A few weeks ago, a family friend called our home in great distress to tell us that she had been diagnosed with stage four ovarian cancer.
This revelation had been shocking enough for an otherwise fit and healthy lady, but her anxiety was compounded by the fact that it had taken several weeks to make her first doctor’s appointment and this was followed by another delay before she managed a consultation at to arrange a specialist. .
Compounding her fears was the news that after receiving the verdict she feared, she would have to wait six weeks for her first session of chemotherapy that would, hopefully, eliminate the disease.
Apart from the fact that she was in pain, this delay was painful in itself and played into her understandable fear that the longer the wait before treatment, the more likely the disease would progress and have negative consequences for her long-term treatment. outcomes in the long term.
Around 375,000 people are diagnosed with cancer each year in Britain, which equates to around 1,000 every day or someone every two minutes
Her fears are well-founded: extensive research in recent years has shown that there is a significant impact on a person’s mortality if cancer treatment is delayed, whether it be surgical treatment, systemic therapy (such as chemotherapy) or radiotherapy.
People whose treatment is delayed for even a month face a 6 to 13 percent higher risk of death – a number that continues to rise with each additional day their treatment is missed.
No wonder my wife’s friend was scared.
Fortunately for her, in this case I was able to beg an oncologist to advance her treatment and within a week she underwent her first chemotherapy session.
That privilege is, of course, not available to most of the 375,000 people diagnosed with cancer in Britain each year – around 1,000 every day – i.e. someone around every two minutes.
This is a huge number and I fear that many of them will face the same problems as our friend, in the form of hugely unacceptable delays in diagnosis and treatment.
The delays are so long that in some cases oncologists give patients appointments in the desperate knowledge that they will not live long enough to keep the appointments.
That is why today, in the wake of my friend’s experience, I do not hesitate to express my deeply held – and I fear rather bleak – belief that cancer care in this country is in a state of enormous crisis.
I do not write this lightly, and I understand that this may come as a shock to some of you who, understandably, cling to the idea that no matter how serious the well-documented crisis in our health care system may be, an exception will be made for offering cancer care.
This idea is supported by the glossy press releases issued almost weekly by NHS England, touting new developments in this area, all of which underline the feeling that patients are being prioritized and treated at an accelerated pace.
The NHS must also rely on the private sector, writes Professor Karol Sikora. That already happens when it comes to surgical procedures, so why not cancer?
In 2000, the government introduced the two-week waiting period for cancer treatment to clear a backlog. But last October, then health secretary Steve Barclay, pictured, announced he would scrap it as it was no longer sustainable.
Just two weeks ago it announced the rollout of a new form of immunotherapy for advanced endometrial cancer, which could offer women in advanced stages of the disease significantly additional time before the disease progresses, compared to standard chemotherapy alone.
I also particularly remember an announcement from April 2021 in which NHS England stated that it was ‘mandating’ faster diagnosis by March 2024, meaning that at least 75 per cent of patients would either receive a cancer diagnosis or be ruled out within four weeks after an urgent diagnosis. GP referral.
Well, it is now March 2024 and as my wife’s friend can testify, the reality is falling somewhat short of this goal. No wonder Britain has some of the worst cancer survival rates in the developed world, ranking just 28th out of 33 countries for five-year survival rates for common cancers such as those of the stomach and lung.
Our figures for pancreatic, liver and oesophageal cancer are slightly better at 26th, 21st and 16th respectively.
On average, only 16 percent of British patients live with these cancers for five years – despite the fact that we spend as much per head on cancer treatment as other developed countries.
Shocking, isn’t it? Shocking enough, you might think, to prompt in-depth scrutiny of NHS panjandrums about where exactly they are going wrong.
Far from it. As I discovered during repeated attempts to reform our cancer care system from within – failed attempts that would ultimately lead to my resigning from the NHS in 2004 – they maintain an almost militant refusal to admit that only fundamental reforms will solve problems. problem with cancer diagnosis and treatment.
Maybe they’re too busy worrying about meeting diversity goals and trumpeting their commitment to using the correct pronouns.
Their refusal to participate in a discussion is all the more frustrating because they have all the skills and technology they need. We have great medical staff, effective medication regimens, and ever-evolving treatments.
As I wrote in The Mail on Sunday this weekend, I have spent almost 50 years in the oncology field and have witnessed first-hand the extraordinary changes that have seen one-size-fits-all chemotherapy treatments replaced by tailor-made programs to fit individual diagnoses, aided by the exciting leaps we have made in DNA screening and risk prediction.
But this all adds up to a lot of beans when you have serious – and serial – delays in both diagnosis and treatment. Because delay means cancer will be in a more advanced stage when it is treated, and that in turn means outcomes will be worse.
It’s not rocket science, but the people in charge nevertheless seem unable to acknowledge this central truth, even when confronted with those grim five-year survival statistics.
As I set out in a five-point plan I presented to the Conservative government at their annual conference last October, the first thing that needs to happen is for the people responsible to recognize that change is needed.
Then they must use existing staff more efficiently and pay overtime to ensure that hospital parking lots are as full of cancer patients in the evenings and weekends as they are from nine to five Monday to Friday.
The same goes for GP practices as they are on the front lines of diagnosis and too many people wait a month for an appointment.
The NHS also needs to rely on the private sector: it already does that when it comes to surgical procedures, so why not cancer? I know of at least one network of private cancer clinics that is currently operating at just 30 percent capacity.
If this sounds like an overly ambitious transformation, consider this: over the past four years, this government has rolled out a massive nationwide Covid vaccination program almost overnight. It also oversaw the creation of a vaccine and a vast network of efficiently organized pop-up centres, backed by brilliant technology and supported by volunteers.
If they can do it for Covid, they can do it for cancer – it just takes commitment. Otherwise, I fear, the already grim statistics will only get worse.
Let’s not forget that the government introduced the concept of a two-week waiting period for cancer treatment in 2000 in an attempt to move cases through the system more quickly and reduce the backlog.
It was seen as an emergency measure that would no longer be necessary in 2005. Eighteen years later, in October last year, then Health Secretary Steve Barclay announced he would scrap the rule as it was no longer sustainable.
That alone tells us everything we need to know about the state of cancer care in modern Britain – and why nothing short of major reform is needed to ensure thousands of lives are not needlessly lost.
- Professor Karol Sikora is former Director of the WHO Cancer Program and Medical Director of Rutherford Cancer Centers