries like Australia, New Zealand and Denmark.

For example, using this new data, 5-year lung and colon cancer survival in England was 15.0% and 58.9% respectively in the 2010-2014 period, which is where Australia were 10 years before that.

5-year survival in Australia were 21.4% and 70.8% for lung and colon cancer respectively between 2010 and 2014.

Why the lag?

The big question then is why is the UK trailing behind other countries?

The reasons behind the lag are complex, multifactorial and are likely to span the whole cancer continuum, from prevention through to treatment.

For example, people in the UK were diagnosed at a later stage than those in countries with better survival, and poorer outcomes were also observed in older people and in people with cancers at more advanced stages.

This is not to say that there has been no progress in the UK. Thanks to the tireless work of the NHS, there have been steady improvements in cancer outcomes in recent decades and increases in survival for most cancer types during the 1995-2014 period.

However, as evidenced by the results of this study, these improvements have not been enough to bring us in line with other countries.

This is therefore not just an issue of progress, but an issue of pace.

For example, Denmark, which at the beginning of the analysis period had amongst the poorest/lowest survival outcomes alongside England, scored highest on cancer policy consistency and showed among the highest increases in survival for most cancers.

The plans they published built successively upon each other, and focus shifted accordingly each time a new plan was published. In addition, it was one of the only jurisdictions to provide an explicit, detailed financial commitment to implementation on a regular basis.

Denmark is now among the best performing countries for certain cancers, demonstrating that the improvements that the UK need to demonstrate are achievable.

“This study found that countries with cancer policies that are consistent over time are more successful in improving survival across a range of cancer types,” says Ellen Nolte, professor at the London School of Hygiene and Tropical Medicine who led the research.

“It emphasises the need for political commitment and the willingness to act upon and fund cancer plans. While targeted funding can help improve cancer outcomes – like in the case of Ireland in the mid- to late-2000s – sustained and consistent strategic planning and investment are crucial to ensure long-term, continued improvements in cancer survival.”

Learning from the best

There’s no silver bullet that would put the UK among the best countries in the world on cancer survival – action is needed on all fronts.

But what this new research makes clear that the countries with the best cancer outcomes have more successfully planned for growing demand in cancer services, prepared for implementing life-saving innovations in cancer prevention, diagnosis and treatment, and crucially invested accordingly.

This Government must deliver – people affected by cancer deserve no less. The upcoming 10-Year Cancer Plan is an opportunity for Rishi Sunak to take these lessons on board and deliver on the Conservative manifesto commitment to improve cancer survival in England.

Michelle Mitchell, our chief executive

This study marks an important step to understanding how getting national policies right can improve cancer outcomes, with important lessons for governments and health systems across the UK on how to improve cancer services.

The English government in particular can take important lessons from these results as it looks to publish a 10-year Cancer Plan.

In February, then Health Secretary Sajid Javid announced the development of this new plan, which he said would address issues across the entire cancer pathway, from prevention through to treatment, with the aim of making England’s cancer care system among the best in Europe.

However, with so much political uncertainty in recent months, the direction of this important plan is uncertain.

The results of this research only reinforce the calls we made earlier in the year for a cancer plan for all.

An ambitious, well implemented and, critically, fully funded cancer plan has the potential to transform cancer survival outcomes in England. The new Prime Minister and Health Secretary must not waste this opportunity to close the gap between England and similar countries.

If the UK really wants to provide world-class cancer services, it must solve its workforce crisis and invest in key diagnostic equipment so we can diagnose more cancers early, at a more treatable stage.

“The UK’s cancer survival is improving, but we need to ensure it matches the pace of other countries,” says Michelle Mitchell, our chief executive.

“Chronic underfunding and the worse staffing crisis in the NHS’s history threaten to undermine the progress we have made.

“We must learn from other countries like Denmark, which has moved faster in improving its cancer survival.

“This Government must deliver – people affected by cancer deserve no less. The upcoming 10-Year Cancer Plan is an opportunity for Rishi Sunak to take these lessons on board and deliver on the Conservative manifesto commitment to improve cancer survival in England. With ambition, investment and leadership, this plan could see England match the very best in the world on cancer outcomes.

“Wales and Scotland are currently developing their own cancer plans and if they are ambitious and funded, we are hopeful that they are, together with England and Northern Ireland, it will help transform the UK’s cancer survival from world lagging to world leading.”

Jacob

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