Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Nicola Barnstaple Programme Manager Key challenges in Scotland • Increasing cancer incidence – predicted 35,000 cases per year in 2020 • Ageing population -proportion of over-75s up 25% by 2023 • Impact of health inequality - mortality rates from cancer in the 10% most deprived areas are around 1.5 times those in the 10% least deprived areas • Survival for some cancer types is lower in Scotland than in other European countries Scotland: age-standardised incidence and mortality rates (EASRs), by SIMD 2009 deprivation quintile Scotland: age-standardised cancer incidence and mortality rates (EASRs), by SIMD 2009 deprivation quintile All cancers 600.0 Breast 160.0 Incidence Mortality 120.0 400.0 100.0 EASR EASR 500.0 300.0 Incidence 140.0 Mortality 80.0 60.0 40.0 200.0 20.0 100.0 - 5=Least deprived 5=Least deprived 4 3 2 1=Most deprived 4 Colorectal Incidence 70.0 Mortality 2 1=Most deprived Lung 120.0 Incidence Mortality 100.0 60.0 80.0 EASR 50.0 EASR 3 40.0 60.0 30.0 40.0 20.0 20.0 10.0 - 5=Least deprived 4 3 2 1=Most deprived 5=Least deprived 4 3 2 1=Most deprived Cancer staging by deprivation 2010/2011 (baseline) Stage 1 Stage 2 Stage 3 Stage 4 Not known 1=most deprived 19.8% 21.4% 19.3% 30.2% 9.3% 2 21.8% 24.1% 18.6% 26.4% 9.2% 3 22.6% 26.1% 18.0% 23.7% 9.6% 4 25.0% 27.5% 16.2% 22.9% 8.3% 5=least deprived 27.2% 28.0% 15.6% 21.1% 8.0% Stage 1 Stage 2 Stage 3 Stage 4 2011/2012 Not known 1=most deprived 20.3% 22.1% 18.6% 30.9% 8.1% 2 23.0% 23.6% 18.8% 27.0% 7.6% 3 23.5% 25.9% 17.5% 25.6% 7.4% 4 26.9% 26.7% 16.5% 23.1% 6.9% 5=least deprived 27.5% 27.1% 16.4% 21.8% 7.1% Key challenges • Increasing cancer incidence – predicted 35,000 cases per year in 2020 • Ageing population -proportion of over-75s up 25% by 2023 • Impact of health inequality - mortality rates from cancer in the 10% most deprived areas are around 1.5 times those in the 10% least deprived areas • Survival for some cancer types is lower in Scotland than in other European countries Five-year age-adjusted relative survival (%) with 95% confidence intervals for adults diagnosed during 2000-2007, by selected country and cancer site/type 90.0 80.0 70.0 Relative survival (%) 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Skin Melanoma UK, Scotland UK,England Norway Finland Denmark Lung UK, Scotland UK,England Norway Type of cancer / Country Finland Rectum Denmark UK, Scotland UK,England Norway Finland Denmark Colon UK, Scotland UK,England Norway Finland Denmark UK, Scotland UK,England Norway Finland Denmark Stomach Five-year age-adjusted relative survival (%) with 95% confidence intervals for adults diagnosed during 2000-2007, by selected country and cancer site/type 100.0 90.0 80.0 Relative survival (%) 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 UK, Scotland UK,England Norway Finland Denmark Kidney UK, Scotland UK,England Norway Type of cancer / Country Finland Prostate Denmark UK, Scotland UK,England Norway Finland Denmark Ovary UK, Scotland UK,England Norway Finland Denmark UK, Scotland UK,England Norway Finland Denmark Breast (Woman) Non-Hodgkin lymphoma Source: Lancet Oncol 2014; 15(1): 23-34 Colorectal cancer diagnosed 1995-99. Five year relative survival vs survival conditional on surviving at least one year 80 70 60 % surviving 50 Denmark England Scotland Finland Norway Sweden 40 30 20 10 0 5-year Relative survival Conditional survival So what is the explanation for this apparent excess of early mortality? •Unfavourable stage distribution due to delays and/or tumour biology? and/or •Poor general health/lifestyle factors laid down over decades? Source: Lancet Oncol 2014; 15(1): 2-3 Source: BMJ 2010; 341: c5133 Eurocare 5 findings • Survival from major epithelial cancers seems to be lower in Scotland (and the UK) compared to all of the Nordic countries except Denmark • The excess risk of death seems to occur early on and is more apparent in oldest age groups • Some evidence suggests that, on average, UK patients may be presenting with more advanced disease at diagnosis • But we don’t know for sure whether this is due to later presentation, later referral, delays in diagnosis or staging, or more aggressive disease • We know that lifestyle factors can influence survival, but we don’t really know to what extent, if any, this contributes to European survival variations • The reasons for reported survival differences seem most likely to be multifactorial Cancer: approx 6% total NHS spend Cancer services: estimated activity and costs: Scotland 2007/08 Acute Services episodes Geriatric long stay episodes Out patient services Pharmaceutical GMS items visits dispensed Activity 188,141 517 144,624 1,153,614 195,363 Cost £390M £8.5M £25M £46M £6.3M Costs • Projected 65% increase in costs of treating cancer by 2021 • For colon cancer: treatment in Stage 1 costs £3131 and treatment in stage 4 costs £12519 DCE HEAT Target • to achieve a 25% increase in the proportion of breast, colorectal and lung cancers (combined) diagnosed at stage 1 by December 2015 when compared to the 2010 and 2011 (combined) baseline (23% → 29%). Social Marketing Primary Care • Review of Scottish Referral Guidelines for Suspected Cancer • New sGMS contract initiative for bowel screening • Primary Care education sessions • Improvements in e-Health, eRAT • Development of practice profiles for cancer Evaluation – key points • • • • • Data on cancer diagnoses not yet available 4.7% increase in cancers diagnosed at Stage I (2012/13 compared to baseline) Priming Campaign - just under half (48%) of all respondents feel more confident about approaching their GP with signs or symptoms which could possibly be cancer Breast Campaign – 50% increase in attendances at GP for breast symptoms Bowel Campaign- increases in requests for replacement kits and calls to screening helpline, increase in screening programme participation (56.1% from 54.9%) • • Lung Campaign - Significant improvement in relation to key campaign message of importance of getting cough checked Other measures of success – emergency admissions, ICBP, TCT, other studies DCE Next Steps • Consolidation • Breast Screening Campaign • Updated bowel and lung cancer campaigns • Interim Evaluation • Consideration of new tumour groups Early diagnosis is important • • • • relations with patients and families RCGP/Patient Safety Agency report best chance for long-term survival. still well enough to tolerate disease modifying treatments • emergency diagnoses don’t do as well • more time to manage symptoms • allows more to join clinical trials Scottish Cancer Taskforce • • • • DCE Treatment capacity TCAT QPI Acknowledgements EUROCARE-5 slides mostly reproduced from the Lancet Oncology papers Data are also now available to download from the EUROCARE website: http://www.eurocare.it/