A new report, Older people living with cancer, commissioned by Macmillan Cancer Support, outlines that older patients are no more likely to refuse cancer treatment than younger people. The charity calls for the health system to assess patients on individual need and circumstance, rather than “making assumptions around age”.
Key findings from the report include:
- The majority of all age groups over 55 both living with (90 per cent) and living without (84 per cent) cancer do not think that cancer is an age-related disease
- Older people are less likely to receive active anti-cancer treatment; 2 per cent of people decline treatment and 14 per cent opted out of some treatment, and this does not increase with age
- 29 per cent of working age people agree that there have been times during their cancer journey they have not gone to see healthcare staff because they didn't want to waste time, compared with 16 per cent of those over the age of 65
- The majority of those aged 55 or over in both groups surveyed stated there is at least some prejudice against older people with cancer in the UK (62 per cent of those living with cancer; 58 per cent of those without cancer)
- 67 per cent of the older retired group living with cancer agree that the life experience of older people allows them to cope better than younger people
- 53 per cent of people living with cancer in the post-retirement age group state that they sometimes do not ask for help because they do not want to be a burden to other people, compared to 63 per cent of people of working age
The Department of Business, Innovation and Skills (BIS) has announced £18 million of support for the “next generation of medical advances”. Twelve treatments, diagnostics and medical technologies are to receive funding from the Biomedical Catalyst (BMC) programme, which is run jointly by the Medical Research Council and Innovate UK.
Three of the projects to receive funding are conducting cancer research. The University of Oxford will receive funding to support the early diagnosis of bowel cancer, MISSION Therapeutics is developing an inhibitor with potential to be developed for treating soft tissue sarcomas and other cancers and Cryosystems Limited is researching bladder cancer screening.
Commenting on the announcement, George Freeman MP, Parliamentary Under Secretary of State for Life Sciences, said that “by providing early support to these latest treatment and diagnosis developments, we are not only going to potentially help improve or save lives, we are helping businesses grow and boost the UK’s productivity”.
The Telegraph has reported that the first hospital in the UK to offer proton beam therapy to fight cancer is to open within two years. The private cancer hospital, which will cost a total of £150 million, is expected to begin treating patients in 2017. It will be built on the site of the historic grade II listed Royal masonic Hospital in Hammersmith in west London, which had been run by the NHS but closed down almost 10 years ago.
The article also highlights that the NHS has promised to build two proton beam therapy centres in England - one in London, the other in Manchester - by 2018.
Cancer Research UK (CRUK) has published a blog on the implementation of the recommendations from the Cancer Taskforce’s report, Achieving world-class cancer outcomes: a strategy for England 2015-2020. The blog calls for “clear, detailed plans” for putting the recommendations of the Taskforce in place and for the Government to make the required funding available.
Under the heading of “Putting it into practice”, the blog calls for the first two recommendations from the report to be implemented as a first priority, for a National Cancer Team to be set up to put the strategy into practice and for a National Cancer Advisory Board to oversee this progress. The support shown for the cancer strategy by NHS England at its Board meeting in July is welcomed.
The piece goes on to state that “money is the other crucial factor” and highlights the Government’s upcoming Comprehensive Spending Review and the £400 million per year that is estimated to be required to fund the strategy’s recommendations, such as the £125 million needed to upgrade diagnostic equipment, as well as a £275 million one-off investment to replace radiotherapy equipment.
The blog calls for George Osborne MP, Chancellor of the Exchequer, to provide the money needed to implement the strategy’s recommendations.
The Daily Telegraph reported this week that a quarter of cancer patients are dissatisfied with the NHS due to the length of time taken to diagnose their cancer. A study of 70,000 patients found that nearly 13,300 had been seen three or more times by their GP before they were referred for cancer tests. Those patients who had taken the longest time to diagnose were the least satisfied with the standard of their care.
The article is based on research published in the European Journal of Cancer Care, and also shows that nearly one in five cancer patients were dissatisfied with how they were told that they had cancer and 40 per cent were unhappy with the communication between hospital staff and their GP.
The Cancer Drugs Funds (CDF) was a main topic of discussion at this week’s NHS England Board meeting, following the publication of a board paper on the issue earlier this week. The proposed new system for a new fund, aligned with adapted NICE processes and revisions to NICE’s End of Life criteria, includes:
- The CDF becoming a ‘managed access’ fund, with “clear entry and exit criteria”
- Where insufficient evidence exists for a drug that appears promising, and additional evidence would support a more informed NICE appraisal, the drug would be given a ‘conditional approval’
- This drug would then be provided via the new fund for a defined period to collected evidence from ‘real world’ use
- At the end of this process, through an abbreviated NICE process, the drug would either receive a NICE positive recommendation (and move into mainstream commissioning) or receive a NICE negative recommendation (and be removed from the new fund)
- The fund will be capped at £300 million
NHS England will be consulting on this process by September 2015 at the latest to allow the new fund to become operational from 1 April 2016.
This paper was discussed at NHS England’s board meeting, at which it was noted that charities have played, and continue to play, a vital role in the development of a sustainable replacement for the CDF. The board also noted the expanded role of NICE in the new fund to ensure that value is increased from the drugs on the CDF, and the board added that NICE reform will need to be openly discussed with stakeholders.
The Independent Cancer Taskforce has published its report, Achieving World Class Cancer Outcomes: A Strategy for the NHS 2015-2020. The strategy sets six strategic priorities for the next five years to improve the outcomes that the NHS delivers for people affected by cancer:
- Make the necessary investments required to deliver a modern high quality service
- Spearhead a radical upgrade in prevention and public health
- Drive a national ambition to achieve earlier diagnosis
- Establish patient experience as being on a par with clinical effectiveness and safety
- Transform our approach to support people living with and beyond cancer
- Overhaul processes for commissioning, accountability and provision
The strategy also set out 96 recommendations under nine headings, which make provisions for reducing the growth in the number of cancer cases, and driving improvements in survival, experiences of care treatment and support, quality of life after treatment and at end of life, and the efficiency and effectiveness of delivery and implementation. The report itself estimates that the 96 recommendations made will cost an estimated £400m per annum, of which approximately £300m per annum may already be included within the NHS’s Five Year Forward View (FYFV) baseline projections (£13 billion by 2020/21, from £6.7 billion in 2012/13).
The strategy was also discussed extensively at NHS England’s board meeting this week. Key points from the discussion are set out below:
- An emphasis was placed on prevention, with four in ten cancers identified as being preventable through improved lifestyle choices
- The gains of earlier diagnosis were identified as two-fold: preventing human suffering and cost savings. Late diagnosis costs, on average, four times as much as late diagnosis
- Patient experience must be a priority, defined by greater control and access to information, as well as improved care
- A recovery package and good end of life planning are crucial matters of compassion and decency
- This package will need to recognise the mental health implications of cancer survival, in particular for those over 65. Furthermore, the Cancer Taskforce will be shared with, and utilised by the Mental Health Taskforce in the coming months
- Cancer commissioning must be made clearer and simplified
- Providers must not cherry-pick recommendations, and must improve existing capacity and social link
- The ‘do nothing’ option currently costs £6.7 billion and is anticipated to rise to £13 billion in 2020, whereas implementing the strategy will cost between £700 million and £1,400 million per year, representing a significant cost-saving
- Implementation of the strategy is to be co-designed with those involved in the strategy’s development
- Geographical variation is a major issue – this was not overly addressed in the strategy and is an issue that NHS England still recognise
- Deep disappointment was expressed that this is the fourth cancer review and yet still very little granular and understandable public data is available. To address this, within a year, data will be made available according to geographic region, CCG, survival rates for types of cancer, staging of cancers and one year survival rates
NHS England anticipates publishing an implementation plan following the cancer strategy, taking into account the outcome of the comprehensive spending review in setting out how the recommendations made in the strategy will be responded to.
The National Cancer Intelligence Network (NCIN) has published mortality and incidence statistics for rarer and less common cancers. The report has shown that 47 per cent of all newly diagnosed cancers in England in 2013 were a rarer or less common cancer, accounting for 54 per cent of all cancer deaths. The report includes data from 2010-2013 on ovarian, cervical and haematological cancers, for which the number of incident cases and incidence per 100,000 population are recorded as well as mortality statistics.
The Times reported on the publication, quoting Juliet Bouverie, Director of Services and Influencing at Macmillan Cancer Support, as saying that these figures showed the “true burden” of being diagnosed with a rarer cancer in the UK, adding that people diagnosed with a rarer cancer are more likely to say they’ve had a poor experience during a stay in hospital and more likely to feel isolated because they know so little about their disease.”
A Cancer Research UK (CRUK) report into clinical cancer research has found that pressures on the NHS are reducing the ability of the health service to support cancer research. The report interviewed clinicians, nurses and administrators involved in clinical cancer research and showed that escalating demands on staff to deliver routine NHS services are affecting the amount of time that hospital staff are able to work on research. The report identifies four key challenges to clinical cancer research:
- The ability of staff to commit time to research, in the light of mounting service pressures
- The availability of keys skills and experience relevant to research within the workforce
- Financial pressures which undermine the robustness and continuity of the research infrastructure and draw close scrutiny on research costs
- The changing nature of clinical research
The report finds that the UK remains a world-leader in research with one in five cancer patients recruited to research studies and pockets of research excellence existing across the NHS, but also criticises NHS England for failing to show “decisive leadership” and "leaving the NHS without a clear vision for how to achieve its legal duty” to promote research. The report recommends that:
- Clinical research capacity is developed in a more distributive way based on a rigorous assessment of where capability is currently lacking
- Academic institutions and individual clinical academics become be more flexible in their attitude to joint enterprises and research partnerships
- NHS organisations go further to accommodate requests from staff for dedicated research time
NHS England has published Standard Operating Procedures (SOP) for the Cancer Drugs Fund (CDF) for 2015/16 and has launched a four-week consultation on proposed “substantive” changes to these SOP. The outcomes of five appeals from pharmaceutical companies against de-listing decisions made earlier in the year have also been announced. NHS England has launched a four-week consultation on the changes which are “substantive”, consulting on proposed changes to three specific sections of the SOP around the Quality of Life score (QoL), the definition of rarity for a treatment, and the process of challenging a decision made by the CDF panel.
Significantly, patient groups are now able to challenge decisions made by the CDF panel. These proposed changes are outlined within the consultation guidance document. The consultation will close on 18 June 2015.
David Cameron MP, Prime Minister, this week made a speech on the NHS in which he stated that that the Cancer Drugs Fund has now “given life-saving drugs to over 65,000 people”.
The quarterly Cancer Drugs Fund statistics were also published this week, meaning that full figures for 2014/15 are now available here.