Achieving world-class cancer outcomes by 2020 — how realistic is this?
Part 2 of our “Right Patient, Right Drug, Wrong Place” series
Both the Møller and the Baldwin commentary, cited in Part 1 of this blog series (link below), got me thinking about what it would take to have active treatments throughout England resemble those in the highest current regional rates. And not just in lung cancer, but in cancer in general.
After some web based research I stumbled upon the March 2015 report entitled “Achieving World-Class Cancer outcomes: A strategy for England 2015–2020”, compiled by the Independent Cancer Taskforce and chaired by Sir Harpal Kumar (now chair of the National Cancer Advisory Group, NCAG).
I would encourage each and every one with a vested interest in cancer to review this now 3-year old report (link below); we have included some headline statements taken from the executive summary:
Firstly, the need to embrace partnerships:
“Success in delivering the aspirations of this strategy will depend on devolved decision-making, agility, and new models of care, within a framework of national standards and ambitions. In turn, this will be reliant on research and intelligent use of data to drive continuous improvement, as well as a “test and learn” approach in areas where the evidence of what works is immature. It will also be reliant on the culture and attitude of health care professionals in embracing partnership working with patients, seeing them as equals in decisions about their treatment and care”.
On the patient experience:
“More than half of people receiving a cancer diagnosis will now live ten years or more. But our mortality rates are higher than they could be. In addition, unacceptable variability exists in access to and experience of care across different areas, sub-groups of the population and cancer types. There is much we could do to improve patient experience and long-term quality of life, and to make our care more patient-centred”.
Anyone working within the diagnostics field should read this:
Drive a national ambition to achieve earlier diagnosis: This will require a shift towards faster and less restrictive investigative testing, quickly responding to patients who present with symptoms, by ruling out cancer or other serious disease. We recommend setting an ambition that by 2020, 95% of patients referred for testing by a GP are definitively diagnosed with cancer, or cancer is excluded, and the result communicated to the patient, within four weeks. Delivering this will require a significant increase in diagnostic capacity, giving GPs direct access to key investigative tests, and the testing of new models which could reduce the burden and expectation on GPs;
and this:
Rolling out a molecular diagnostics service which is nationally-commissioned and regionally delivered, enabling more personalised prevention, screening and treatment.
If the NHS were to be successful in implementing the many initiatives listed in the report, of which there are numerous benefits, three goals in particular made us sit up and take note:
- An additional 30,000 patients per year surviving cancer for ten years or more by 2020, of which almost 11,000 will be through earlier diagnosis;
- A closing of the gap in survival rates between England and the best countries in Europe and elsewhere;
- A reduction in the variability of access to optimal diagnosis and treatment and the resulting inequalities in outcomes.
But now, the crushing reality
The strategy for England report, as fantastical and inspiring as it is, is exactly that — a strategy. Making it happen is another thing entirely.
3 years on we decided to dig deeper and see what progress has been made by reviewing the Independent National Cancer Advisory Group Meeting Minutes. The latest available online (16th January 2018) did outline progress made on the cancer strategy (e.g. the availability of 56 new radiotherapy machines), however the update related to patient and public engagement and involvement summed up the enormity of the situation:
“Members expressed concerns about the level of engagement being achieved by NHS England and the Cancer Alliances. (National Cancer Director) outlined the steps that NHS England are taking to improve engagement, but asked NCAG members to provide suggestions as to what approach would work”.
Yes, 3 years on we are still at the suggestion box stage.
And “on areas of little or no progress” (yes, that actually is written into the minutes)
“Communications and engagement: Members agreed again that communications and engagement with patients, public and health professionals has not been good enough yet…”.
“Research: Members raised the fact that while big hospitals continue to do well, smaller hospitals are seeing declining performance in terms of patient access to research, creating two-tier access to patients for clinical trials or even information about research. Access for Teens and Young Adults is not happening either”.
An observation, if I may
It is extraordinarily easily to cite, reference and quote facts, figures and shortcomings from articles and reports. Everyone is trying to fight the good fight, it’s just that sometimes the fight ends up being considerably more than one originally bargained for.
The objective after all is to achieve world-class outcomes by 2020, not just incremental improvements.
However, one can try to connect the dots in a bid to better the situation.
We, at Indigo Medical, know that pharma is willing and able to seize an opportunity to actively support the clinical community by:
“Extending a clinical culture that is active in its use of available therapies will mean more patients will receive the right treatment”.
(remember that quote from earlier?).
And think-tanks such as the Independent Cancer Taskforce lack resource / ideas / clout to really engage the numerous stakeholders (patients, public, advocacy groups and health professionals) and communicate access to research for patients.Yet patient advocacy groups have experience to effectively engage, communicate and share the patient perspective in the hope to achieve better health outcomes.
Surely we can balance these equations and leverage pharma, advocacy groups and technology better?
End of Part 2.
Join us next week for our final blog from this series where we look at examples of co-creation and how pharma, advocacy groups and technological gurus could / should be better utilised.
And in case you missed the first part, here is the link:
Møller H, Coupland VH, Tataru D, et al. Geographical variations in the use of cancertreatments are associated with survival of lung cancer patients.
http://thorax.bmj.com/content/early/2018/02/05/thoraxjnl-2017-210710
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license
National Lung Cancer Audit Annual report 2017 (for the audit period 2016), January 2018) from the Royal College of Physicians, Care Quality Improvement Department.
The Report entitled Achieving World-Class Cancer Outcomes: A Strategy for England 2015–2020 can be found at:
Photo credits
- Photo by Samantha Sophia on Unsplash
- Photo by Noah Silliman on Unsplash