Transcript Detect Cancer Early - CaCTUS

Nicola Barnstaple
Programme Manager
Key challenges in Scotland
• Increasing cancer incidence – predicted 35,000
cases per year in 2020
• Ageing population -proportion of over-75s up
25% by 2023
• Impact of health inequality - mortality rates from
cancer in the 10% most deprived areas are
around 1.5 times those in the 10% least deprived
areas
• Survival for some cancer types is lower in
Scotland than in other European countries
Scotland: age-standardised incidence and mortality
rates (EASRs), by SIMD 2009 deprivation quintile
Scotland: age-standardised cancer incidence and mortality rates
(EASRs), by SIMD 2009 deprivation quintile
All cancers
600.0
Breast
160.0
Incidence
Mortality
120.0
400.0
100.0
EASR
EASR
500.0
300.0
Incidence
140.0
Mortality
80.0
60.0
40.0
200.0
20.0
100.0
-
5=Least
deprived
5=Least
deprived
4
3
2
1=Most
deprived
4
Colorectal
Incidence
70.0
Mortality
2
1=Most
deprived
Lung
120.0
Incidence
Mortality
100.0
60.0
80.0
EASR
50.0
EASR
3
40.0
60.0
30.0
40.0
20.0
20.0
10.0
-
5=Least
deprived
4
3
2
1=Most
deprived
5=Least
deprived
4
3
2
1=Most
deprived
Cancer staging by deprivation
2010/2011
(baseline)
Stage 1
Stage 2
Stage 3
Stage 4
Not known
1=most deprived
19.8%
21.4%
19.3%
30.2%
9.3%
2
21.8%
24.1%
18.6%
26.4%
9.2%
3
22.6%
26.1%
18.0%
23.7%
9.6%
4
25.0%
27.5%
16.2%
22.9%
8.3%
5=least deprived
27.2%
28.0%
15.6%
21.1%
8.0%
Stage 1
Stage 2
Stage 3
Stage 4
2011/2012
Not known
1=most deprived
20.3%
22.1%
18.6%
30.9%
8.1%
2
23.0%
23.6%
18.8%
27.0%
7.6%
3
23.5%
25.9%
17.5%
25.6%
7.4%
4
26.9%
26.7%
16.5%
23.1%
6.9%
5=least deprived
27.5%
27.1%
16.4%
21.8%
7.1%
Key challenges
• Increasing cancer incidence – predicted
35,000 cases per year in 2020
• Ageing population -proportion of over-75s
up 25% by 2023
• Impact of health inequality - mortality rates
from cancer in the 10% most deprived
areas are around 1.5 times those in the
10% least deprived areas
• Survival for some cancer types is lower in
Scotland than in other European countries
Five-year age-adjusted relative survival (%) with 95% confidence intervals for
adults diagnosed during 2000-2007, by selected country and cancer site/type
90.0
80.0
70.0
Relative survival (%)
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Skin Melanoma
UK, Scotland
UK,England
Norway
Finland
Denmark
Lung
UK, Scotland
UK,England
Norway
Type of cancer / Country
Finland
Rectum
Denmark
UK, Scotland
UK,England
Norway
Finland
Denmark
Colon
UK, Scotland
UK,England
Norway
Finland
Denmark
UK, Scotland
UK,England
Norway
Finland
Denmark
Stomach
Five-year age-adjusted relative survival (%) with 95% confidence intervals for
adults diagnosed during 2000-2007, by selected country and cancer site/type
100.0
90.0
80.0
Relative survival (%)
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
UK, Scotland
UK,England
Norway
Finland
Denmark
Kidney
UK, Scotland
UK,England
Norway
Type of cancer / Country
Finland
Prostate
Denmark
UK, Scotland
UK,England
Norway
Finland
Denmark
Ovary
UK, Scotland
UK,England
Norway
Finland
Denmark
UK, Scotland
UK,England
Norway
Finland
Denmark
Breast (Woman)
Non-Hodgkin lymphoma
Source: Lancet Oncol 2014; 15(1): 23-34
Colorectal cancer diagnosed 1995-99. Five year relative survival vs survival
conditional on surviving at least one year
80
70
60
% surviving
50
Denmark
England
Scotland
Finland
Norway
Sweden
40
30
20
10
0
5-year Relative survival
Conditional survival
So what is the explanation for this
apparent excess of early mortality?
•Unfavourable stage distribution due to
delays and/or tumour biology?
and/or
•Poor general health/lifestyle factors laid
down over decades?
Source: Lancet Oncol 2014; 15(1): 2-3
Source: BMJ 2010; 341: c5133
Eurocare 5 findings
• Survival from major epithelial cancers seems to be lower
in Scotland (and the UK) compared to all of the Nordic
countries except Denmark
• The excess risk of death seems to occur early on and is
more apparent in oldest age groups
• Some evidence suggests that, on average, UK patients
may be presenting with more advanced disease at
diagnosis
• But we don’t know for sure whether this is due to later
presentation, later referral, delays in diagnosis or
staging, or more aggressive disease
• We know that lifestyle factors can influence survival, but
we don’t really know to what extent, if any, this
contributes to European survival variations
• The reasons for reported survival differences seem most
likely to be multifactorial
Cancer: approx 6% total NHS
spend
Cancer services: estimated activity and costs: Scotland 2007/08
Acute
Services
episodes
Geriatric
long stay
episodes
Out
patient
services
Pharmaceutical GMS
items
visits
dispensed
Activity
188,141
517
144,624
1,153,614
195,363
Cost
£390M
£8.5M
£25M
£46M
£6.3M
Costs
• Projected 65% increase in costs of
treating cancer by 2021
• For colon cancer: treatment in Stage 1
costs £3131 and treatment in stage 4
costs £12519
DCE HEAT Target
• to achieve a 25% increase in the proportion of
breast, colorectal and lung cancers (combined)
diagnosed at stage 1 by December 2015 when
compared to the 2010 and 2011 (combined)
baseline (23% → 29%).
Social Marketing
Primary Care
• Review of Scottish Referral Guidelines for
Suspected Cancer
• New sGMS contract initiative for bowel
screening
• Primary Care education sessions
• Improvements in e-Health, eRAT
• Development of practice profiles for
cancer
Evaluation – key points
•
•
•
•
•
Data on cancer diagnoses not yet available
4.7% increase in cancers diagnosed at Stage I (2012/13 compared to
baseline)
Priming Campaign - just under half (48%) of all respondents feel more
confident about approaching their GP with signs or symptoms which could
possibly be cancer
Breast Campaign – 50% increase in attendances at GP for breast
symptoms
Bowel Campaign- increases in requests for replacement kits and calls to
screening helpline, increase in screening programme participation (56.1%
from 54.9%)
•
•
Lung Campaign - Significant improvement in relation to key campaign
message of importance of getting cough checked
Other measures of success – emergency admissions, ICBP, TCT, other
studies
DCE Next Steps
• Consolidation
• Breast Screening Campaign
• Updated bowel and lung cancer
campaigns
• Interim Evaluation
• Consideration of new tumour groups
Early diagnosis is important
•
•
•
•
relations with patients and families
RCGP/Patient Safety Agency report
best chance for long-term survival.
still well enough to tolerate disease modifying
treatments
• emergency diagnoses don’t do as well
• more time to manage symptoms
• allows more to join clinical trials
Scottish Cancer Taskforce
•
•
•
•
DCE
Treatment capacity
TCAT
QPI
Acknowledgements
EUROCARE-5 slides mostly reproduced from the Lancet
Oncology papers
Data are also now available to download from the EUROCARE
website: http://www.eurocare.it/