Cancer Drugs Fund contribution to survival rates "very limited"
Intense focus in the media on access to new cancer drugs belies the fact that it is likely to have little outcome on England's cancer survival rates, suggests a new review of international research.
The King's Fund's report ("How to improve cancer survival") states that the contribution of the Government's Cancer Drugs Fund - designed to improve access to drugs not yet approved for use on the NHS - to improved survival rates will be "very limited".
Improving access to surgery and radiotherapy - treatments which receive far less media attention - is more likely to help to close the gap with the outcomes achieved in other countries, the thinktank reports.
Although cancer survival rates in England are improving overall, they vary between tumour types and remain lower than in many other countries including Canada, Australia, Sweden and Norway. Although the gap is closing for breast cancer, it has not narrowed for colorectal and ovarian cancer and has widened for lung cancer.
Although a recent report for the Department of Health found that the UK’s uptake of some cancer drugs was low in comparison to other countries, evidence from clinical trials suggests access to drugs is "unlikely to be sufficient to explain the observed international survival differences".
The King's Fund review suggests that most likely factors that might improve survival are diagnosis at an early stage, access to the best treatment and improvements in the management of older people.
Studies have shown that there is significant variation across England in the number of cancer patients receiving surgery and radiotherapy, and in the use of the most up-to-date techniques. The most recent National Lung Cancer Audit found the rate of surgery was four times higher in some parts of the country than others. There is also international variation in the use of surgery, which appears to be linked to differences in survival.
Access to radiotherapy is also highlighted in the report, which notes that, in 2005, just 38.2% of patients were treated with radiotherapy, despite evidence suggesting that the optimal rate is around 52%. The NHS is currently expanding radiotherapy capacity and the use of complex radiotherapy treatments currently used in the private sector.
While England has high quality national screening programmes (for breast, bowel and cervical cancers) there is "strong" evidence that patients in England are diagnosed with more advanced cancers than in other countries and experience delays in accessing care. This is likely to be the result of a number of factors including the time patients wait before presenting symptoms to their GP and GPs' ability to identify cancer when it is presented. The King's Fund has warned that the increasing financial pressure on the NHS has led some NHS managers to issue blank instructions to GPs to make fewer referrals to consultants, efforts which "risk damaging attempts to diagnose more cancers at an earlier stage".
The King's Fund report also highlights research which suggests that older patients are under-treated and that people from deprived groups experience poorer access to treatment.