Concerns over big variations in cancer care

Cancer treatment has improved significantly but major variations remain in NHS care depending on where people live, a report concludes today.

The National Audit Office says further improvements could be made, at the same time as making cost savings worth hundreds of millions of pounds, by better use of information about the disease.

Primary care trusts (PCTs), which pay for services, had "poor understanding" of costs and outcomes which meant they did not know if they were commissioning care which was best for patients.

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Its study found emergency hospital admissions of cancer patients had doubled in almost a decade to 300,000 in 2008-9. But it said there was little understanding of the reasons behind the rise.

Research shows survival rates among cancer patients diagnosed with cancer following an emergency hospital admission are about half of those for people urgently referred by their GP.

Around 80 per cent of people admitted as an emergency have a pre-existing cancer diagnosis, while 20 per cent are diagnosed with the disease during their hospital stay.

Today's report finds wide variations in how many cancer patients are admitted as emergencies depending on where people live but a third of PCTs had never compared their levels with others.

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It also reveals spending on cancer by the NHS was around 6.3 billion in 2008-9 – almost double the total five years earlier – but the Department of Health had "limited assurance" over whether the 2007 cancer reform strategy to build on previous improvements in care was achieving value for money. Costs per head of treatment varied three fold between 55 per head in some areas to 154 per head in others.

The chief executive of Macmillan Cancer Support, Ciaran Devane, said: "English cancer services have improved but there is still an incredibly long way to go for the country to be a world leader.

"The NHS won't be able to support the growing number of cancer patients unless it seriously ups its game. The whole NHS needs to realise that cancer is a long-term condition for many.

"If the NHS does not provide appropriate services after patients leave hospital, they can expect to see a massive increase in costs as cancer patients are forced to use emergency services.

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"Abandoning cancer patients after treatment is no longer acceptable, nor does it make any financial sense."

The report said there had been "high levels of achievement" against waiting time targets for cancer treatment and reductions in time patients spent in hospital.

But it pointed to "substantial scope to make further improvements by tackling variations and raising performance to the standard of the best".

Tory MP Richard Bacon, a member of the Commons Public Accounts Committee, said information on the stage of cancer diagnosis and the costs of chemotherapy and radiotherapy were incomplete.

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"Until we have a clear idea of the costs of cancer services, it is difficult to improve services to patients or explain fully the reasons behind these variations," he said.

250,000 people a year fall victim

More than 250,000 people a year are diagnosed with cancer in England.

Around half will die from the disease.

About one in three people will develop the illness during their lifetime and it accounts for one in four of all deaths.

There are an estimated 1.7 million cancer survivors, many with long-term needs caused by the disease and its treatment, but survival varies depend on the type of cancer, treatment and the stage at which it is diagnosed.

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There are 200 different types of cancer, but breast, lung, colorectal and prostate cancer account for more than half of all new cases.

Three quarters of cases are diagnosed in people over 60 but it is the most common cause of death in people under 60.

Numbers of new cases are expected to reach 300,000 by 2020.