Conclusions and recommendations
1. The Department should publicise some simple
guidelines to help people recognise and act on appropriate symptoms
for major cancers. UK
survival rates from cancer are still well below the best in the
world. A key factor is the tendency of patients in England to
be diagnosed at a later stage of the disease.
2. Research indicates that cancer is likely
to be more advanced by the time it is diagnosed in poorer areas.
Cancer Networks should identify areas where cancer is diagnosed
at a more advanced stage, with reference to measures of deprivation,
so as to determine and tackle the underlying reasons for late
presentation.
3. Action is needed to help GPs improve their
ability to identify symptomatic patients. Helpful
measures would include better guidance; closer monitoring of GP
referrals; and the development of GPs specialising in cancer as
champions to spread good practice among the profession.
4. A significant number of patients referred
non-urgently, and who eventually are diagnosed with cancer, wait
much longer than they should to be treated.
The Department needs to develop a mechanism to record the time
taken to assess and diagnose all patients who are routinely referred
and then diagnosed with cancer. Delays in the patient pathway
should be identified and reduced by redesign of services drawing
on good practice such as that identified in the C&AG's Report.
5. Better information is needed on how far
cancer has advanced at the point of diagnosis, so
that quality of treatment can be benchmarked properly for the
first time. The Department should press ahead with its work to
develop a database of waiting times for cancer diagnosis and treatment
in order to set priorities for improvement and deal with blockages.
6. Patients and the public should have the
information to help them press for improvements in cancer services
in their locality. Information about the
level of cancer service provision, whether surgery is being carried
out by specialists, and the performance of service providers should
be disseminated locally.
7. A deadline should be set for ending the
current wide variations in prescribing of anti-cancer drugs such
as Herceptin. The recommendations by the
National Cancer Director regarding resources, clinical practices
and enhancements in NICE guidance should be implemented speedily,
with a clear timetable for monitoring their impact and reviews
of progress.
8. Some areas benefit more than others from
the current distribution of pathologists, diagnostic radiographers
and scanner provision. Lack of skilled
staff is a major problem, not just in diagnostics but also in
specialist surgery. The results of the exercises should then be
used to work towards greater equity of provision over an explicit
timescale.
9. Waiting times for radiotherapy treatment
are too long and getting longer. Besides
continuing efforts to recruit more staff, there is a clear need
for identification and dissemination of good practice and re-design
of services. The National Cancer Director should lead and co-ordinate
this activity, following from his recent "stocktake"
sessions with relevant stakeholders.
10. Primary Care Trusts in their role as commissioners
of cancer services should promote the concentration of cancer
surgery in the hospitals which carry out higher volumes of such
operations, in line with best practice.
The National Cancer Director should report progress made in this
respect.
11. The Department should commission research
into the long term effectiveness of its Stop Smoking services.
Currently it is not clear why more than
two thirds of people who initially quit using the service are
likely to be smoking again within the year.
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