Lowering the age of referrals, speedier access to tests, and more community programmes to help people spot the early signs of cancer are among a raft of new measures – unveiled by London’s health leaders today – to tackle the capital’s biggest cause of premature death.
More than 13,600 people die of cancer every year in London and survival rates are lower than many other countries. Today’s announcement forms part of a five year collaborative strategy from NHS England (London) to boost early detection of the disease, improve survival rates and transform cancer services.
The plans for the first year will mainly focus on early detection, in a bid to cut the substantial number of Londoners who are diagnosed late. Currently, more than a quarter of cancers are diagnosed in A&E or as an emergency referral, and it is estimated that at least 1,000 lives could be saved if cancers were spotted earlier.
The strategy also sets out measures to improve the care and support for the increasing numbers of people living with and beyond cancer, as cutting-edge treatments and advancements in care across the NHS mean numbers are set to double in London to 400,000 by 2030.
The plans for the coming year in the finalised five year Cancer Commissioning Strategy include:
- Ensuring more people are diagnosed earlier with bowel cancer by recommending CCGS go beyond the national guidelines by cutting the age for referring patients with symptoms from 60 to 55 years, with the aim of reducing this further to 45 the following year;
- Getting ovarian cancer diagnosed and treated faster, by encouraging CCGs to change the way in which tests are done, so that two tests can be done at once, instead of one at a time – going beyond current NICE guidelines;
- Rolling out new risk assessment tools for GPs so cancers are diagnosed quicker and earlier;
- Training GP trainers across London in signs and symptoms of cancer and how to use simple tools to improve referral rates for suspected cancer.
- Providing all patients with a holistic assessment and care plan to address any long term health conditions caused by either the disease or the treatment, as well as offer practical support and advice on finances and careers. Cancer survivors are 37 per cent more likely to be unemployed and many struggle to return to work, at a time when income has diminished drastically.
The NHS in London also wants to build on the success of its ‘Get to know cancer’ campaign – which has already trained 1077 volunteer cancer activists to share information in their local communities – and is now learning from successful schemes in America where barbers and beauticians were recruited to raise awareness of cancer signs.
Improving the understanding of cancer symptoms is critical to early detection – yet most Londoners can only name a lump as a potential symptom. Research shows that more than three quarters of people nationally failed to mention either pain, coughing or problems with bowels or bladder. To help tackle this, the NHS England (London) Get to know cancer campaign formed a season-long partnership with Tottenham Hotspur Football Club to raise awareness and promote early diagnosis among fans.
Dr Andy Mitchell, Medical Director, NHS England London Region, said: “Tackling cancer is one of our biggest priorities in the capital and we need to do everything we can to prevent so many lives being lost, so I am pleased to put forward a package of measures that will help drive real change across London.
“London’s poor record of early detection makes it clear that we need to do more to raise awareness and encourage more people to visit their GPs with worrying symptoms.
“By setting out our priorities for the next 12 months, we want to boost survival rates, ensure patients are receiving a world-class standard of care all across London, as well as provide much better support and care for the growing numbers of patients living with and beyond cancer.”
Dr Tony Brezecki, a GP and chair of Croydon Clinical Commissioning Group, said: “Driving up outcomes for cancer patients across the capital is an absolute priority for the NHS in London. We can and must do better. CCGs have a fundamental role to play in implementation of this strategy – particular in increasing the earlier detection of cancer and supporting people living with and beyond cancer. As CCG chair for Croydon and as a GP, I know that implementation of this strategy will deliver better cancer outcomes and better patient experience for Londoners.”
Professor Kathy Pritchard-Jones , Professor of Paediatric Oncology at the UCL Institute of Child Health, said: “In London, we are fortunate to have some of the best cancer experts in the country, but our services are often not joined up, leading to later diagnosis, poor patient experience and less favourable outcomes. Our specialist care in particular does not join together the critical mass of expertise in the way that is needed to achieve the best for the whole patient population and to ensure equal access to new technologies and innovations that we know could make a difference.
“As clinicians we are recommending changes to create an integrated system of cancer care with fewer, larger centres for specialist services working in partnership to support enhanced local services. This would reduce the variation of care that Londoners experience, will save lives and benefit thousands of patients by providing equitable access to the latest treatments, research and medical innovation.”
Professor Martin Gore, Medical Director at the Royal Marsden Hospital, said: “Early detection increases survival and a good experience during treatment improves quality of life. These are our two main strategic aims in London.
“Education for everyone, public and healthcare professionals alike, is the key to achieving early detection. The development of clear and rapid pathways to treatment helps to reduce the anxieties that all patients feel and we must also encourage and nurture a culture of individual patient care and compassion so that patients can cope with the side effects of treatment and the issues of survivorship.”
Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “Cancer Research UK wants to see everyone with cancer diagnosed as quickly and accurately as possible and receiving prompt access to the best treatments.
“Sadly this is not the case all across London, with the city having some of the best and also the very poorest cancer outcomes anywhere in the country. This variation is totally unacceptable, unfair to patients and must be addressed, so we are delighted to see such a focus on early diagnosis in NHS England’s plans for London. We look forward to working with our colleagues in London to ensure effective use of the evidence-based activities most likely to have an impact improving the speed of diagnosis and access to curative treatment.” 
The strategy also sets out measures to reduce variations in care across the capital and improve patient experience – nine out of the 10 worst reported hospitals for cancer patient experience are in London.
Fran Woodard, Macmillan Cancer Support Director for England, says: “London’s poor early detection rates for cancer are inexcusable and united action is needed across the capital to improve early diagnosis and patient experience. We look forward to working with NHS England (London), London NHS Trusts and the Integrated Cancer Systems to move towards the goal of London having the best cancer outcomes of any capital city in the world.
“It is vital that GPs are better equipped to diagnose cancer and play an important role throughout a person’s cancer journey. We are supporting GPs to help them spot patients at risk of cancer by using a new electronic tool.
“Cancer patients’ experience will not significantly improve unless they are helped to manage their own recovery. Every patient has the right to receive a holistic needs assessment and personalised care plan which addresses such things as their physical, emotional and social needs. Fewer than one in four cancer patients received such a plan in London last year. This is unacceptable and must be rectified.”
Other recommendations for commissioners include:
- Holding workshops with trusts to examine why there are sometimes delays in diagnostics
- Auditing how many women are having mastectomies as day surgery
- Assessing transport options for each trust, particularly around parking and public transport
- Examining chemotherapy waiting times across the capital
- Sharing best practice on how trusts are improving standards of behaviour and the patient experience.
- Allowing patients to view and contribute to their electronic medical records
The appendices of the strategy are available on request. Please contact firstname.lastname@example.org
- Cancer is the leading cause of premature (or under 75) death in London. As documented in London borough Joint Strategic Needs Assessments. London accounted for 10 per cent of deaths from cancer during 2009 (Source: The NHS Information Centre for health and social care).
- Compared to other countries in the International Cancer Benchmarking Partnership. This partnership aims to understand how and why cancer survival varies between countries which all have comparable wealth, a universal access to health care and longstanding, high-quality, population-based cancer registration. Others in the partnership include Canada, Australia, Sweden and Norway.
- The strategy was produced in partnership between NHS England (London), London’s CCGs, Public Health England, the Integrated Cancer systems, charity partners and patients.
- A working document was published setting out the proposed cancer strategy earlier this year. Following consultation with stakeholders, clinicians and charities, the final version has been published today. Read the full strategy here.
- See The Case for Change which suggests that around 1000 lives could be saved each year if early diagnosis of cancers matched the best in Europe.
- National Cancer Intelligence Network, (2012) Routes to Diagnosis.
- NICE guideline
- The strategy recommends conducting both the standard CA125 and the Trans vaginal ultrasound at the same time.
- Read more about Macmillan’s support tool. The rollout is dependent on the positive evaluation of the tool, which is currently being assessed by Cancer Research UK. Macmillan Cancer Support’s Cancer Decision Support Tool (CDS) is an electronic tool that runs alongside the GPs’ clinical system. The tool is designed to be used in consultations and uses information from a patient’s record, including information about previous GP visits and symptoms, as well as demography and family history to calculate a patient’s risk of having cancer.
- The ‘Get to know cancer’ programme aims to ensure every Londoner can recognise the signs and symptoms of cancer and feels confident to consult their GP as soon as they notice something unusual.
- NHS England wants to explore alternative “touchpoints” such as hairdressers to disseminate information and promote early awareness of cancer. Project Brotherhood is a Chicago based project that aimed to raise colorectal screening rates amongst black men. Eleven barbers were trained from five barbershops in order to educate their clientele about colon cancer while they cut hair. Educational information and screening test kits were distributed to each shop. Another project in North Carolina trained cosmetologists (beauticians) to deliver health promotion messages to their customers. At 12 months, 55% of customers reported making changes in their health because of the conversations they had with their cosmetologist. A summary of the project is available here.
- 2012 Cancer Awareness Measure
- Cancer Research UK is committed to funding research into the best ways to prevent, diagnose and treat cancers of all types, as well as providing information and ensuring that everything we learn through research is turned into best practice for cancer patients.
- See Macmillan’s Cancer Patient Experience Survey.
- For more information, contact the NHS England (London region) media team on 020 7932 3911 or email email@example.com