Time to diagnosis: The weak link in cancer care and how to strengthen it

Time to diagnosis: The weak link in cancer care and how to strengthen it
Matthew Reed
Matthew ReedEquipsme

Posted: Mon 4th Feb 2019

Everyone fears cancer. One in two of us will get it in our lifetime. It's Britain's biggest killer, accounting for 28.1% of deaths in 2017.

And if the papers are to be believed, the NHS isn't coping. It consistently missed its target of treating 85% of patients within two months of referral in the five years to 2018.

Now for some good news. Cancer survival rates have more than doubled in the past 40 years to 50% and survival rates are at an all-time high, said NHS England in December 2017.

In fact, adults diagnosed with melanoma, prostate or breast cancer in the earliest stage are today just as likely to survive the year than if they didn't have cancer at all.

Beat the clock: 81% of cancers caught early don't kill

So long as it's diagnosed in time. You're more than three times as likely to survive cancer if it's caught early; 81% of patients live for at least another decade after stage I or II diagnosis, but if cancer is diagnosed at stages III or IV, those odds fall to just 26%.

The significance of this shouldn't be underestimated. While it's true some types of cancer can come back years or even decades after diagnosis, most recur within the first two years. Indeed, if cancers such as testicular, malignant melanoma or breast do not recur after 10 years, a doctor may say a patient is cured. It seems early diagnosis is the best cure.

Sadly, this is the weakest link in the NHS's cancer strategy: catching and treating it quickly enough. In the four years following April 2014, the NHS hit its monthly target of treating 85% of patients within two months of an urgent GP referral just once.

Some of the pressures contributing to this are well documented. A poll in January 2018 found that two in three hospitals and half of GP surgeries were facing shortages of doctors, a situation compounded by tightening rules around immigration. Another found that nearly 40% of GPs planned to leave the profession within five years.

Meanwhile, urgent GP referrals for cancer have almost doubled. In 2010/11, an average of nearly 3,000 patients were urgently referred for suspected cancer every day. In 2017/18, that number had risen to 5,300. Just as the NHS was facing its biggest ever staffing crisis.

World class cancer care?

But remember those survival rates. Back in 1961, your chances of living 10 years after a cancer diagnosis were less than one in four. By 2011, they were 50%. The odds continue to improve. In 2004, 79.8% of people survived five years after diagnosis with breast cancer, the most common cancer in the UK. By 2014, that number was 85.6%.

In fact, breast cancer survival rates in the UK saw the joint second greatest improvement between 2000 and 2014, according to a ranking of OECD countries by Quality Watch. Colon cancer survivals saw the second greatest improvement and cervical cancer the third.

It's true UK survival rates for some kinds of cancer still lag behind other countries, but the increasingly favourable odds of beating cancer in Britain suggests the balance is being redressed. For example, the UK survival rate for cervical cancer grew by 4.9% points to 63.8% between 2000 and 2014. In the US it fell 1.7% points to 62.6%.

The omens are good for progress to continue. The 2015 strategy paper Achieving World Class Cancer Outcomes detailed how NHS England would increase cancer survival, reduce preventable cancers and improve patient quality of life by 2020.

In 2017, it reported "significant and rapid progress", with £130m invested in new and upgraded radiotherapy equipment and £200m spent on accelerating diagnosis and enhancing patient care.

Strengthening the weak link

The NHS is already a world leader in cancer treatment, which it continues to invest in. As we've seen, it's less effective at diagnosis, meaning that for too many, cancer is caught too late. This weak link needs strengthening.

"There is a missing element in the cancer pathway, which has no target: time to diagnosis," said Quality Watch in January 2018.

"None of the current targets capture the time elapsed from GP urgent referral to the patient receiving a definitive diagnosis or cancer exclusion. It is extremely important, as earlier diagnosis is a key determinant for cancer survival."

Another is age. Sixty five per cent of cancer diagnoses in 2016 were in people aged 65 or over; 34% were in those of working age. Not only do the chances of getting cancer increase with age, so do the chances of it killing you. Adults aged 25 to 49 accounted for just 4% of cancer deaths from 2014 to 2016; 42% were aged 50 to 74; 54% were over 75.

So what's the chance that you or one of your employees will get cancer before retirement? Things aren't as bleak as that startling one in two figure suggests. Men have a one in nine chance of getting cancer before 65; for women it's one in seven, although survival rates are higher for women.

As we've seen, diagnosing the cancer early enough is crucial to survival. That's why Equipsme provides access to private doctors that ensure speedy referral and diagnosis, the weakest part of the chain for the NHS. If cancer is confirmed, patients are then referred to the NHS for treatment, the strongest part of the chain.

It's the best of both worlds: speedy diagnosis, world class treatment and affordable health insurance.

Matthew Reed
Matthew ReedEquipsme

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