Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based studyBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k764 (Published 14 March 2018) Cite this as: BMJ 2018;360:k764
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In discussing the modest improvement in lung cancer survival over the period they have studied, Exarchakou and colleagues point to improvements in the provision of specialist thoracic surgical services as being the reason for an increase in the proportion of patients undergoing surgery. These developments have facilitated the increased activity but they have not caused them.
Thoracic surgery was one of three specialised services that were centralised in the Hospital Plan of 1960. At the start of the period they studied, there was a strong effect of decreasing use of surgery with increasing distance of the surgical centre from the patient’s residence, especially those living in deprived areas. This has not totally resolved following the implementation of the Cancer Plan . However, the process initiated by the Calman-Hine report has meant that it has become routine to discuss cases in a multidisciplinary meeting which allows surgical input into the decision about who should be offered surgery rather than expecting a non-surgeon to decide whom to refer for surgery and whom should be referred elsewhere.
An audit of one general hospital practice showed that a factor influencing the referral rate for surgery was the participation of the surgeon in the meeting.
1] Exarchakou A, Rachet B, Belot A, Maringe C, Coleman MP Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study BMJ 2018;360:k764
2] CRAWFORD SM, SAUERZAPF V, HAYNES R, ZHAO H, FORMAN D, JONES AP. Social and geographical factors affecting access to treatment of lung cancer. British Journal of Cancer 2009; 101: 897-901.
3] MURAGE P, CRAWFORD SM, BACHMANN M, JONES A. Geographical disparities in access to cancer management and treatment services in England. Health & Place, Health and Place 2016; 42:11-18.
4] BOGDAN C, MINHAS T, TUGGEY J, CRAWFORD M, MILTON R. Impact of surgical attendance on referral for thoracic surgery. British Thoracic Oncology Group Conference, Dublin 23rd-25th January 2013 Lung Cancer, 79, suppl 1, S71, (abstract 206) 2013
Competing interests: No competing interests
It was with disappointment that I read of the cancer outcomes for the period 2000 – 2014 (1) . However, all is not lost. A statistical bulletin released on 29.11.17, from The Office of National Statistics “Index of cancer survival for Clinical Commissioning Groups in England: adults diagnosed 2000 to 2015 and followed up to 2016” (2) shows a much more positive picture: “The one-year all-cancer survival index for England increased steadily from 61.2% for patients diagnosed in 2000 to 72.3% in 2015.” Furthermore, “The inequality gap in the cancer survival index between the highest and lowest CCG in England has shrunk since 2000.”
Further data from the National Cancer Registration and Analysis Service (NCRAS) shows that the 1-year average of proportion of cancers diagnosed in England at an early stage has increased from 44.0% in 2012 Q4 to 52.5% in 2016 Q1 (3).
The above data would suggest that a combination of improved public awareness, increasingly appropriate referrals from Primary Care and increased workload by our diagnostic colleagues, has improved outcomes and reduced variation across CCGs.
To extend these improvements further, more resourcing of the NHS in terms of investment and workforce are needed.
Richard Roope, RCGP and Cancer Research UK Clinical Champion for Cancer
Competing Interests: Clinical Champion role is funded by Cancer Research UK
(1) Cancer inequalities 17.3.18. BMJ 2018;360;k764
(2) www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditio... (last accessed 18.3.18)
(3) www.ncin.org.uk/cancer_type_and_topic_specific_work/topic_specific_work/... (last accessed 18.3.18)
Competing interests: Clinical Champion for Cancer Role is funded by Cancer Research UK