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Consequences of cancer
and its treatment
Improvements in early detection and
diagnosis
More advanced treatments
From acute to long-term condition
Increasing numbers of people living
with and beyond cancer
Maddams J, Utley M, Moller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202.
More people are living with cancer
1. Macmillan Cancer Support. Estimate for 2015 based on extrapolation of data in: Maddams J et al. Projections of cancer
prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202. (Projections scenario 1)
2. ‘Five years’ refers to 2010-2015
Half of people with cancer may live more than ten
years after their diagnosis
Total Prevalence – now
Total Prevalence – 2030
Maddams J, Utley M, Moller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer. 2012. 107: 1195-1202.
Surviving cancer does not necessarily mean living well
3 in 4 people living with cancer are
in the survivorship stage1
1 in 4 of them deal with
consequences of their treatment2
1 in 5 of cancer survivors may have
unmet needs3
1. Maher J and McConnell H. New pathways of care for cancer survivors: adding the numbers. Br J Cancer. 2011. 105: S5-S10
2. Macmillan Cancer Support. Throwing light on the consequences of cancer and its treatment. 2013. London
3. Armes J et al. Patients’ supportive care needs beyond the end of treatment: A prospective, longitudinal survey. Journal of Clinical
Oncology.2009. 27:36 6172-6179
Cancer affects all areas of people’s lives
left with financial needs1
People with cancer are
more likely to be unemployed
than the general population2
1.Macmillan Cancer Support. Cancer’s Hidden Price Tag. 2013.
2.de Boer AG et al. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA. 2009. 301: 753-762
People with cancer have significant social care needs
Practical and
personal needs
Mobility - 32%
64%
Housework and cooking
- 31%
Emotional
needs
Macmillan Cancer Support. Hidden at home. 2015. London
Personal care - 14%
78%
Cancer increasingly co-exists with other conditions
Macmillan Cancer Support. Cancer in the context of other long-term conditions. Scoping evidence review and secondary
data analysis. 2015.
Costs accumulate over time
Macmillan Cancer Support. Routes from Diagnosis. The most detailed map of cancer survivorship yet. 2014. London
At least 500,000 people in the UK
experience long term health conditions
caused by their cancer or its treatment
•
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•
•
•
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90,000 affected by gastrointestinal problems,
including faecal incontinence, diarrhoea and bleeding
350,000 experiencing sexual difficulties
150,000 with urinary problems
63,000 affected by lymphoedema
350,000 with chronic fatigue
240,000 living with mental health problems
Macmillan Cancer Support. Throwing light on the consequences of cancer and its treatment. 2013. London
Cancer Patient Experience Survey 2014
25% not informed about
side effects before
treatment
74% not offered a written
assessment and care plan
41% not enough support
from health and social care
services after
Patient Reported Outcomes
Assessing cancer survivors quality of life through crosssectional population surveys
Key factors found to impact on patient outcomes:
• Emotional impact of a cancer diagnosis
• Experience of care during treatment
• Comorbidities, exacerbated by cancer treatment
• Treatment side effects
• Social and financial difficulties
• Inadequate preparation for the impact of cancer
and its treatment
Corner et al BMJ Open 2013;3:e002316
PROMs report 2015
I have control of my bowels
(in the last week)
• Very much (48%)
• Quite a bit /Somewhat /a little
(36%)
• Not at all (16%)
Downing et al JCO 33:6, p616-624
Analysis of 4,000 care plans based on Electronic Holistic
Needs Assessments (eHNA)
The top ten issues people with cancer are concerned about:
1. Worry, fear or anxiety
2. Tiredness / exhaustion or fatigue
3. Sleep problems / nightmares
4. Pain
5. Eating or appetite
6. Anger or frustration
7. Getting around (walking)
8. Memory or concentration
9. Hot flushes / sweating
10. Sore or dry mouth
25% of cancer
patients struggle to
manage the
emotional impact of
the disease
Macmillan Cancer Support. Electronic Holistic Needs Assessment data as of 20/06/2015
.
National cancer strategies
reflect the changing story of cancer
The NHS Cancer Plan (2000)
• Focused on survival, adequate funding, cancer waiting times
Cancer Reform Strategy (2007)
• Prevention, treatment guidelines, reduce variation, improve
access
Improving Outcomes: A Strategy for Cancer (2011)
• Efficiency, prevention, patient choice
Achieving World-Class Cancer Outcomes (2015)
• Prevention, diagnosis, treatment, patient
experience, quality of life, living with and beyond
cancer
2013 NCSI report - 5 step framework
1.
Information and support from
the point of diagnosis
2. Promoting recovery (the
‘Recovery Package’)
3. Sustaining recovery
4. Managing the consequences of
treatment
5. Supporting people with active and
advanced disease.
https://www.gov.uk/government/publications/living-with-and-beyond-cancer-taking-action-to-improve-outcomes
2014 NHS England 5 Year Forward View
“We will also work in partnership with patient organisations to
promote the provision of the Cancer Recovery Package, to
ensure care is coordinated between primary and acute care,
so that patients are assessed and care planned appropriately.”
Achieving world-class cancer outcomes
A strategy for England 2015-2020
(July 2015)
• Recommendation 63: The NHS and partners should drive
forward a programme of work to ensure that people living
with and beyond cancer are fully supported and their needs
are met. This should include approaches to reducing and
managing long-term consequences of treatment.
• Recommendation 65: NHS England should accelerate the
commissioning of services for patients living with and
beyond cancer, with a view to ensuring that every person
with cancer has access to the elements of the Recovery
Package by 2020.
macmillan.org.uk/cot
[email protected]
@MacConsequences