Download 5.3 Better Cancer Care Action Plan

Highland NHS Board
2 December 2008
Item 5.3
BETTER CANCER CARE, AN ACTION PLAN
Report by Christine McIntosh, Cancer Network Manager, Highland & Western Isles
The Board is asked to:


1
Note the publication of “Better Cancer Care, An Action Plan” - the new National
Cancer Strategy.
Note that an Implementation Plan will be presented to the Board at its February
meeting.
Background and Summary
The purpose of this paper is to report the publication of the attached report “Better Cancer
Care, An Action Plan” - the new National Cancer Strategy. The strategy provides a detailed
picture of the prevalence and impact cancer is having on the population of people in Scotland
and comprehensively describes progress to date and clear actions for each phase in the
cancer pathway. The strategy’s action-plan format gives a clear message on the importance
of implementation.
Better Cancer Care Action Plan updates and refreshes the direction of travel for cancer care
in Scotland, previously set out in Cancer in Scotland (2001). There is a renewed
commitment by the Scottish Government to tackle inequalities, trail-blaze the importance of
the patient experience and patient access, actively encourage and support research and
genetic testing, and strive to ensure world class services through evidenced best practice
where research and audit drive performance.
2.
Cancer Context in Scotland
Cancer touches almost everyone at some time in their lives. Each year about 27,000 people
in Scotland are diagnosed as having cancer and about 17,000 people are predicted to die
from cancer by 2015-2019.
Scotland’s Cancer Scenarios projections show that by 2016-2020, the number of people
diagnosed with cancer is likely to rise to 35000 per year.
We already know that deprivation has a significant effect on incidence and mortality, and
people living in the most deprived areas of Scotland have highest risk of being diagnosed
with cancer, and the lowest chances of survival.
Considering all cancers combined, the most deprived areas report incidence rates almost
40% higher than the least deprived. Mortality rates for all cancers combined are
approximately 75% higher in the most deprived compared to the least deprived areas.
Almost all cancers have shown an improvement in survival five years after diagnosis, with
particular improvements in 5-year survival in malignant melanoma, large bowel, Hodgkin’s
disease and leukaemia
Working with you to make Highland the healthy place to be
Cancer remains the most common cause of premature death in Highland in people under 65,
with lung cancer continuing to be the commonest cause of death from cancer. In total, there
are 1600 new registrations of cancer per year, approximately 8000 people and their families
living with cancer in any year, and 900 people who die each from cancer in Highland.
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Key Messages in Better Cancer Care
3.1
Prevention
A number of lifestyle factors contribute to an increased risk of getting cancer. Smoking, the
proportion and distribution of fat in the body, poor diet, alcohol consumption, and inactivity
are the key modifiable factors evidenced by national and global research studies. The
Scottish Government has set out a number of national health improvement strategies and
action plans which - in addition to setting targets related to key Health Improvement
measures - are aimed at encouraging ownership and responsibility in individuals, families
and communities; to make changes; and to facilitate informed choices.
3.2
Early Detection
The Scottish Government are taking steps to heighten public awareness of each of the
national programmes, and ensure specific action on groups less likely to participate.
In addition to the ongoing screening programmes, NHS Highland is preparing for the
implementation of Bowel Screening. Targeting to improve uptake of screening is being
progressed led by Public Health, and progress will be demonstrated in the HEAT target
performance.
3.3
Genetics
New investment will resource posts across the spectrum of Genetic Testing which will
consolidate the current consortium model; continue to enhance the genetics knowledge &
skills of all healthcare professionals; improve the availability of specialised counselling and
raise public awareness of the benefits.
3.4
Referral
Early recognition of symptoms is vital in successful management of the disease and Better
Cancer Care aims to improve public awareness and ownership. Auditing the use of
electronic referral systems will inform best ways to build on this to ensure seamless primary
and secondary care communication.
3.5
Treatment
Many clinical networks are already in place regionally and nationally, and actively agreeing
improvements in clinical practice, and ensuring that solutions to workforce capacity issues
locally regionally and nationally meet the growing demand. Better Cancer Care also
describes the actions to improve the process and the accessibility for new cancer drugs.
3.6
Living with Cancer
Cancer patients often receive treatment over many years and there is growing recognition of
cancer as a chronic life-limiting illness. Better Cancer Care challenges all providers to work
across agencies to support people living with cancer, enabling them to maintain dignified
independence to their own chosen level. Ninety percent of people affected by cancer
experience a drop in income and an increase in daily living expenditure.
2
Statistically Scottish cancer patients face the highest costs in the UK for travelling to hospital
for treatment. Investment will enhance the training for welfare rights workers and others, and
NHS teams should ensure that referral to benefits advisors is the norm. New funding will
also support specific research into programmes to support people back into work.
3.7
Quality
National Audit work fed by individual boards will comprehensively inform on the effectiveness
of services. Formal reporting against the national QIS Standards for cancer will be
coordinated across Scotland for the Core Standards and the QIS cancer specific Standards
for Breast, Colorectal, Lung, and Ovarian cancers.
By 2011, all patients diagnosed with cancer will have their treatment within 31 days of
Decision to treat. The 62-day target will affect all those diagnosed with cancer, and who
were referred urgently with a suspicion of cancer, and will be extended to include all
screened cancers. The finer details have yet to be received from the Scottish Government.
3.8
Delivery
The Scottish Cancer Taskforce will replace the Scottish Cancer Group and will provide a
determined focus on achieving outcomes. The group will review the current infrastructure in
place across the country and identify ways to improve their efficiency. The leadership from
this group will ensure delivery of an ambitious work-plan. Clinical collaboration through
Managed Clinical Networks will continue and will report work-plan priority outcomes to the
Scottish Cancer Taskforce.
4
Governance Implications
The implementation of Better Cancer Care will impact on Clinical Governance and will have a
Financial impact. The impact will be assessed as part of the development of the
implementation plan.
5
Impact Assessment
The implementation Plan will be impact assessed including the capacity needed in relation to
the projected increases expected in the total number of cancers and in some particular
cancers.
The projections made as part of the scenario work carried out by the Information Services
Division (ISD) has been assessed in terms of the numbers of cancers expected to be
annually diagnosed within the population of NHS Highland in the next 7 years i.e. 2015. For
NHS Highland as a whole, the expected increase is 27% between 2005 and 2015 (Appendix
1, figure 1). This is equivalent to a year on year increase of 2.4% with the largest
proportionate increases expected in the haematological cancers, bowel cancer, Head and
Neck, oesophagus, stomach and pancreas. Only cancers of the Cervix and Bladder are
expected to decrease. Whilst some of the increases are expected to be associated with
better outcome e.g. bowel and breast cancers through the implementation of screening and
in the case of breast screening, an earlier detection through two view mammography, many
of the others are potentially avoidable by preventative measures e.g. alcohol related cancers,
head & neck, pancreatic.
The projections for the ‘Northern’ NHS Highland population are shown (reflecting where the
majority of the workload lies), and have similar proportionate increases (Appendix 1, figure
2).
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Conclusion
The cancer agenda is far reaching, impacting on acute and community settings. Recognition
of the health, personal, and financial impact of cancer has driven much of the innovative
work around living with cancer. Cancer also cuts across each of the new collaborative
initiatives as well themes from other clinical networks.
Work is underway to develop an Implementation Plan and this will be reported to the NHS
Board at its next meeting in February 2009.
Christine McIntosh
Cancer Network Manager
Highland & Western Isles
21 November 2008
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APPENDIX 1
BETTER CANCER CARE, AN ACTION PLAN
Report by Christine McIntosh, Cancer Network Manager, Highland & Western Isles
Figure 1
Expected Number and Percentage Change in new cases for
Highland Post 2006
Average Annual
Projected Cases
20151,2,3
% Change
(2005-2015)
Average %
Change per
Year (over
2005-2015)4
Cancer (ICD code)
Actual New
Cases 2005
Head and Neck (C00-C14, C30-C32)
52
86
66%
5.18%
Oesophagus (C15)
64
84
31%
2.74%
Stomach (C16)
38
50
30%
2.68%
Colorectal (C18-C20)
230
326
42%
3.55%
Lung (C33-C34)
226
240
6%
0.61%
Pancreas (C25)
40
58
46%
3.83%
Melanoma skin (C43)
48
66
38%
3.28%
Breast (C50)
228
309
36%
3.09%
Cervix (C53)
19
14
-24%
-2.76%
Corpus Uteri (C54)
35
37
6%
0.55%
Ovary (C56)
43
55
27%
2.44%
193
202
4%
0.43%
Testis (C62)
10
15
47%
3.90%
Renal (C64)
42
58
38%
3.28%
100
88
-12%
-1.28%
16
29
78%
5.96%
6
9
46%
3.87%
Non-Hodgkin lymphoma (C82-C85)
68
95
40%
3.44%
Leukaemia (C91-C95)
26
63
142%
9.25%
Other and unspecified
183
236
29%
2.58%
1,667
2,119
27%
2.4%
Prostate (C61)
Bladder (C67, D09.0, D41.4)
Brain, meninges and CNS (C70-C72)
Hodgkin disease (C81)
Total
Source: NHS Scotland Cancer Registry
1
The projections are based on incidence trends observed during 1961 to 2000 and Government Actuary Department
2006-based population projections for Scotland, published October 2007[i].
These 2006-based population projections replace the 2002-based populations used in the original document.[ii]
[i] Population projections by the Office for National Statistics, Projected population by age last birthday in five year age bands
http://www.gad.gov.uk/Demography_Data/Population/Index.asp?v=Principal&chkDataTable=yy_5y&chkDataGraph=&y=2006&data
Country=scotland&subTable=Search+again
[ii] Because population projections are not a precise science the Government Actuarial Department (GAD) in consultation with the
General Registrar’s Office (GRO) for Scotland develop alternative or variant projections.
One of these projections is defined as the principal, medium or central variant. In both the original and updated projections of
cancer incidence, the principal projections have been used.
More information on the projections and the effect of change in the population projections is available at
http://www.scotland.gov.uk/Resource/Doc/924/0067460.pdf
2
3
4
The projections by NHS Board or Region are based on the ratio of 2000-2004 incidence rates by age and sex for each cancer site
relative to the Scotland ratio and the GRO Scotland based area based population projections by age and sex.
There is an issue with stability when 'drilling down' below an All Scotland picture or region picture, largely because the numbers of
incident cases for some boards and cancers can be very small.
No methodological approach can compensate for the issue of small numbers.
Average annual percentage is calculated by fitting a regression line t the natural logarithm of the number of cases using calendar
year as a regressor variable, i.e. y=mx+b where y= ln(number of cases) and x=calendar year.
Then APC=100*(em-1)
5
Figure 2
Expected Number and Percentage Change in new cases for
Highland Pre 2006
Average Annual
Projected Cases
20151,2,3
% Change
(2005-2015)
Average %
Change per
Year (over
2005-2015)4
Cancer (ICD code)
Actual New
Cases 2005
Head and Neck (C00-C14, C30-C32)
35
58
66%
5.18%
Oesophagus (C15)
49
64
31%
2.74%
Stomach (C16)
27
35
30%
2.68%
Colorectal (C18-C20)
154
218
42%
3.55%
Lung (C33-C34)
153
163
6%
0.61%
Pancreas (C25)
26
38
46%
3.83%
Melanoma skin (C43)
31
43
38%
3.28%
Breast (C50)
169
229
36%
3.09%
Cervix (C53)
13
10
-24%
-2.76%
Corpus Uteri (C54)
23
24
6%
0.55%
Ovary (C56)
32
41
27%
2.44%
150
157
4%
0.43%
Testis (C62)
9
13
47%
3.90%
Renal (C64)
34
47
38%
3.28%
Bladder (C67, D09.0, D41.4)
66
58
-12%
-1.28%
Brain, meninges and CNS (C70-C72)
13
23
78%
5.96%
5
7
46%
3.87%
Non-Hodgkin lymphoma (C82-C85)
46
64
40%
3.44%
Leukaemia (C91-C95)
16
39
142%
9.25%
Other and unspecified
80
103
29%
2.58%
1,131
1,438
27%
2.4%
Prostate (C61)
Hodgkin disease (C81)
Total
Source: NHS Scotland Cancer Registry
1
The projections are based on incidence trends observed during 1961 to 2000 and Government Actuary Department
2006-based population projections for Scotland, published October 2007[i].
These 2006-based population projections replace the 2002-based populations used in the original document.[ii]
[i] Population projections by the Office for National Statistics, Projected population by age last birthday in five year age bands
http://www.gad.gov.uk/Demography_Data/Population/Index.asp?v=Principal&chkDataTable=yy_5y&chkDataGraph=&y=2006&data
Country=scotland&subTable=Search+again
[ii] Because population projections are not a precise science the Government Actuarial Department (GAD) in consultation with the
General Registrar’s Office (GRO) for Scotland develop alternative or variant projections.
One of these projections is defined as the principal, medium or central variant. In both the original and updated projections of cancer incidence,
the principal projections have been used.
More information on the projections and the effect of change in the population projections is available at
http://www.scotland.gov.uk/Resource/Doc/924/0067460.pdf
2
3
4
The projections by NHS Board or Region are based on the ratio of 2000-2004 incidence rates by age and sex for each cancer site
relative to the Scotland ratio and the GRO Scotland based area based population projections by age and sex
There is an issue with stability when 'drilling down' below an All Scotland picture or region picture, largely because the numbers of
incident cases for some boards and cancers can be very small.
No methodological approach can compensate for the issue of small numbers.
Average annual percentage is calculated by fitting a regression line t the natural logarithm of the number of cases using calendar
year as a regressor variable, i.e. y=mx+b where y= ln(number of cases) and x=calendar year.
Then APC=100*(em-1)
6