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Improving Cancer Outcomes at a national level - The story from England Professor Sir Mike Richards National Cancer Director June 2012 1 Improving Cancer Outcomes in England ● What were the problems? ● What have we done? ● Where next? 2 Cancer in England 20 years ago ● High incidence (like other developed countries) ● Poor survival (most cancers) ● High mortality (especially lung cancer and breast cancer) 3 Cancer in England 20 years ago ● Why were outcomes so poor? 4 England had particularly high smoking rates in the 1950s and 1960s Our services were very fragmented, both within hospitals and between hospitals and the community, with long waiting times We were complacent – we believed our National Health service was amongst the best in the world We chose to ignore emerging findings from the EUROCARE studies as unreliable Our services were ‘doctor-centred’ not ‘patient-centred’ Cancer in England: What changed? (1) ● The evidence of poor outcomes became more difficult to dismiss ● The voice of cancer experts, charities and patient groups started to be heard by the media by politicians ● The Chief Medical officers for England and Wales published a report highlighting problems – The Calman-Hine report (1995) 5 Five year period survival profiles from 1991 to 2002 for colorectal and breast cancer: The EUROCARE Studies 6 Cancer in England: What changed? (2) ● Tony Blair calls a “Cancer summit” in May 1999 and declares cancer ‘a top priority’ ● National Cancer Director appointed – November 1999 ● First comprehensive Cancer strategy published September 2000: The NHS Cancer Plan 7 What was achieved? 2000 - 2007 ● Reduced smoking rates (from around 28% to around 21%) – through concerted efforts (taxation; ban on smoking in public places; stop smoking services, etc) ● Improved cancer screening programmes for cervical, breast and colorectal cancer ● Reduced waiting times ● Improved services – with almost all patients being assessed by a multidisciplinary specialist team ● Centralisation of complex surgery ● Improved radiotherapy and chemotherapy services 8 How was this achieved? 2000 – 2007 ● “Community building” – nationally and regionally clinicians academics managers civil servants ▪ ▪ ▪ ▪ patients politicians charities industry ● 28 cancer networks – each serving on average 1.8m population (range 1-3m) ● National Cancer Action Team – to support change ● Clearly defined targets/commitments ● Additional funding – but no more than for the rest of the NHS ● New cancer standards – and peer review assessment of individual services ● Rigorous monitoring and reporting 9 The position in 2007 ● Much better services ● Much shorter waits ● Better patient experience/satisfaction but… ● Survival rates still lagged behind other countries 10 ICBP: 5 year relative survival. Coleman et al, Lancet 2011 70 20 AUS CAN SWE NOR DEN 65 UK AUS CAN CAN 18 AUS 16 SWE 60 55 SWE NOR 14 DEN 12 NOR UK DEN 10 50 UK 8 45 6 1995-99 2000-02 2005-07 1995-99 2000-02 2005-07 Lung Cancer 5yr RS Colorectal Cancer 5yr RS 90 45 SWE AUS 85 CAN NOR CAN NOR 40 AUS DEN 80 UK UK DEN 35 75 70 1995-99 AUS 2000-02 Breast Cancer 5yr CAN SWE NOR 2005-07 RS DEN UK 30 1995-99 AUS Ovarian CAN 2000-02 Cancer RS NOR 5yrDEN 2005-07 UK ICBP: 1 year relative survival. Coleman et al, Lancet 2011 45 90 AUS CAN SWE NOR DEN SWE UK AUS 85 CAN 40 AUS SWE CAN 80 NOR NOR 35 DEN DEN UK 30 75 UK 25 70 20 65 1995-99 2000-02 1995-99 2005-07 Colorectal Cancer 1yr RS 2000-02 2005-07 Lung Cancer 1yr RS 100 80 SWE 98 NOR 75 CAN AUS CAN AUS 96 70 DEN NOR DEN 94 UK 65 UK 60 92 55 90 1995-99 AUS 2000-02 BreastSWE CancerNOR 1yr CAN 2005-07 RSDEN UK 50 1995-99 AUS CAN Ovarian 2000-02 2005-07 NOR DEN RS UK Cancer 1yr Cancer Reform Strategy: 2007 ● Second cancer strategy – with a new emphasis on: 13 A National Awareness and Early Diagnosis Initiative (NAEDI) A National Cancer Survivorship Initiative (NCSI) – “living with and beyond cancer” A National Cancer Intelligence Network (NCIN) – to provide better data on all aspects of cancer National Awareness and Early Diagnosis Initiative ● 4 components 14 Public awareness campaigns to promote earlier presentation Support for GPs Better diagnostic services Research and evaluation How many deaths might be avoided if cancer survival in England matched the best in Europe? Total around 10,000 pa Breast ~ 2000 Myeloma 250 Colorectal ~ 1700 Endometrial 250 Lung ~ 1300 Leukaemia 240 Kidney/Bladder ~ 990 Brain 225 Oesophagogastric ~ 950 Melanoma 190 Ovary ~ 500 Cervix 180 NHL/HD 370 Oral/Larynx 170 Pancreas 75 [NB Prostate has been excluded as survival ‘gap’ is likely to be due to differences in PSA testing rates.] Data derived from Abdel-Rahman et al, BJC Supplement December 2009 15 Lung cancer – cough campaign 16 Be clear on cancer: Bowel cancer 17 Improving Outcomes: A Strategy for Cancer ● Third cancer strategy – with a new focus on outcomes 18 Survival Quality of life (PROMs) Recovery from treatment Patient experience (survey) Safety Patient experience survey 19 National Cancer Intelligence Network ● We aspire to having the “best cancer intelligence network in the world” 20 Cancer registration as the foundation Linking datasets (primary care, screening, radiotherapy, chemotherapy, hospital administrative systems, etc) Bringing together the relevant expertise Producing useful outputs for hospitals, commissioners, patients, etc Summary ● We have definitely made progress over the past 12 years ● Even with a national focus it has not been easy ● We know we still have a long way to go 21