The announcement by Wes Streeting, Secretary of State for Health and Social Care for the UK, of his intension to re-introduce a National Cancer Plan1 offers real hope to get cancer back on track; it’s decidedly off-piste at the moment. The announcement also represents a significant victory for intelligence over opinion. On World Cancer Day 2022, Secretary of State at the time, Sajid Javed, bullishly announced a “war on cancer” and the development of a 10 year Cancer Plan.2 Yet within a year, this Plan had been inexplicably subsumed into a Major Conditions Strategy,3 a decision made in spite of evidence from the International Cancer Benchmarking Partnership (ICBP), a global initiative (which I am privileged to chair) which compares cancer survival and outcomes across the world.4 Our scientific evidence showed unequivocally that countries with consistent national cancer plans had better outcomes.5 We developed a cancer policy “scorecard”; regrettably, the four UK nations were at the bottom of this league table.5
Other data also supported reintroduction of a National Cancer Plan.4 Five year survival rates in lung and stomach cancer for example languish at 28th out of 33 comparable countries.6 A decade of unrivalled mismanagement is reflected in the startling fact that that the 62 day target from referral to treatment has not been achieved since 2015, a disgraceful legacy of a flawed strategy that valued opinion over evidence.7 From a UK cancer workforce perspective, there are 0.6 nuclear medicine physicians per million of population, a near 10 fold difference that severely compromises the UK’s ability to both diagnose and treat cancer effectively.8 Despite this compelling evidence, the previous administration made no move to reverse their decision.
Thankfully, we were invited to give evidence to the Health and Social Care Select Committee’s Future Cancer Inquiry at Westminster. Presenting to this cross-party committee, I was struck by the rising concern of the MPs (of every hue) as I built layer after layer of evidence that irrefutably copper-fastened the case for the need for a National Cancer Plan.9 The Committee acted on our evidence, their Number one priority being the reinstatement of a National Cancer Plan.10 It is this evidence that the Minister of State has used to justify the reversal of the previous administration’s ludicrous decision.1
Workforce is a significant issue; we are in staff retention freefall. The 2024 workforce census by the Royal College of Radiologists warns of an impending cancer workforce crisis, with a 15% and 30% shortfall in clinical oncologists and radiologists respectively.11 Workforce shortages are also more acute in areas such as the Midlands, (less than half as many consultant oncologists per 100,000 population as in London), highlighting geographical disparities in workforce provision.11 Northern Ireland is even more challenging, But this crisis will not be solved by simply employing more healthcare professionals. We must combine appropriate recruitment with digital transformation, deploying innovative technologies to address pertinent issues e.g. wastage, inappropriate use of health professionals’ time, need for rapid data intelligence. Approaches such as health digitization through the London Care Record highlight the pathway we must take.12
The overwhelming evidence also illuminates a way forward. Updating our equipment, bringing our workforce into line with other similar high-income countries and delivering digital transformation could prevent as many as 30,700 UK deaths from 11 common cancers by 2030,13 while also yielding a return of £17.30 per £1 invested, an economic benefit of £24.4 billion – improving our health can also yield large societal gains, as cancer survivors return to the workforce and play an active role in society. 13 If imaging modalities were also scaled up, a total of 68,400 deaths from the 11 common cancers could be prevented, with even larger financial benefits (£52.9 billion, a return on investment of £31.05 for every pound spent). 13 Truly, Your Health Can also be Your Wealth.
While I’m delighted that the current Secretary of State has listened to us and committed to a national cancer plan, the responses of his colleague Stephen Kinnock at a Westminister Hall Debate14 suggest that such a plan may be as much as a year away. This prompted us to team up with Radiotherapy UK at the Houses of Parliament in a campaign to deliver better treatment for cancer patients across the UK.
New analyses indicated that a decade of delays had left > 500,000 cancer patients waiting too long for treatment. For patients and their loved ones, this decade of delays has been devastating. While the Government have promised to produce a cancer plan, it must be “big, brave, and bold” and not a “tick box exercise.”15 The data do not lie – we’re lagging behind significantly in our efforts to beat cancer. We need the political will behind a supercharged cancer plan to save thousands of lives. At the turn of the century, Denmark lagged behind on cancer, as we are now, but an ambitious cancer strategy turned it around. We need to “do a Denmark.”
Sarah Quinlan CEO Radiotherapy UK, Bryan Robson OBE and Professor Mark Lawler QUB campaigning outside the Houses of Parliament
On World Cancer Day, I joined over 40 cancer charities, patients, and clinicians; and Radiotherapy UK patron, football legend and former England captain Bryan Robson OBE, to call for urgent action, meeting with over 100 MPs in a special session to highlight their concerns (amazing how many MPs will turn up when a celebrity is in the hallowed halls of Westminster! No matter, it was an unrivalled opportunity to present our case). Following the session in the Houses of Parliament, a delegation led by Bryan Robson OBE delivered a petition to Number 10 Downing Street, calling for urgent action.
Prof Lawler, Denise Robson, Bryan Robson, Sarah Quinlan and Pat Price delivering the petition at 10 Downing Street
After nearly a decade of deadly delays and systemic failure to treat cancer patients on time, this must be the turning point. A decade of decisive action must ensure that every patient gets the timely care they deserve. But we need to act quickly. We won’t wait, cancer patients can’t wait. We want to be leaders not laggers. 15
Let’s be big and bold and brave and deliver an effective national cancer plan we can all be proud of.
References
3. Wilson R, Kinloch E, Makaroff LE, Bailey-Bearfield A, Stephens R, Rawlinson J, Oliver K. A major conditions strategy cannot replace a national cancer plan-patient advocates voice their concerns. Lancet Oncol. 2023 May;24(5):425-427. doi: 10.1016/S1470-2045(23)00145-6.PMID: 37142368
4. Aggarwal A, Choudhury A, Fearnhead N, Kearns P, Kirby A, Lawler M, Quinlan S, Palmieri C, Roques T, Simcock R, Walter FM, Price P, Sullivan R. The future of cancer care in the UK-time for a radical and sustainable National Cancer Plan. Lancet Oncol. 2023 Nov 14:S1470-2045(23)00511-9. doi: 10.1016/S1470-2045(23)00511-9. Online ahead of print. PMID: 37977167
5. Nolte E, Morris M, Landon S, McKee M, Seguin M, Butler J, Lawler M.Exploring the link between cancer policies and cancer survival: a comparison of International Cancer Benchmarking Partnership countries. Lancet Oncol 2022; 23(11): e502-e514.
6. Less Survivable Cancers Taskforce. UK survival ranks among the worst in the world for deadliest cancers. 2024. https://ecancer.org/en/news/24058-uk-survival-ranks-among-the-worst-in-the-world-for-deadliest-cancers
7. Department of Health and Social Care. Independent investigation of the National Health System in England. https://assets.publishing.service.gov.uk/media/66f42ae630536cb92748271f/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England-Updated-25-September.pdf
8. Scott AM, Zeglis BM, Lapi SE, et al. Trends in nuclear medicine and the radiopharmaceutical sciences in oncology: workforce challenges and training in the age of theranostics. Lancet Oncol 2024; 25(6): e250-e259.
9. https://committees.parliament.uk/event/20227/formal-meeting-oral-evidence-session/
10. https://committees.parliament.uk/publications/45148/documents/223584/default/
11. The Royal College of Radiologists. The Clinical Radiology and Clinical Oncology Workforce Census 2023: Policy Briefing; 2024. https://www.rcr.ac.uk/media/vaslin4x/rcr-workforce-censuses-2023-policy-briefing.pdf
13. Ward ZJ, Scott AM, Hricak H, Atun R. Global costs, health benefits, and economic benefits of scaling up treatment and imaging modalities for survival of 11 cancers: a simulation-based analysis. Lancet Oncol 2021; 22(3): 341-350.
15. Lawler M, Aggarwal A, Gralow J, Sullivan R, Price P. The UK needs to be a leader, not a lagger, in the global cancer effort. Lancet Oncol 2024; S1470-2045(24)00448-0.