Our cancer
survival
must match
EuropE’s best
Lives depend on it
Everyone should have the best possible chance to survive cancer.
But UK survival rates are among the worst in Europe. And 1 in 3
of us diagnosed with cancer will die within a year. This must change.
Ahead of the General Election, Macmillan is calling on all political
parties to commit to delivering cancer outcomes that match the best
in Europe by the end of the next parliament.
Almost 1 in 2 people will receive a cancer diagnosis in their lifetime by the time the next
parliament ends. A recent major study of 29 European countries found survival rates for almost
all common cancers in the UK are worse than the overall European average.1 Urgent action
is needed so that more people survive cancer and are able to live well after treatment.
There is also significant variation in cancer outcomes across the country. Recent Macmillan
analysis has shown that the proportion of people dying within a year of being diagnosed with
cancer is 61% higher in the worst-performing local healthcare area in England than the best.
38% of people with cancer die within 12 months in the worst area, Barking and Dagenham,
compared to 24% in the best, Hampshire and Farnham.2
Barking and Dagenham
North East Hampshire and Farnham
Die within
a year
Survive at
least a year
This variation is not explained by some areas having an older population, higher levels of
deprivation or higher rates of certain types of cancer which have a particularly poor prognosis.
The difference could be down to how quickly patients are being diagnosed and treated.
To make sure that cancer outcomes in the UK match the very best in Europe, it’s crucial
that they are:
• diagnosed at the earliest opportunity
•a
ble to access the best treatment that is right for them, irrespective of their age
or where they live, and
• properly supported to live well once treatment has finished.
We need to improve early diagnosis
People have a better chance of surviving cancer and
having fewer long-term consequences if their cancer
is caught early. However, cancer services in this country
perform poorly on early diagnosis compared with
many other developed countries.
Almost 1 in 4
people with cancer in England are diagnosed as an emergency 4,
for example in A&E. Those diagnosed in this way are likely to have a worse survival rate.
They are twice as likely to die
within a year of diagnosis as those diagnosed through an urgent GP referral.5
There are three main ways of improving early diagnosis
and reducing the proportion of people diagnosed via
an emergency route. They are:
• improving awareness of signs and symptoms of
cancer and making sure people visit their GP if
they are concerned
In work for the Department of Health, the economics
consultancy Frontier Economics estimated that diagnosing
cancer earlier could be very cost-effective.6 This estimate
is based on the cost of additional diagnostic tests and
changes to treatment costs if patients are diagnosed
at an earlier stage.
• s upporting GPs to make timely referrals for
diagnostic tests if they suspect cancer, and
•m
aking sure that once a referral has been
made, the person is tested as quickly as possible.
‘I went to the GP with weight loss and serious
stomach problems a number of times but
it wasn’t until I collapsed and went back to
the doctor again that I was diagnosed with
Stage 3 bowel cancer.’
Sonia, Manchester
We need to ensure everyone has access
to the most appropriate treatment
Too many people with cancer in the UK are not receiving
the best possible treatment. Treatment rates vary
depending on where people live and how old they are.
For example, for people with early-stage non-small cell
lung cancer, surgery often offers the best chance of a
cure. But in the UK we carry out less surgery for lung
cancer than in other European countries. What’s more,
the proportion of people who receive surgery varies
widely across the country.7
Variation in proportion
of people with non-small
cell lung cancer who
receive surgery, based
on 2012 cancer networks
in England and Wales 8
Over 1.3 million
older people (aged 65 and over) are living with
cancer in the UK 9 and that number is set to
treble by 2040
10
However, the UK has some of the worst survival rates for older people in Europe and rates of surgery decline sharply
with age.
The reasons for poorer outcomes in older people are complex. They may include delays in diagnosis and treatment,
cancer being diagnosed at a more advanced stage and the increased likelihood of other health issues in addition to
cancer. However, there is also a growing body of evidence to suggest that many older people are not being offered
optimal treatment.11
In assessing suitability for and providing appropriate advice on treatment, cancer care teams should take mental
and physical considerations into account. They should avoid making decisions based on chronological age alone.
By addressing inequalities associated with age we have
the potential to drastically improve outcomes for older
people with cancer.
‘I’m sure if I was 65 I’d be on a different
treatment. I’ve always been really active;
I’m not necessarily a typical 85-year old.’
Barbara, Coventry*
We need to invest in care after treatment
for people living with and beyond cancer
There are currently 2 million people in the UK living with
and beyond cancer. Although people with cancer are
living longer that does not necessarily mean they are
living well. At least 1 in 4 of them face poor health or
disability after treatment.12
The physical consequences of treatment range
from general fatigue to more severe issues such as
incontinence, osteoporosis and chronic pain. There
are also emotional consequences of cancer and its
treatment to consider, such as anxiety and depression.
To help improve the support that people receive,
Macmillan has developed the Recovery Package.
This is a combination of different interventions that,
when delivered together, will improve outcomes and,
consequently, lives.
The components of the package include:
• a holistic assessment of the patients’ needs, and
a tailored care plan to meet these
• a treatment summary explaining both the treatment
received and the next steps to the patient and their GP
• a cancer care review, completed by a GP or practice
nurse, allowing the patient to discuss their needs and
monitor progress, and
• a health and wellbeing event to prepare the person
for the transition to supported self management,
which helps educate and empower the patient to
manage their condition and keep themselves fit
and healthy.
an Phys
d h ica
ea l a
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ife
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Recovery
package
Treatment
summary and
cancer care
review
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fin ort
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In nd
a
Assessment
and care
planning
Health and
wellbeing
event
Managing consequences
of treatment
Copyright © Macmillan Cancer Support 2013.
Permission granted for use as seen, this notice must remain intact in all cases. All rights reserved.
People living with and beyond cancer must be properly supported in their recovery once their treatment
ends. This will help to minimise the impact of their illness on their health and their life. An individual
Recovery Package is an important part of that support. It will help people to prepare for the future, identify
their individual needs and return to work, should they wish to, and as near to a normal lifestyle as possible.
What is Macmillan calling for?
The next government should deliver cancer outcomes that match the best in Europe by the end
of the next parliament. Macmillan is calling on all political parties to:
1 dramatically decrease the number of people diagnosed with cancer via an emergency route
2 reduce variations and inequalities in access to treatment, particularly for older people.
This includes:
i.Publishing an action plan to tackle the reasons why older people have some of the worst survival rates in Europe
ii.Ensuring that every cancer care team uses a comprehensive assessment of the needs of older people and is
able to provide appropriate advice to inform the best possible treatment for them
3
make sure all people with cancer are better supported after treatment has ended
This includes ensuring that everyone diagnosed with cancer receives a Recovery Package.
Help us make cancer a priority
Call on your manifesto leads to make matching the best cancer outcomes in
Europe an election pledge and make it a priority for the next government.
Ahead of next year’s General Election, Macmillan is also calling on political
parties to commit to ensuring that:
·a
ll people with cancer are treated with the highest levels of dignity and
respect, and for NHS staff to be supported to do this; and
·e
veryone at the end of their life is given free social care, so that they can
spend their final days in the place of their choosing.
References
1 De Angelis et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5-a population-based study. Lancet
Oncology 2014: 15: 23-34
2ONS and London School of Hygiene and Tropical Medicine. 2013. Cancer Survival Index for Clinical Commissioning Groups, Adults
Diagnosed 1996-2011 and Followed up to 2012 http://www.ons.gov.uk/ons/rel/cancer-unit/a-cancer-survival-index-for-clinicalcommissioning-groups/adults-diagnosed-1996-2011-and-followed-up-to-2012/index.html (accessed April 2014)
3One-year survival for people diagnosed with lung cancer during 2005-2007 is 29.7% in the UK and 43.6% in Sweden. UK figure refers
to people diagnosed with lung cancer in England, Wales or Northern Ireland. Source: Coleman MP et al. Cancer survival in Australia,
Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis
of population-based cancer registry data. Lancet 2011; 377: 127–138 http://www.thelancet.com/journals/lancet/article/PIIS01406736(10)62231-3/ fulltext?_eventId=login#tbl2
4Public Health England’s National Cancer Intelligence Network. Routes to diagnosis 2006-2010 workbook (a): http://www.ncin.org.uk/
publications/routes_to_diagnosis (accessed July 2014)
5Elliss-Brookes L et al. Routes to diagnosis for cancer – determining the patient journey using multiple routine data sets. Br J Cancer
2012; 107: 1220-1226
6Department of Health. The likely impact of earlier diagnosis of cancer on costs and benefits to the NHS, January 2011 https://www.gov.
uk/government/uploads/system/uploads/attachment_data/file/213788/dh_123576.pdf
7Health and Social Care Information Centre. National Lung Cancer Audit 2013. Variations persist after adjusting for age, sex,
socioeconomic status, stage of disease and general health
8Health and Social Care Information Centre. National Lung Cancer Audit: 2013. http://www.hscic.gov.uk/
searchcatalogue?productid=13406&q=title%3a%22Lung+cancer%22&infotype=0%2fAudit&sort=Relevance&size=10&page=1#top
(accessed February 2014) Variations persist after adjusting for age, sex, socioeconomic status, stage of disease and general health
(performance status)
9Macmillan Cancer Support. The rich picture on older people with cancer. 2013 http://be.macmillan.org.uk/Downloads/
CancerInformation/RichPicture/OlderPeopleRichPicture2013MAC136681113-FINAL.pdf
10Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 11951202
11Age UK, Department for Health and Macmillan Cancer Support. Cancer Services Coming of Age: Learning from the Improving
Cancer Treatment Assessment and Support for Older People Project. 2012 http://www.macmillan.org.uk/Documents/AboutUs/Health_
professionals/OlderPeoplesProject/CancerServicesComingofAge.pdf
12 Macmillan Cancer Support. Throwing light on the consequences of cancer and its treatment. 2013
*Names and locations have been changed as requested to protect anonymity
The UK is facing a cancer crisis. By the end of the next government’s
term in 2020, almost half of us will have to face cancer sometime
during our lives. And while the majority of us will receive a good
standard of care, this sadly isn’t the case for everyone.
We urgently need to change this.
Our survival rates are among the worst in Europe – not least
because thousands of us are diagnosed too late. And many
thousands more are treated with a lack of compassion or denied
the right to die where we want, with dignity. If we’re struggling
to ensure everyone receives a good standard of care now, how
will we cope as the number of us diagnosed with cancer grows?
Next year’s General Election is our chance to make sure the new
government tackles this looming crisis. Without urgent action,
not everyone with cancer will get the care that’s right for them.
No one should face cancer alone.
Help us raise standards of cancer care and make sure it is
a priority for the next government.
Find out more at macmillan.org.uk/GeneralElection2015
Macmillan Cancer Support, registered charity in England and Wales (261017),
Scotland (SC039907) and the Isle of Man (604). MAC15065_LFT
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