National Cancer Standards Framework
53. Providing the right organisational structure
for research into cancers and delivering cancer care is essential
for improving outcomes for cancer patients. It is, however, also
necessary to ensure that the treatment provided in the new organisation
is the most appropriate. Identifying best clinical practice for
patient outcomes and communicating this across the cancer networks
will help to ensure a uniformly high standard of care. The Department
of Health told us that "Guidance on improving outcomes for
breast, colorectal, lung and gynaecological cancers has been published
and targeted funding has been allocated to improve service delivery
and in particular to establish specialist teams".[70]
There are also plans to publish guidance covering upper gastrointestinal,
urological, head and neck cancers and haematological malignancies.[71]
Professor Crowther, President of the Association of Cancer Physicians
and Emeritus Professor of Medical Oncology at Manchester University,
told us that "Good clinical scientific research can only
follow from the application of 'Good Clinical Practice Guidelines'...
These are not implemented widely because of under-funding for
staff".[72]
He estimated that "no more than 50 per cent" of patients
were treated in accordance with those guidelines.[73]
54. The Government has recently launched a consultation
on a manual for national cancer care standards and performance
indicators for cancer care, initially for breast, bowel and lung
cancer.[74]
These are intended to ensure high standards of practice, to encourage
good communications with patients, and to monitor cancer incidence,
waiting times for treatment and patient satisfaction.
55. Guidance and monitoring will not alone deliver
high standards in care or research. Leadership and funding, supported
by sound research-based evidence are required to ensure that high
standards are implemented across the NHS. For example, guidance
on gynaecological cancers, published in July 1999, recommended
that for ovarian cancer "paclitaxel [Taxol] plus carboplatin
should be standard therapy unless there are particular concerns
about toxicity in relation to the individual patient's fitness".[75]
It was not, however, until May 2000 that NICE issued guidance
to the effect that "paclitaxel in combination with a platinum
therapy (cisplatin or carboplatin) should be the standard initial
therapy for patients with ovarian cancer following surgery".[76]
Thus many oncologists were faced with national guidance to use
a particular drug which, in the absence of NICE approval, the
Health Authority was unwilling to fund. There is no guarantee
that NICE-approved treatments will be funded by Health Authorities
and, similarly, there seems to be no guarantee that clinicians
will automatically follow the guidance provided. Cancer patients
are often very well informed about the latest treatments and will
no doubt become informed of the national guidance on treatment
standards. We welcome the introduction of national guidance
on improving outcomes for cancer patients and the initiatives
to monitor delivery. It is, however, wholly unacceptable that
delays in implementing the guidance on treatment should be the
result of tardiness on the part of NICE or contrary funding decisions
on the part of Health Authorities.
Education and Prevention
56. Another of the main elements of the Government's
strategy to tackle cancer is through prevention and public health
education. There are several well-recognised risk factors associated
with cancer which result from lifestyle, the most significant
and best-known being tobacco smoking. The Government estimates
that "about a third of cancer deaths are caused by smoking".[77]
The links between cancer incidence and diet, alcohol consumption,
and exposure to sunlight, certain infections or certain chemicals
(either in the workplace or through environmental pollution) have
been clearly demonstrated. These are all areas where Government
can take action either through public health campaigns or through
legislation to reduce or prevent exposure. Such legislative actions,
which require research to establish the validity of the link between
exposure and disease, include pollution controls and health and
safety at work regulations. These are enforced by Government agencies
such as the Environment Agency and the Health and Safety Executive
(HSE). The HSE has an extensive research programme to identify
occupational carcinogenic agents and to prevent exposure of workers.[78]
57. Public health awareness campaigns are important
and can be successful. Most people, including children, are aware
that smoking causes cancer of the lung and other organs. The Government's
recent measures to intensify action to reduce smoking include
restricting tobacco advertising and the promotion of nicotine
replacement therapy.[79]
Nevertheless Professor Selby of the ICRF told us that "there
will have to be a significant reduction in smoking quite quickly"
if the Government is to meet its target for reducing cancer deaths
over the next 10 years, although it is questionable whether even
a large, immediate decline in smoking would produce a significant
decline in lung cancer deaths in this time frame.[80]
We welcome the Health Committee's recent Report on The Tobacco
Industry and the Health Risks of Smoking.[81]
58. The GP also has an important rôle in cancer
prevention. The GP is in a prime position to advise patients of
lifestyle factors which can affect cancer such as diet, smoking,
alcohol consumption and exposure to sunlight. Advice from GPs
can be tailored to the individual which will often be more effective
than mass public health programmes which by necessity can only
disseminate messages broadly. GPs are also in a good position
to promote the use of self-examination to help with early detection,
particularly for skin, breast and testicular cancers. The rôle
of the GP is particularly important in deprived areas where low
levels of literacy, poor education and cultural barriers to seeking
diagnosis and treatment may all contribute to late diagnosis and
poorer cancer outcomes.[82]
In such areas the national public health messages may not get
across to individuals as easily as in more affluent areas.
58 See Annexes
1-8. Back
59 Q.
3. Back
60 Calman-Hine
report, page 9. Back
61 See,
for example, Annex 7. Back
62 Ev.
p. 1. Back
63 Q.
2. Back
64 Q.
499. Back
65 Q.
499. Back
66 Q.
469. Back
67 Department
of Health, press notice 2000/0356, 15 June 2000. Back
68 Oncologists
are doctors who treat cancer patients. Medical oncologists treat
cancer with chemotherapy and clinical oncologists treat cancer
with radiotherapy although there is some overlap between these
disciplines. Back
69 See
Annex 4. Back
70 Ev.
p. 2. Back
71 Ev.
p. 2. Back
72 Ev.
p. 133. Back
73 Q.
369. Back
74 Department
of Health, press notice 2000/0356, 15th June 2000. Back
75 Improving
outcomes in gynaecological cancers - The manual,
NHS Executive, July 1999, p.31. Back
76 Guidance
on the Use of Taxanes for Ovarian Cancer,
NICE, May 2000. Back
77 Saving
Lives: Our Healthier Nation,
p. 63. A similar estimate has been made by the National Cancer
Policy Board in the United States. Back
78 See:
Ev. pp. 313-321. Back
79 Saving
Lives: Our Healthier Nation,
p. 64. Back
80 Q.
294. Back
81 Second
Report from the Health Committee, Session 1999-2000, on The
Tobacco Industry and the Health Risks of Smoking, HC 27-I. Back
82 See
Q. 579; Saving Lives: Our Healthier Nation, p. 62. Back
