Only together can we beat cancer

The government’s latest strategy to improve cancer treatment in the UK is welcome, but extra funding alone is not the answer. Greater collaboration is the key to winning the war.

UK cancer survival rates have doubled over the past five decades. For the first time, those developing cancer stand more of a chance of surviving for 10 years or more than they do of getting the disease in the first place.

‘Cancer survival rates in the UK lag behind those achieved by many of our European cousins by more than two decades’

Despite this, cancer survival rates in the UK lag behind those achieved by many of our European cousins by more than two decades. The fight to close this gap, while continuing to improve patient outcomes, is one of the most profound facing our health service.

Future challenges

The problem is compounded by challenges on the road ahead. A growing population of older people, combined with improving patient outcomes for other conditions, mean there is greater demand for NHS oncology resources and palliative care.

Another issue is presented by the future of cancer treatment itself. Advances in medical technology and an increasingly sophisticated understanding of genetics is leading to a greater shift towards personalised medicine. Although highly effective, these treatments escalate per patient costs significantly.

All of these factors conspire to make the NHS’s war on cancer increasingly complex and challenging. They also serve to put a heightened strain on already limited budgetary resources.

The £2bn strategy announced on 19 July, and set out in the independent cancer taskforce’s report, Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020, is a welcome contribution to improving cancer outcomes. It is correct to identify earlier diagnosis and improved radiotherapy services as vital components in this process. But the solution is more complex than increased public sector financing alone.

Learn from the best

The UK has a per capita public health expenditure rate of $2,802 adjusted for purchasing power parity, above the average for the developed world of $2,536, including countries such as Australia ($2,614) and Finland ($2,583). Despite this, both mortality and five-year relative survival rates for a range of common cancers – including breast and cervical cancers – are below those of most developed countries.

‘If it is to win its own conquest against cancer, the NHS must adapt and deliver more for less’

If it is to win its own conquest against cancer, and address the struggle against healthcare injustice, the NHS must adapt and deliver more for less. It must learn from other health systems around the world, in particular about the ability to collaborate with other organisations to help carry the heavy load of patient care.

Although non-NHS providers currently account for around 9 per cent of the acute or hospital care budget, this still comes nowhere near the level of provider plurality observed in many European systems. In Germany the voluntary sector accounts for more than a third of all hospital beds, while the private sector accounts for almost a fifth. In France, the private sector accounts for 38 per cent of all hospital beds, while in Austria the figure is 30 per cent.

Procurement problems

Harpal Kumar, chief executive of Cancer Research UK and chair of the independent cancer taskforce, says: “The vast majority of patients who are cured of their cancer are cured because of surgery or radiotherapy.”

‘The current system of procurement precludes the NHS from taking full advantage of the latest cutting edge treatments’

Despite the vital importance of radiotherapy – and the report’s welcome commitment to improving existing services – the current system of procurement precludes the NHS from taking full advantage of the latest cutting edge treatments.

This is highlighted in the NHS’s provision of proton beam therapy – a high cost, advanced form of radiotherapy that targets tumours with greater precision than other radiotherapy based treatments.

In 2010, the coalition government announced its intention to build two new proton therapy centres at a cost of £250m.However, given the nature of this therapy – cutting edge but capital intensive – combined with the drawn out nature of the NHS’ procurement process, the health service has now found itself committed to purchasing a first-generation technology that has already been superseded by developments in the private sector, before the machines have even been built.

Consequently, the health department is facing the prospect of a £250m bill for two outdated, oversized, inferior proton therapy centres, which one cancer expert has described as “concrete mausoleums”.

A way forward

For treatments such as proton therapy, rather than procuring the treatment technology for use in house and taking responsibility for the ongoing maintenance and service costs, the health department could make greater use of subcontracting arrangements with the private sector, whereby external providers are responsible for establishing, operating and maintaining clinical centres.

‘The health department could make greater use of subcontracting arrangements with the private sector’

This revised approach will afford the NHS the ability to adapt more quickly to the advent of new cutting edge forms of treatment – a key requirement in the struggle ahead.

It is essential all organisations, public or private, with a vested interest in conquering this devastating disease work together. Victory in the war on cancer and the levelling of existing healthcare imbalances is possible, but not if we continue to fight alone.

Sanjeev Pandya is chief executive of Advanced Oncotherapy