Transcript Slide 1

Improving Cancer Outcomes
at a national level
- The story from England
Professor Sir Mike Richards
National Cancer Director
June 2012
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Improving Cancer Outcomes in England
● What were the problems?
● What have we done?
● Where next?
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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?
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
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’
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
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clinicians
academics
managers
civil servants
▪
▪
▪
▪
patients
politicians
charities
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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ICBP: 5 year relative survival. Coleman et al, Lancet 2011
70
20
AUS
CAN
SWE
NOR
DEN
65
UK
AUS
CAN
CAN
18
AUS
16
SWE
60
55
SWE
NOR
14
DEN
12
NOR
UK
DEN
10
50
UK
8
45
6
1995-99
2000-02
2005-07
1995-99
2000-02
2005-07
Lung Cancer 5yr RS
Colorectal Cancer 5yr RS
90
45
SWE
AUS
85
CAN
NOR
CAN
NOR
40
AUS
DEN
80
UK
UK
DEN
35
75
70
1995-99
AUS
2000-02
Breast Cancer
5yr
CAN
SWE
NOR
2005-07
RS DEN
UK
30
1995-99
AUS Ovarian
CAN
2000-02
Cancer
RS
NOR 5yrDEN
2005-07
UK
ICBP: 1 year relative survival. Coleman et al, Lancet 2011
45
90
AUS
CAN
SWE
NOR
DEN
SWE
UK
AUS
85
CAN
40
AUS
SWE
CAN
80
NOR
NOR
35
DEN
DEN
UK
30
75
UK
25
70
20
65
1995-99
2000-02
1995-99
2005-07
Colorectal Cancer 1yr RS
2000-02
2005-07
Lung Cancer 1yr RS
100
80
SWE
98
NOR
75
CAN
AUS
CAN
AUS
96
70
DEN
NOR
DEN
94
UK
65
UK
60
92
55
90
1995-99
AUS
2000-02
BreastSWE
CancerNOR
1yr
CAN
2005-07
RSDEN
UK
50
1995-99
AUS
CAN
Ovarian
2000-02
2005-07
NOR
DEN RS UK
Cancer
1yr
Cancer Reform Strategy: 2007
● Second cancer strategy – with a new emphasis on:
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A National Awareness and Early Diagnosis Initiative
(NAEDI)
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A National Cancer Survivorship Initiative (NCSI) –
“living with and beyond cancer”
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A National Cancer Intelligence Network (NCIN) – to
provide better data on all aspects of cancer
National Awareness and Early
Diagnosis Initiative
● 4 components
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Public awareness campaigns to promote earlier
presentation
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Support for GPs
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Better diagnostic services
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Research and evaluation
How many deaths might be avoided if cancer
survival in England matched the best in Europe?
Total around 10,000 pa
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
[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
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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
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Survival
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Quality of life (PROMs)
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Recovery from treatment
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Patient experience (survey)
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Safety
Patient experience survey
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National Cancer Intelligence Network
● We aspire to having the “best cancer intelligence
network in the world”
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Cancer registration as the foundation
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Linking datasets (primary care, screening, radiotherapy,
chemotherapy, hospital administrative systems, etc)
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Bringing together the relevant expertise
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Producing useful outputs for hospitals, commissioners,
patients, etc
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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