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Page last updated at 11:16 GMT, Monday, 6 April 2009 12:16 UK

UK still behind on cancer targets

By Susan Watts
BBC Newsnight

Sooner or later we all come face to face with cancer - as a patient, carer, friend or relative. And there is nothing that can prepare you for the dull shock of it.

Watch Susan Watts' film

Newsnight asked our audience for one sentence describing their reaction to the word cancer.

One responded that at least today we can say it out loud, instead of mouthing it. Many describe the fear, sadness and frustration that come with a diagnosis.

And then comes the soul-searching. Should you have insisted that friend go to the GP sooner with symptoms?

Should you have refused to be reassured, and demanded to see a specialist? Or fought harder for the expensive drug?

Cash injection

In the short time that I have spent talking to cancer experts and to patients it has become clear that we still do not know enough about how well we are doing in controlling cancer in the UK.

We do know that things got so bad here, compared with other European countries, that in 2000 the government introduced the NHS cancer plan and a massive injection of cash.


There is no striking improvement despite the huge resources involved

Professor Karol Sikora

The data we need to work out just how effective this has been is only now beginning to emerge.

One set of statistics, in April's issue of The Lancet Oncology, compares England and Wales.

The authors are cautious in their conclusions, stating that the patterns they found show "some beneficial impact of the NHS cancer plan for England, but they do not yet provide a definitive evaluation of its efficacy".

In its editorial, The Lancet itself was less diplomatic. It pointed out that the stated aim of the NHS cancer plan was "by 2010, our five year survival rates for cancer will compare with the best in Europe."

Cancer diagnosis
Experts are split over the real impact of the NHS cancer plan

Yet, the editorial goes on "the evidence presented here suggests that England is at best keeping track with improvements elsewhere rather than closing the gap, and that the 2010 target looks optimistic."

Others were more forthright.

Professor Karol Sikora, medical director of CancerPartnersUK, says that despite the tripling of investment in cancer care in the UK "there is no striking improvement despite the huge resources involved and the very diplomatic language of the authors."

"The diagnosis has to be a whole system fault within the NHS with serial delays, poor access, and serious under-capacity," he adds.

Unequal access

While the cancer plan was well conceived, Professor Sikora says, the system of targets - two weeks to be seen for the first time, 31 days from diagnosis to start of treatment and 62 days from referral to treatment - have meant staff are preoccupied with these.

Cancer graphic

As a result, he says, they are distracted from pressing problems such as the lack of radiotherapists, and poor and unequal access to new cancer drugs, in spite of last year's Cancer Reform Strategy, aimed - again, at addressing some of these issues.

This month we have seen the latest batch of Europe-wide figures, the so-called Eurocare 4 study.

These show that the UK still lags behind the European average on survival of cancer patients at five years.

It was the Eurocare work - which began in the early 1990s, and reports every five years or so, which in part prompted the NHS cancer plan in the first place, by highlighting the UK's poor relative performance.

Eurocare 4 has calculated five-year relative survival for all cancers combined, which the team describes as "the most succinct indicator of cancer control performance".

It calculated the figure for Europe as a whole as 49.6% for both sexes - 44.8% for men and 54.6% for women.

The UK comes in at number 14 of 19 countries for both men and women, (41.4% for men and 51.4% for women), and France at number 10 for men and number five for women (45.5% for men and 56.6% for women).

Iceland is ranked number one (at 48.5% for men and 58.2% for women) and Slovenia performs the worst (at 36.5% for men and 49.4% for women).

woman having mammogram
The incidence of cancer in the UK is increasing with life expectancy

The researchers also looked at the "total national expenditure for health", or TNEH, of each country, adjusted to show per capita purchasing power.

Overall, this correlates with five-year relative survival for all cancers combined.

Interestingly, the UK and Denmark had lower survival than countries with similar TNEH, and Finland had better survival than expected from its "moderate" health expenditure.

The researchers go on to note that this suggests "effective health management" - appearing to imply that the UK and Denmark do not perhaps enjoy the same "effectiveness".

The idea that more money does not necessarily mean better cancer control fits with the Karol Sikora analysis, that the UK has thrown lots of money at the problem, but the outcome does not reflect that.

Somewhere along the line, Professor Sikora argues, we are not getting the most we might out of that spending.

Some improvements

And it fits with some of what Newsnight found when we spoke to a father and daughter who both work in cancer care, and have experience of the UK and the French approach.

Corinne Faivre-Finn
As a doctor I should be offering my patients the best treatments available and there shouldn't be restrictions based on cost
Corinne Faivre-Finn

Corinne Faivre-Finn is an oncologist at the Christie Hospital in Manchester running an international trial on the best way to treat lung cancer. She is French, but has been working in the UK for 10 years.

When Corinne began she was so disheartened by the delays in the UK system that she nearly returned to France, but she says things have changed.

"My patients used to wait for three to four months sometimes to start radiotherapy treatment and now the delays are a maximum of one month," she says.

But she would like to see that speeded up. "In France, when a new cancer drug is licensed it becomes available to be prescribed to all patients who may be benefiting from that drug and the money is coming from a central budget, so there is no restriction or no delays in the availability of the drug for cancer patients."

Her father, Professor Jean Faivre, works at Dijon's Bocage Hosptial. He is an expert on European cancer survival statistics and a gastroenterologist.

He says the five-year survival rate for colon cancer is about 60% in France, but still only 45% in the UK.

The UK is very good at new science, and at creating innovative drugs and therapies, he says, but not so good at getting all this to patients.

There are several steps in the process, and delays can creep in at any of these.

But it seems the UK may have something to offer the US. Professor Harold Varmus is a Nobel prize-winning cancer genetics expert, and president of the Memorial Sloan-Kettering Cancer Centre in New York.

He is also co-chair of President Barack Obama's new council of advisors on science and technology.

Nobel prize-winner on future of cancer science

In a recent interview he told me that the ever increasing cost of cancer drugs, and of healthcare in general, has prompted the president to consider a system that reviews a new drug's effectiveness and cost together, similar to the system run here under Nice, the National Institute of Health and Clinical Excellence.

Surprising perhaps, given its controversial track record here in the UK.

The emphasis everywhere is on the quest for earlier diagnosis - and that is fuelling debate here in the UK over whether we should start prostate cancer screening or lower the age at which young women are screen for cervical cancer.

But Professor Varmus urges caution. "Detecting very early cancers may not be the same as detecting cancers that will kill you at an early stage, and there is a possibility of over treatment that is not only costly but actually harmful," he told me.

Funding plea

Eurocare 4 includes cases diagnosed only up to 1999. As new drugs, genetic research and earlier diagnostic techniques increasingly come into play, population studies have an important role in monitoring the impact of these changes.

It is hard then to understand that the team is struggling for money.

The team notes "it is unfortunate that European governments are reluctant to finance studies that assess the comparative effectiveness of their health systems."

Watch Susan Watts' films on cancer care in full in a special edition of Newsnight on Monday, 6 April, 2009 at 10.30pm on BBC Two.



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