The National Health Service (NHS) cancer plan for England shows some beneficial effect on survival, although wide regional variations remain; more follow-up data are needed before the true impact of the cancer plan can be fully established. These are the conclusions of the first study to assess whether the cancer plan is working, published in an Article Online First and in the April issue of The Lancet Oncology.
In an accompanying Reflection and Reaction comment, Karol Sikora (CancerPartnersUK) states that, despite the tripling of investment in cancer care in the UK over the past decade, these findings show that there has been no striking improvement in cancer survival. According to a Leading Edge editorial published with the Article by The Lancet Oncology, the evidence shows that: “We are at best keeping track with improvements elsewhere rather than closing the gap.” The editorial adds that the cancer plan’s stated aim – of having five year cancer survival rates comparable with the best in Europe by 2010 – is looking optimistic.
In 2000, when the NHS cancer plan for England was introduced, Britain had one of the poorest levels of cancer survival in Europe. The plan was designed to improve 5-year survival rates for cancer, so they would compare with the best in Europe by 2010. In Wales there was no comparable cancer initiative until 2006, thus providing an opportunity to compare survival trends in England and Wales and assess the effectiveness of the English cancer plan.
In this study, Michel Coleman from the Cancer Research UK Cancer Survival Group London School of Hygiene and Tropical Medicine in London, UK, and colleagues report the national and regional survival trends in 2•2 million adults diagnosed with 21 common cancers in England and Wales and followed up to 2007. They analysed trends in short-term survival for patients diagnosed before the cancer plan (1996-2000), during initialisation (2001-03), and after implementation (2004-06).
Overall, 1-year survival* improved for most cancers in England and Wales between 1996 and 2006. Findings showed a slightly faster improvement in 1-year survival in Wales than in England between 1996 and 2003, but this was reversed after 2004 when annual trends in survival were more favourable in England than in Wales. For cancers of the stomach, colon, rectum, uterus, ovary, and kidney, survival trends in England improved after 2001, even without screening or the widespread use of effective new treatments. By contrast, bladder cancer, Hodgkin’s lymphoma, and leukaemia all showed a fall in survival.
However, differences in 3-year survival patterns between England and Wales were less obvious, with no difference in survival trends at 3 years or more for patients diagnosed up to 2003, and slightly faster increase in survival in England than in Wales between 2001-03 and 2004-06.The authors also note continued wide regional variation in survival, with more affluent southern regions having generally higher survival than the average survival for England.
They suggest that the improvements in survival trends in England since 2004 might be related to the cancer plan, but caution that it is not known whether the various initiatives in the cancer plan were fully implemented by that time. They conclude by calling for detailed analysis of the effect of more specific measures in the cancer plan, such as shorter waiting times and the creation of multidisciplinary teams, on cancer survival.
Mike Richards, the National Cancer Director for England, questions whether Wales is an appropriate control group for assessing progress in England in a second accompanying Reflection and Reaction comment. He points out that both countries took very similar approaches to cancer control by implementing cancer strategies that have worked at different times. He suggests that the differences in trends between the countries in 2001-03 and 2004-06 reflect Wales moving forward faster in the earlier years as a result of the Cameron report in 1996, and survival improving more quickly in England after 2000 as a result of the cancer plan.
Sikora also argues that the modest improvement in survival is because of: “a whole system fault within the NHS with serial delays, poor access and serious under-capacity.” He concludes: “We need to derive value from cancer services by increasing access and quality but not cost”. The Lancet Oncology editorial concludes that: “Perhaps the time has come to consider rather more fundamental changes to the NHS than are offered in the cancer plan if England is to truly offer world-class healthcare.”
*1-year survival can be considered to reflect early or late diagnosis of cancer, and 3-year and 5-year survival to reflect both early diagnosis and the effect of treatment.
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