Reducing emergency presentations of cancer patients remains a challenge, says cancer tsar

BMJ 2012; 344 doi: (Published 22 June 2012) Cite this as: BMJ 2012;344:e4341
  1. Paul Dinsdale
  1. 1Rome

Late diagnosis and treatment of cancer in England remains one of the biggest challenges in reducing the 10 000 deaths that could be avoided if the country’s cancer treatment matched the best in European countries, the government’s cancer tsar has said.

Speaking at a conference on cancer treatment in Europe organised by the European Union and member states, Mike Richards said that his unit’s work was currently focusing on why so many patients were presenting as emergencies to cancer specialists and, as a result, had a reduced chance of recovery.

Around a quarter of new cancer cases are currently in people who present to doctors as “emergencies,” and the cancer tsar’s unit, set up as part of the national cancer plan, is studying the reasons why the figure is still so high.

“There is a big problem of late diagnosis, and so we’re spending a lot of time on how many people present as emergencies to doctors,” said Richards. “The whole business of quality of life after surgery and treatment is crucial, and we’re currently looking at measuring quality of life after, for example, colorectal cancer and how many people have control of their bowels one year after treatment.

“We’re also using the figures on cancer deaths from 2010 to evaluate how far we’ve moved towards reducing the 10 000 avoidable deaths figure, and this is still being carried out. Reducing the figure altogether is our ultimate goal.”

Richards also said that the Department of Health was moving towards having more detailed data on survival rates after surgery, particularly 30 day mortality, but that there was no plan to collect data on success rates of individual surgeons.

Since his appointment as cancer tsar in 1999 and the development of a national cancer plan, the model has been taken up by many European countries, but not all EU member states have one. Austria and Poland are still developing plans, and Bulgaria and the Czech Republic are at an early stage of preparation.

However, Richards warned that simply having a plan was not a success in itself. “I have a large number of NCPs [national cancer plans], and I can divide them into ‘aspirational’ plans and those with concrete proposals. It’s very easy to write a plan saying what we should have, but a good one needs to have benchmarking against other EU countries and, for example, data collection on five year survival rates,” he said.

For the first time the health department will also shortly be publishing the results of a survey of bereaved relatives of cancer patients on the quality of the treatment of the patients after diagnosis. He admitted that the department had “absolutely no idea” how patients’ families would rate their relatives’ care and acknowledged that the quality and availability of palliative care still varied widely.

At a press briefing, concern about the effect of the economic crisis on health services in Greece and Spain were raised with the EU’s health commissioner, John Dalli. Greece has seen cuts of around 40% in its health spending in the past two years, with many hospitals unable to pay drug bills, and Spain is now facing similar problems.

Dalli said: “Healthcare is a member state competence [responsibility] and is jealously guarded. Countries want to have their hands on the purse strings, and rightly so, but the economic situation has increased the inequity of cancer treatment. We have talked to companies about the non-payment of drug bills, and I am confident that they will continue to shoulder their responsibilities.”

The European Partnership for Action Against Cancer (EPAAC), which organised the conference, is a joint action initiative between the EU and member states. Data from the “Globocan” project of the International Agency for Research showed that in 2008 2.5 million people in the EU were given a diagnosis of cancer ( Cancer was the second major cause of death in the EU, accounting for more than a quarter of deaths in men (29%) and almost a quarter in women. The most common types of cancer in the EU were colorectal, breast, prostate, and lung cancers.


Cite this as: BMJ 2012;344:e4341

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