King's College London

The Policy Review, published today in The Lancet Oncology, say these issues must be urgently addressed by a comprehensive national cancer control plan.

The authors say the NHS is at a tipping point in cancer care, and the UK is behind other countries. They warn that if focus is lost now, a high price will be paid in terms of additional strain on the NHS, widening social inequality, and weakening economic recovery.

The review highlighted ongoing failures to reduce cancer survival inequalities and warned of treatment delays, noting the UK has one of the highest rates of cancer diagnoses following emergency admissions. The paper warns that “novel solutions” such as new diagnostic tests have been wrongly hyped as “fixes” for the cancer crisis, but notes that “none address the fundamental issues of cancer as a systems problem.”

The experts provide recommendations for understanding the complexity of cancer services and the wider health system, to drive improvements in survival, quality of life, and experience for patients.

To tackle the ten issues, the experts put forward several policy recommendations, including:

• Tackling entrenched social inequalities in access and outcomes of cancer, by creating an NHS task force for social and commercial determinants to inform policy solutions.
• Reducing the cancer backlog by identifying spare capacity using modelling and creating governance for the efficient use of regional capacity, as well as testing operational interventions to speed up processes e.g, waiting times.
• Tackling variation in the quality of cancer care across the NHS by expanding national audits across the UK and researching how audits and feedback to hospitals and professionals can drive change.
• Creating a dedicated unit to support the translation of evidence-based treatment into routine care given that many effective treatments are not received by patients.
• Delivering improved services for cancer survivors, including specialist clinics for long term chronic complication from treatment and the routine collection of data on the impact of cancer care on quality of life.
• Fixing the reimbursement system for cancer care to ensure cancer patients have access to the latest effective treatments, but that this includes investment in workforce and infrastructure such as operating theatres.
• Creating fiscal headroom not just for technology adoption but also for an increased NHS cancer workforce as implementation of new technologies requires increasing resources which, if not budgeted for, leads to lengthening waiting times as we are observing.
• Cancer research strategy needs to be re-profiled to avoid an over-focus on biopharmaceutical research but that also considers other domains e.g. surgery, radiotherapy and palliative care as well as other methodological disciplines e.g. implementation and improvement science research and health economics.

“Waiting lists, for example, are often a downstream consequence of introducing new technologies without adequate consideration of how and who will deliver them within existing capacity constraints,” said Professor Sullivan.

The Review was a collaborative piece of work including clinicians and experts from King's, The London School of Hygiene and Tropical Medicine, Guy’s & St Thomas’ NHS Trust and others.