Cancer Treatment ? New Record For Length Of Time To Wait ! Sector News And Reports

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https://www.theguardian.com/society/201 ... -standards

NHS cancer treatment wait statistics " Set to be worst on record "

Lowest percentage of patients treated since new standards introduced, figures show.
The NHS is on course for its worst annual cancer waiting statistics on record, official figures suggest.

In eight out of nine published cancer targets, between April and September, the health service treated the lowest or joint lowest percentage of patients since operation standards were introduced, according to official figures published on Thursday.

They show that with half of the year gone, 133,843 cancer patients have not been treated within the relevant standards.

The figure amounts to 77% of the number of patients treated outside the standard in the previous 12 months, and is greater than the total in each of the first three years that all nine standards – introduced in 2012/13 – were in operation.


Dr Fran Woodard, the executive director of policy and impact at Macmillan Cancer Support, said: “These figures are further evidence of a worrying trend which demonstrates that the pressure on cancer services is truly beginning to bite. We must not forget that at the heart of these figures are thousands of cancer patients anxiously waiting for referral for diagnosis or to start treatment.

“It is imperative the government now seizes the once-in-a-generation opportunity to address the challenges facing the workforce in the NHS long-term plan. We cannot expect world-class cancer care for patients in the future without enough staff with the right skills to deliver it.”

From July to September, the percentage of patients who went into surgery within a month of a decision to treat fell to 93.5%, meaning 897 were not operated on within 31 days, the first quarter in which the 94% operational standard was not met.

Last month, 78.2% of patients started treatment within two months of being urgently referred by their GP with suspected cancer, against the target of 85%. This was the 33rd month in a row in which the target was breached. In the second quarter of the year, 8,836 patients (78.6%) did not start treatment with two months of an urgent GP referral, according to the figures.

Since the target was first breached in January 2014, more than 118,000 people have waited more than two months for treatment to start.

The latest NHS figures also show there were 48,650 patients waiting at least four hours for a hospital bed after being admitted in an emergency last month, and of these, 212 were waiting at least 12 hours, more than three times the number a year ago. In October last year, 45,500 had “trolley waits” of at least four hours, and 57 waited at least 12 hours.


The British Medical Association said the latest A&E figures “should ring alarm bells for the NHS and government as we approach winter”.
It's loads cheaper NOT to treat cancer patients.

That way they die sooner, and so cost the NHS far less.

Dead patients are the cheapest of all!

You know it makes sense.
The sooner part I can vouch for.

In my late fathers case not having it diagnosed until the point its actually become untreatable/terminal
GP's were useless when it came to referrals and by the time hospital specialist actually got around to taking the symptoms seriously (to where I was practically begging them to do something) it was terminal/untreatable because of how quick/aggressive it was.

He was gone in under a month (not the 3-6 they said) because of complications i.e. lung cavity, pneumonia and multiple infections on the side, immune system basically couldn't cope with it all and shut down.. and we're not talking about an old person either, this was a 60 plus healthy bloke built like a brick house eaten away by the disease to nothing.

Not to mention coming onto the ward a few days before the end to find out from him the catheter had been put on incorrectly, some idiot member of staff decided because the shower facility was broken it was a good idea to chuck buckets of water over them instead... in WINTER and I'm not talking warm water either.

My role model growing up, a friend and honestly a wonderful person who could not do enough for others.
Nobody deserves to die in such a horrible undignified way like a prisoner in that place (they stalled on us getting him back home or to a palliative respite centre, wouldn't relent until he became end of life and could no longer be moved).
Treated worse than an animal. Couldn't even get the body back for a month.

Its 2018, and thanks to medical science advances most forms of cancer have not been a death sentence for a long time with the proper support and treatment but if a person of strong constitution is aloud to go this way what chance does the average person have. Its a disgusting condemnation of the state our health service has fallen into in recent years and is only getting worse.

Whole system from the ground roots (screening) to front line (diagnosis) to treatment (hospital) and after care needs revitalisation. In my heart of hearts I feel utter dread because I just know this isn't a one off, and many poor souls have had to undergo the same and probably much worse treatment on their journey.

Best put myself back in my box, as you likely deduced it was a bad experience for the family and not easily forgotten.

/rant
Early diagnosis is essential.

We do have to beware of 'lead time bias' though - for example, if someone has cancer, and it is diagnosed early (in 2013), and they are treated, and then they finally die, say, five years later, in 2108, (it comes back and kills them), that MIGHT not be any longer than if they had NOT been diagnosed as far back as 2013, but only when they were terminal in 2018.....

But, 'that apart', obviously if early diagnosis leads to early intervention leads to removal or massive reduction in the amount of cancer in the body, and then the body CAN 'last longer overall', then 'more life' has been gained for the patient, than if the diagnosis were NOT early.

The grim truth, however, is that most cancer, by the time it produces symptoms that we can go to the doctor about, is ALREADY 'relatively advanced', and actually does little to improve overall longevity.

Studies with patients reporting a persistent cough who went to the doctor, and got an X-ray and then treatment, and those who did have lung cancer, did no better than those who didn't have an X-ray and treatment. ie, by the time they were coughing, the cancer was already 'in charge'.....

The REAL key is effective screening, to spot VERY early cancer, that is asymptomatic (ie, no sign whatsoever you've got it).

However, we only screen for Cervical, Breast and Bowel, and screening for Prostate is 'optional' (it can be requested from our GPs).

Screening is always controversial for two reasons - firstly because it may not be sufficiently accurate 'at all' (ie, producing false negatives and false positive) and because, especially for Breast cancer, it can reveal tumours which are never going to be invasive (DCIS - ductal carcinoma in situ). BUT, we dont' yet have the adequate medical means to distincguish, realibly, which screening-revealed early tumours are 'harmless' and which 'invasive'.

It can be similarly hard to tell from the prostate screening test (PSA levels) whether that is indicative of dangerous cancer or not.....

Attitudes to screening in general are HIGHLY controversial and disparate. The 'anti-screening' lobby prates on about 'unnecessary stress and anxiety' and 'over-treatment' for DCIS etc.

The 'pro-screening' lobby tends to be folk like me, widowed by a horrendously late-diagnosed cancer in my husband. I'd far rather have an 'unnecessary' operation (eg, for DCIS) than risk NOT having a 'necessary' operation (eg, for aggressive breast cancer).

To me, the key is to provide the full and accurate information to patients, who then decide FOR THEMSELVES whether they want to take a risk (ie, assume there IS no risk!) or NOT take a risk (ie, assume there IS a risk)

No doctor should make that decision for them. It is not the doctor who will die if the 'wrong' decision is made.....
From the perspective of Health Economics....in fact it is LOADS cheaper for the NHS to pursue 'mass screening' (of ALL cancers - through body scans, blood tests - lots of 'new markers' being uncovered all the time in the labs!), as treatment for very EARLY cancer is WAY cheaper than for late cancer.

However, whether it is cheaper than the option at the far end of the spectrum - ie, not diagnosing AT ALL (diagnose when dying!) - I don't know.

It is certainly cheaper pursuing VERY early diagnosis than the 'mid-term diagnosis' that most cancer patients get.
Quite a bit in today's media about the league table across developed countries with the UK continuing to underperform.
Cancer care : England still lagging behind the best.

England has failed to close the gap on the best-performing nations when it comes to cancer care despite 20 years of trying, analysis suggests.

The review by the Health Foundation of the government's record between 1995 and 2015 said that despite four strategies setting ambitious goals, the NHS was still lagging behind the best.

It said if services were improved, 10,000 lives could be saved each year.

Ensuring earlier diagnosis was key, it said.

Prof Sir Mike Richards, a former government cancer tsar who led the review, warned patients were finding it too difficult to get access to the tests and scans.

"Although progress has been made, the aims of all these strategies have not been achieved."


Earlier diagnosis the theme of this article :

More tests key to raising English cancer survival rates – charity.

Earlier diagnosis is essential, either by GPs or referrals to hospital, report says.


Many more people who go to see their GP with possible cancer symptoms need to be sent for hospital tests if England is to have a hope of bringing survival rates up to the level of equivalent countries, according to a report.

The report by a team from the Health Foundation led by the former national cancer director Sir Mike Richards calls for a radical rethink of the way the NHS deals with the disease.

Crucially, much earlier diagnosis of cancer is essential if fewer people are to die from it, the report says. Either GPs need to be trained and supplied with technology to carry out more tests themselves or their “gatekeeper” role – deciding who will be referred to hospital – may have to be bypassed, it says.

Richards, who spent 14 years as the government’s cancer director before moving to oversee hospital inspection at the Care Quality Commission, said GPs needed support.

“I’m a strong believer in GPs and primary care. It’s a key component of our health service and I don’t want to see anything that undermines that. GPs are under pressure not to refer people on to secondary care. That’s what we have got to change.”

“One-stop shops” dedicated to diagnosing cancer, equipped with all the necessary technology and offering a battery of tests, could offer a solution, he said.

There has been progress over the years since Richards introduced England’s first cancer plan in 2000, but a promise that by 2010 “our five-year survival rates for cancer will compare with the best in Europe” was not met.

More people survive for longer in England, but other countries have also improved. Survival data from the recent Concord-3 study showed the UK as a whole lagging behind Australia, Denmark, Norway and Sweden in six common cancers. It came last in all but prostate cancer, where it was second to last after Denmark. A person diagnosed with colon cancer in the UK had a 60% chance of surviving for five years, compared with 71% in Australia, for instance.

The report identifies early diagnosis as key to changing this. In breast cancer, 97.5% of women referred urgently by their GP (to be seen within two weeks) between 2011 and 2015 survived for 12 months, but only 57.2% of those who arrived as an emergency in hospital did so. The latter patients inevitably had cancers that had progressed further and were harder to treat.

The same sort of split applied in colorectal cancer: 83.1% survival when referred by a GP versus 50.6% of those who went to A&E. In lung cancer the figures were 46.5% versus 16%.

Almost 2 million people a year are now referred by their GP to be seen for diagnosis within two weeks, and 8% of those are found to have cancer. Not all those referred are being seen as quickly as they should be. There was a sharp drop this year below the 93% standard, although Richards said this was probably because of a surge in people going to their GP with suspected cancer.

“It is particularly down to referrals for possible prostate cancer increasing – almost certainly in response to the Bill Turnbull and Stephen Fry effect,” Richards said, referring to diagnoses in the former BBC Breakfast presenter and the former QI host. There was a similar rise in young women going for cervical cancer screening after the death of Jade Goody from cancer in 2009.

The report says hospitals are not investing sufficiently in diagnostic equipment such as CT scanners and MRI machines and the staff to operate them. “We have never found the right incentives to get hospitals to invest in them,” said Richards. The UK is 35th out of 37 countries in the report for numbers of CT scanners and 31st out of 36 for MRI scanners.

The report also says changes initiated by the former health secretary Andrew Lansley affected progress in cancer care. The “disruption caused by the Health and Social Care Act 2012 led to a loss of momentum that is only recently being rebuilt”, it says.

Richards said Theresa May had set an “ambitious” target to increase early cancer detection from 50% to 75% of patients by 2028. He welcomed that but added: “If we are serious about moving the dial on early diagnosis, then setting targets and handing out money will not be enough.”

Andrew Goddard, the president of the Royal College of Physicians, said there were growing pressures on hospital doctors, and immigration restrictions were making recruitment harder, but the entire NHS workforce had to do more and patients should be encouraged to come forward.

“Diagnosing cancers earlier will reduce pressure on acute services and new technology could help with offering screening, but it is essential too that we create a culture of patients not being embarrassed, inhibited by ‘social duty’ or afraid to seek help for their symptoms,” he said.