Cancer Survival Rates ? Better But ... We Still Lag Behind Other Countries

**UK still behind in cancer survival despite recent surge.

Big improvement in past two decades fails to close gap with likes of Australia and Canada.**


**_Cancer survival rates in the UK have improved markedly over recent decades but still lag behind those of comparable countries, a major research exercise has shown.

The study looked at one-year and five-year survival of cancer patients in Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK between 1995 and 2014. It found that while the chances of surviving cancer have improved in the UK, they have not caught up with other countries, which are also doing better thanks to new technologies and efforts to catch the disease at an earlier stage before it becomes hard to treat.

Better surgery, in particular, led to a rise in five-year survival rates for colon cancer in the UK from 48% to 62%. One-year survival for lung, ovarian and oesophageal cancer all increased by about 15 percentage points over the 20 years. However, the UK fared worst of the countries examined in four of the seven cancers measured by five-year survival rates: rectal, pancreatic, lung and stomach.
Australia’s high cancer survival rates attributed to earlier detection
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John Butler, a co-author of the study and clinical adviser to Cancer Research UK, said: “There isn’t one specific reason why survival in the UK has improved – it’s a combination of many different factors. Over the last 20 years we’ve seen improvements in cancer planning, development of national cancer strategies and the rollout of new diagnostic and treatment services.

“For lung, ovarian and oesophageal cancer in particular, survival has increased largely because the quality of surgery has radically improved, and more surgery is taking place than before. More people are being looked after by specialist teams, rather than surgeons who aren’t experts in that area.

“But while we’re still researching what can be done to close the survival gap between countries, we know continued investment in early diagnosis and cancer care plays a big part. Despite our changes we’ve made slower progress than others.”
Cancer Research UK, which helped fund the study known as the International Cancer Benchmarking Partnership, said more NHS cancer staff were needed if the UK was to catch up.

“More people than ever before are surviving cancer thanks to research and targeted improvements in care. But while we’re on the right track, the numbers show we can certainly do better,” said Sara Hiom, the charity’s director of early diagnosis.

“We will not see the necessary improvements in diagnosis and access to treatment unless we have enough of the right staff across our NHS. Cancer Research UK has been calling for staff shortages to be addressed because, quite simply, it will give people a better chance of surviving their cancer.

“If we are to achieve world-class cancer outcomes in the UK, then we need to see comparable investment in the NHS and the systems and innovations that support it. It’s never been a more crucial time for the government to put new money where it matters.”

The study, published in the Lancet Oncology journal, looked at 3.9 million cancer cases across the seven countries. The researchers say the variations between countries are probably mostly to do with how early the cancer is diagnosed, whether the patient receives prompt treatment and whether they have other health problems at the same time.
Australia, Norway and Canada generally had better survival rates than New Zealand, Denmark, Ireland and the UK.

In the most recent years with data available, between 2010 and 2014, Australia topped the five-year survival league table in five out of seven cancers – oesophageal (23.5%), stomach (32.8%), colon (70.8%), rectal (70.8%) and pancreatic (14.6%). In the latter two cancers, the UK had the lowest survival rates over five years, at 62.1% and 7.9%.

The UK was also last in lung cancer (14.7%), in which Canada did best (21.7%), and stomach cancer (20.8%). Ovarian cancer survival was highest in Norway (46.2%) and lowest in Ireland (36%).

The lead author, Dr Melina Arnold of the International Agency for Research on Cancer, said: “The improvements in cancer survival observed are likely a direct consequence of healthcare reforms and technological advances that enable earlier diagnosis, more effective and tailored treatment and better patient management.

“Improvements in surgical techniques and new guidelines including preoperative radiotherapy as well as better diagnosis and scanning, enabling better staging of cancers and selection for targeted therapies, have all improved patient outcomes.”

The trajectory over the two decades shows the UK improving but failing to catch other countries that are also improving. However, NHS England rejected the findings, claiming things have changed. “In the five years since the study’s research ends, cancer survival has actually hit a record high, thanks to improvements in NHS cancer services, including the introduction of revolutionary treatments like proton beam therapy and immunotherapy,” said a spokesperson.

“The NHS long-term plan will build on this progress by ramping up action to spot more cancers at the earliest possible stage when the chance of survival is higher, saving tens of thousands more lives every year.”_**

**UK cancer survival rates are too low – our priorities are all wrong.

Short-termism has hampered investment in equipment and staffing that could help the NHS keep people alive.** >


Cancer survival rates in the UK have long lagged behind those in other countries of comparable wealth and income levels. And an international study published this week shows that while the UK is making rapid progress, there’s still a big gap in the survival rates cancer patients can expect in Britain compared with countries such as Australia, Canada and Norway.

The good news is that the outlook for patients suffering from major forms of cancer has got much better. On an age standardised basis, fewer than half of patients with rectal cancer in the UK lived more than five years in 1995. By 2014, more than 60% did.

And we should take the bad news with a pinch of salt because comparing cancer survival across countries is so inherently difficult. There is a risk that some countries look as though their patients are more likely to live extra years just because they have started counting sooner.

But this isn’t an isolated finding: the UK performs consistently poorly in international studies, suggesting there is something very real to worry about. The gaps are not small: if people in the UK survived at the same rate as those in Austria or Canada, 20 in every 100 people with lung cancer would live for five years, instead of 13 in every 100. For some cancers, the international gap doesn’t even appear to be closing.

So why aren’t patients in the UK living as long, and what can we do about it ?

Attention often falls on the expensive and dramatic aspects of cancer treatment: proton beam machines and breakthrough medicines. Other explanations focus on the state-funded nature of the NHS – ignoring the fact that many of the better-performing countries use the same model.

Experts who have studied possible reasons for worse performance in the UK have concluded that it may have more to do with subtle everyday behaviours of doctors and patients that influence how fast diagnoses can be made. Studies have found British patients are more likely to be reluctant to come forward with symptoms than in countries that largely have better cancer survival rates.

Compared to people in Scandinavian countries, Australia and Canada, they were most likely to worry about wasting their doctor’s time. British GPs are also less likely to refer people to hospitals for further tests – and this is statistically linked to worse survival rates.

You can always blame the alleged culture of the “stiff upper lip”. But it is also not difficult to see why the NHS might incentivise doctors and patients to be constantly mindful of scarce resources. The NHS has fewer of nearly all types of staff than its counterparts overseas, relative to the number of patients. It also seems to have far fewer scanners than comparable countries we looked at in western Europe, the Anglosphere and the G7 – around seven MRI machines per million people, compared to an average of almost 20. It has a low number of hospital beds as well.

The recent NHS long-term plan includes a battery of measures to improve cancer survival. It emphasises earlier diagnosis, and specifically aims to “lower the threshold of referral” so that symptoms are investigated more readily. A review of screening is monitoring how well current programmes work and what the future should be. These are in line with where the problems appear to be.

But we should also reflect on the deeper reasons we ended up here. The NHS has often suffered from short-termism, with low levels of investment compared to its peers. Last year Theresa May announced an extra £20.5bn for the day-to-day running of the service. But there was nothing extra for the budget that funds investment and equipment, which has been raided repeatedly in recent years.

Although the government has since pledged to put more money in, we at the Nuffield Trust have warned that much of this is just allowing trusts to spend money they already have – which they need for repairs after years of austerity, leaving little to spend on new projects. The budget for staff training has also suffered, and seen only partial relief, despite spiralling shortages of both nurses and the radiographers who scan people for cancer.

Politicians in the UK tend to talk a great deal about NHS waiting times – which actually seem to be fairly average compared to other countries. Our performance in keeping people alive, which has some serious shortcomings, often takes second place.

This week’s study shows rapid improvements in cancer care are possible, and the NHS is capable of making them. But we need to take a long, hard look at our priorities if we want to improve quickly enough to close the gap with other countries, and give British cancer patients a chance as good as any.

• Mark Dayan is a policy analyst at the Nuffield Trust

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