2 Saving more lives through improved treatment
5. During his evidence, the National Cancer Director
expressed confidence that cancer mortality rates would fall by
20% for people under the age of 75 by 2010 and that over time
our survival rates will reach the level of the rest of Europe.[14]
Although survival rates for men and women are improving they still
lag behind countries in continental Western Europe with broadly
similar population structures, health care systems and per capita
wealth (Figure 2).[15]
If England's survival rates were comparable with the best in Europe,
thousands more people across society, particularly those from
deprived backgrounds, would survive for appreciable amounts of
time after diagnosis.[16]
Figure 2:
Five-year relative survival rates for men and women diagnosed
between 1990 and 1994
Note: Data for France and Germany are based on outcomes
in only a small proportion of those diagnosed with cancer
Source: EUROCARE 3
6. Achieving improvements requires a need for NHS
diagnostic and treatment services to ensure that patients are
treated more promptly and appropriately, besides enhanced detection
of cancer and an improvement in low levels of awareness among
sections of the public to facilitate earlier diagnosis, as discussed
in part 1.[17]
7. To contribute to earlier detection of cancer,
the bowel screening programme is likely to be introduced in 2006,[18]
while the breast screening programme is being extended to cover
older women at risk and is being carried out using improved screening
techniques. If these improvements are to be introduced successfully,
more skilled staff need to be recruited to relieve increased pressures
on other parts of the system and improve patient outcomes.[19]
8. Surgery remains the main curative treatment for
a large majority of cancer patients. Research shows that the best
results come when surgery is carried out by specialist surgeons.
For the most prevalent cancers, such as breast cancer, specialisation
in surgery is becoming the norm. However, the situation is not
so satisfactory for prostate cancer. Although most prostatectomy
operations are now carried out by surgeons who do at least 5 such
operations per year, this a long way off the NICE guidance target
that all operations be carried out by teams who do 50 or more
prostate operations a year.[20]
Out of 133 Trusts where prostatectomies were carried out in 2002-03,
only 12 Trusts carried out more than 50 operations.[21]
There are also insufficient specialist surgical resources to increase
surgery for lung cancer to desirable levels.[22]
9. Survey results from the Royal College of Radiologists
show that radiotherapy waiting times in many parts of the country
are too long to conform with clinical guidelines on the maximum
acceptable delay before the start of treatment. This is putting
the lives of many people at risk. The National Cancer Director
is now carrying out a "stocktake" of the system and
acknowledges the need to improve recruitment and retention of
staff, but cannot provide a timetable for improvements in waiting
times.[23]
10. As long ago as 1996, we recommended that the
NHS should direct clinical audit activity towards those areas
of national importance where there was evidence of people receiving
sub-optimal treatment.[24]
Only now is the Department, in co-operation with clinician groups,
developing a national clinical audit database for major cancers
to determine why certain groups within the population, such as
the elderly and the deprived, receive less radical treatment purely
because of their poor physical condition or for other reasons.[25]
14 Qq 158-159, 163 Back
15
Securing our future health: taking a long-term view,
Derek Wanless (HM Treasury, 2002) Back
16
Q 43 Back
17
C&AG's Report, paras 17-18, 21-24, 26 Back
18
Q 90 Back
19
Q 91; C&AG's Report, para 2.22 Back
20
Qq 16-24 Back
21
Ev 19-20, 24 (Annex A (i)) Back
22
Q 88 Back
23
Qq 10, 84-87 Back
24
31st Report from the Committee of Public Accounts,
National Health Service Executive Clinical Audit in England
(HC 304, Session 1995-96). Back
25
Q 14 Back
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