Headway has been made to improve cancer care in England but more is still needed, says a progress report.
Most patients were content with the care they received in hospitals
Patients are more involved in their care and are being seen more quickly, according to the National Audit Office.
But the spending watchdog says two-fifths of patients do not see a specialist within the target two weeks, and a fifth wait more than a month.
Londoners and men with prostate cancer report the least improvement since the NHS Cancer Plan was introduced in 2002.
The NAO looked at the four main cancers - breast, lung, bowel and prostate, and surveyed 4,300 patients.
Patients were broadly positive about their experiences with GPs, the speed of diagnosis and how they were informed they had cancer.
Most patients were content with the care they received in hospital and after discharge.
But there were still gaps in supportive and palliative care.
Prostate cancer patients were dissatisfied with the information they received about side effects and treatment outcomes, as well as waiting times to be seen by a specialist.
London patients also reported a less positive experience of care, but this did not translate to worse survival than in other parts of England.
Edward Leigh MP, chairman of the committee of public accounts, said cancer care was still a "lottery" for many people.
"The service is good for some - it needs to be just as good for all," he said.
Sir John Bourn, head of the NAO, said although large improvements had been made, there was no room for complacency.
"Even if only 10% of patients with major cancers were dissatisfied with some aspect of their care, that amounts to over 10,000 people a year," he said.
Peter Cardy of Macmillan Cancer Relief said the charity was concerned that "many of the aspects that matter to patients are being ignored, especially good quality information and support".
These also included financial support and benefits advice, he added.
John Neate, chief executive of the Prostate Cancer Charity, said the deficiencies in care for men with prostate cancer should be addressed as a matter of urgency.
Health Secretary John Reid said equipment and staffing levels, screening and waiting times had all improved, but there was more work to do to make sure all patients benefited from these.
"That is why we have set a government spending target for research into prostate cancer to help patients reap the benefit of pioneering new techniques," he said.
"We are also making sure that prostate cancer patients are diagnosed and treated quickly." Liberal Democrat Shadow Health Secretary, Paul Burstow MP said ministers were exaggerating their record on cancer services.
"Far too many patients are stuck on hidden waiting lists for diagnosis and treatment," he said.
Conservative Shadow Health Minister John Baron said targets were not working.
"Conservatives would abolish targets and replace them with a set of clinical standards, drawn up by medical experts, which would be much fairer to all patients."