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In 1999-2000 the Department of Heath surveyed 65,000 cancer patients across all NHS Trusts in England. The Department identified areas for improvement, but found generally high levels of patient satisfaction in most areas, including dignity, privacy and respect. When published in 2002, the survey provided a baseline against which to measure changes in cancer patient experiences. Since this survey was carried out, additional funding of more than £1 billion has been provided for cancer services and the Department of Health and the NHS have introduced a range of measures to improve access. Guidelines have also been published by the National Institute for Clinical Excellence on the optimal treatment of breast cancer (1996), bowel cancer (1997), lung cancer (1999), and prostate cancer (as part of the urological cancer guidelines in 2002). The NHS Cancer Plan has also been issued governing what needs to be done to make the patient experience as acceptable as possible.[1]
To gauge progress made in the four years since the introduction of the Cancer Plan, the National Audit Office carried out a national follow up survey of cancer patients in early 2004[2] involving 4,300 patients in 49 NHS Trusts with the four commonest cancers: breast, lung, bowel and prostate cancer. Overall, patients were broadly positive about their experiences; some progress had been made in most aspects of the patient experience since 2000, though less so for prostate cancer patients. In addition, both prostate cancer patients and cancer patients in London as a whole reported a worse experience than other cancer patients.
Other elements of the patient experience were still not as good as they might be, regardless of cancer type, such as communicating information, symptom relief and the lack of options for some patients in their last days. In particular, terminally ill cancer patients were often not made aware of nonmeans tested disability benefits that they could have claimed to alleviate financial hardship, estimated by Macmillan Cancer Relief at over £100 million in a six month period.
The main focus for the Department and local cancer networks over the past four years has been to improve cancer supportive and palliative care in line with the National Institute for Clinical Excellence guidance. Hospice services and palliative care have received additional funding since 2003-04, though patients who wished to die at home or in a hospice were still more likely to die in hospital.
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