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Joint Strategic Needs Assessment Briefing: Analysis of Cancer Mortality in Oldham May 2014 Joint Strategic Needs Assessment Key Findings and Implications The study was carried out because cancer mortality in Oldham is higher than that for England. Although mortality has declined, the rate of decline for Oldham has been much slower. Key Findings The prospects for future reduction in cancer mortality are mixed. Our incidence rates remain higher than England. Lung cancer incidence is of particular concern. However, we have lower rates for colorectal and cervical cancer incidence. The biggest causes of cancer deaths are Digestive, Respiratory, Breast, Lymphoid, Haematopoietic and related, Male genital including prostate, Urinary Tract and Female genital including cervical. Although this is broadly similar compared to England there are some marked differences. Lymphoid and related cancers are much higher in Oldham. The biggest inequality gap between England and Oldham is that for lung cancer. Stomach cancer in men and Upper Gastrointestinal cancers are also comparatively high. In addition to respiratory and digestive cancers, breast cancer is a significant contributor to female mortality. There were marked ethnic differences in mortality with the South Asian group having a much lower mean age of death. They also had much higher mortality from Lymphoid, haematopoietic and related cancers. There were large differences in mortality at the ward level. Although this was associated with deprivation, deprivation alone, does not fully account for the observed differences. Medlock Vale, Shaw and Hollinwood wards had much higher mortality compared to wards such a Saddleworth South, St Mary’s and Saddleworth North. Some of the more deprived wards such as St Mary’s, Coldhurst, Werneth and Chadderton South had relatively much lower rates. At the District Partnership level, Failsworth and Hollinwood and Oldham District had the highest rates. There were some significant differences at the primary care cluster level. The highest number of deaths, were in Royton, Shaw & Compton cluster and the lowest in Werneth. When the number of cancer deaths, were adjusted for the size of the registered population, the cluster with a significantly high proportion was East Oldham. Royton, Shaw and Crompton and the Integrated Care Centre were also much higher. Saddleworth, Glodwick and Werneth clusters had the lowest proportion. The findings need to be explored to understand the underlying differences in outcomes between person characteristics such as age, sex and Joint Strategic Needs Assessment Introduction ethnicity, where people live (e.g. ward) and variations in primary care outcomes. This will enable better targeting of interventions to help reduce future mortality. Key Implications Reducing the number of people developing cancer (incidence) is the most effective way of reducing cancer mortality in the future. The main risk factors for cancer are related to lifestyle: smoking, unhealthy diets, overweight and obesity, physical inactivity and alcohol. Smoking is by far the biggest contributor to cancer mortality and our smoking prevalence is comparatively high. The other risk factors are also important particularly when they are grouped together. For people who develop cancer, early presentation to the GP, timely referral of suspected cancer and access to high quality diagnostic and treatment services, will improve the survival of cancer patients. Good quality palliative care can make a big difference in improving the quality of life for patients and their families and carers. Introduction: Why is cancer mortality an important issue to consider? Cancer mortality in Oldham is higher than that for England and compared to statistical neighbours. Although cancer mortality has declined in Oldham, the rate of decline has been much slower in Oldham. Oldham had the lowest decline of all areas in the North West. Cancer is a major burden on the health and wellbeing of individuals and communities. There are estimated to be 5600 people in Oldham with cancer. Over 1000 people diagnosed with cancer in Oldham every year. Over 300 people in Oldham die prematurely from cancer every year and cancer is the most common cause of death in Oldham. Cancer has major economic impacts and increases demand for health and social care services. In England, the economic cost of cancer in 2008 was estimated at £18.3 billion. This is projected to increase to 24.7 billion by 2020. The impact of increasing costs to the health and social care economy will make it harder to allocate resources for prevention and for improving the health and wellbeing of people in Oldham. Joint Strategic Needs Assessment Methods and Implications What has been done for the JSNA? This study is an exploratory analysis, to provide a starting point for understanding the reasons for our high cancer mortality. To provide the context for the mortality study the main trends in incidence were summarised based on existing information. The main focus was on analysing cancer deaths. This involved analysing nearly 5000 deaths between 2004 and small numbers where subsets of the data set were analysed. The strength of the study is the size of the sample and the techniques used to minimise bias. However, the study was limited in scope, and further work needs to be done not just on cancer mortality but to explore the full cancer pathway 2012. Various statistical techniques were used to minimise the impact of What use can stakeholders make of the findings? Stakeholders such as Oldham Council, CCG, Secondary Care providers and the third sector should consider what role they can play in reducing cancer mortality in Oldham. Oldham council has a key role in primary prevention. It is responsible for commissioning services that help to reduce exposure to cancer risks. These include Health Improvement Services that help people to give up smoking, and improving the uptake of healthier lifestyles such as improving access to fruit and veg and opportunities for physical activity. Nearly half of all cancers are potentially preventable Oldham had the lowest decline in cancer mortality in the North West There are estimated to be 5600 people in Oldham with cancer. Over 1000 people are diagnosed with cancer in Oldham every year Over 300 people in Oldham die prematurely from cancer every year Cancer is the most common cause of death in Oldham The economic cost of cancer in 2008 was estimated at £18.3 billion. This is projected to increase to 24.7 billion by 2020 Joint Strategic Needs Assessment Implications Deprivation is associated with increased risk for certain cancers and reduced survival from cancer. Improving the overall wellbeing of Oldham residents and reducing deprivation has a key role in improving future cancer outcomes. NHS England and Public Health England have the lead role in promoting awareness of cancer and providing and promoting the uptake of screening services. This includes making services accessible to deprived communities and people from BME communities. Oldham CCG and primary care services in Oldham have a vital role in early diagnosis and referral to secondary care diagnostic and treatment services. They can also play in important part in primary prevention by providing brief interventions on lifestyle and referral to services such as smoking cessation. Pennine Acute Hospitals Trust and other secondary care providers such as Christie’s, have a big role to play in diagnosing and treating patients and improving survival from cancer. This involves timely and equitable access to their services, and using evidenced based and effective treatment. Around half of all cancer is preventable so stakeholders working with each other and their clients can make a major contribution in reducing cancer mortality in Oldham. A full copy of the JSNA is available from the public health department.