Cancer Care Report Card: Grading the UK's Performance

Cancer remains one of the top health challenges facing the UK, with over 165,000 cancer deaths annually. The NHS aims to provide timely, high-quality cancer care, but how does our performance stack up? In this edition, we'll review the data on UK cancer care quality and survivorship compared to other nations, along with steps we can take to improve outcomes.

Cancer Care Performance

The latest NHS England cancer waiting time statistics for May 2023 show:

• 80.8% of people were seen by a specialist within two weeks of an urgent GP referral for suspected cancer. (This figure was 91.5% pre-pandemic)

• 90.3% of people treated began first definitive treatment within 31 days of receiving their diagnosis, all cancers. (The equivalent figure was 96.2% pre-pandemic)

• 58.7% of people treated began first definitive treatment within 62 days of an urgent GP referral for suspected cancer, all cancers. (This was 79.7% pre-pandemic)

• Patients waiting over 62 days rose by 19%, representing an additional 26,000 patients

UK Cancer Survival Rates vs Other Countries

With Cancer performance data showing a worsening picture, how does this translate to cancer outcomes in the UK and how do we compare internationally?

According to NHS England the worst performing tumour sites in terms of one-year survival rates are:

Pancreatic Cancer one-year survival rates are only 23%. It also has the lowest five-year survival rate at only 7.7%.

The one-year survival rate for lung is 40% with a five-year survival rate of just 16.3%.

For Oesophageal cancer, one-year survival rates are 43% and five-year 20.8%

With Brain cancer, one year rates are 47% and five year just 19.6%.

When looking internationally, the UK does not benchmark well. Based on 2020-2023 data, the UK lags behind other European nations:

• 5-year breast cancer survival: 88% UK vs 91%+ in Italy, France, Germany

• 5-year colon cancer survival: 62% UK vs 72% Australia, 71% Canada

• 5-year lung cancer survival: 15% UK vs 22% Canada, 24% France

• The UK also trails on early diagnosis, with only 60% of cases caught early compared to 90% in Canada.

Regional Variations in UK Cancer Outcomes

The picture gets worse when you look at the variation in outcomes regionally with England. The variation is both significant and troubling:

• One-year breast cancer survival is 5% lower in the North East compared to London. Factors like later stage diagnosis and treatment delays contribute.

• Lung cancer survival rates are 7% higher in the South West versus the North East. This correlates with higher smoking rates but poorer access to early interventions in the North East.

• Men in the North East have 30% higher prostate cancer mortality than in the South East. This stems from lower PSA testing rates resulting in fewer early stage diagnoses.

• Pancreatic cancer mortality is 13% higher in the North East versus South West, linked to higher smoking prevalence and lower specialised staffing.

• Patients in Manchester have a 17% higher chance of dying from colorectal cancer within 5 years than in Guildford. Screening program differences are a key driver.

These disparities result from uneven distribution of specialist staff shortages, diagnostic equipment limitations, and discrepancies in public health prevention efforts across UK regions.

A parliamentary report in 2022 called these variations “unacceptable” and demanded specific actions to redress them including:

• Expanding screening programmes, prioritising improved access in underserved areas like the North East.

• Focusing recruitment and retention efforts on regions with the biggest cancer care workforce shortfalls.

• First targeting radiotherapy machine replacements in Northern regions where equipment is oldest.

• Funding smoking cessation and lung cancer screening initiatives specifically for higher risk populations.

• Directing research funding to innovations tailored to regional cancer profiles.

Cancer Workforce Shortages

There is undoubtedly workforce challenges within the cancer pathway generally, however there are some very specific challenges when assessed regionally:

• Oncologists - Shortfall estimated at over 400 across the UK. Severe deficits in the East of England and South West regions.

• Histopathologists - National shortage of over 250. Major gaps in London and South East driving diagnosis delays.

• Radiologists - England alone facing a shortfall of over 1,000 radiologists, with worst impacts in Midlands, East and South West.

• Specialist cancer nurses - Estimated total shortfall of 2,500 in the UK. Needs growing significantly with aging population.

• Oncology pharmacists - Only ~150 in the UK versus over 300 required to meet medication management demand.

Whilst undoubtedly these shortages will play a role, it remains very difficult to explain such a dramatic reduction in performance on these shortages alone. According to NHS England, cancer activity accounts for just 6% of total NHS activity in England. To put it another way, the NHS has a lot more capacity that it could use to improve cancer performance than it currently does. But what other factors could be affecting the deterioration in cancer performance?

In a previous post, we highlighted a more general issue with elective care waiting lists that we believe is heavily impacting cancer as well. Administrative and managerial workforce shortages play a huge role in the capacity to track patients which has definitely deteriorated over the period. Common tracking reasons for delays on cancer pathways include:

• Delayed referrals from primary care to specialists when cancer symptoms are present.

• Imaging delays due to long wait times for key scans like CT, MRI.

• Lag between test ordering and scheduling due to coordination failures.

• Pathology backlogs and analysing biopsy results.

• Multidisciplinary care coordination issues between various specialists.

• Treatment planning delays between diagnosis and development of optimal treatment regimen.

• Administrative delays from scheduling lags, lost paperwork, unclear accountabilities.

• Antiquated patient tracking systems that fail to utilise workflow optimisation and analytics to minimise delays.

Correcting these administrative challenges would go a long way to improving cancer performance statistics relatively quickly and should be thought of nationally as a “quick-win”.

In addition to clinical staff shortages and administrative improvements there are further operational actions that could be taken swiftly to improve the position. These actions have been done before and have been proven internationally to improve outcomes.

Proven Operational Solutions

Key proven operations solutions include:

• Rapid diagnostic centres for accelerated one-stop testing to reduce time to diagnosis. One-stop appointments are very common in some tumour site pathways e.g., Breast. However these have not been rolled out consistently across pathways that would benefit significantly.

• Stratified follow-up pathways so low-risk patients require fewer face-to-face appointments, freeing up resources.

• Clinical prioritisation systems using algorithms to expedite urgent cancer cases automatically.

• Optimisation of multidisciplinary team coordination for streamlined, integrated cancer care.

• Increasing nurse-led clinics and Telehealth to improve efficiency of routine cancer care delivery.

• Patient tracking systems using workflow optimisation analytics to minimise delays.

• AI tools for improved screening, diagnosis, treatment decisions and patient monitoring.

The Role of Technology

Another often overlooked problem with cancer tracking is the design of electronic health record (EHR) systems, which can significantly impact clinician workflows and documentation burdens. Poor EHR system design is a major factor currently driving clinician burnout and inadequate tracking of patients:

• Clunky interfaces - Hard to navigate systems, tiny fonts, complex menu trees make documentation tedious and time-consuming.

• Information overload - Showing all fields/templates, even irrelevant ones, creates cognitive strain for providers.

• Alert fatigue - Too many pop-up alerts on screen makes clinicians ignore them entirely.

• Fragmented views - Data silos within the EHR require switching between interfaces, disrupting care.

• Auto-populated fields - Copy-pasted or inaccurate information clutters the record.

• Inflexible templates - Rigid structured data entry doesn't match clinical decision-making needs.

• Duplicative documentation - Recording the same data in multiple fields for compliance.

• Usability issues - Small buttons, unclear icons, tiny text boxes increase errors.

Improving EHR usability with user-centered design principles is critical. Optimised interfaces, contextual information displays, speech recognition, and natural language processing can reduce the documentation burden substantially. Smart EHR design alleviates clinician pain points so they can focus on delivering patient care.

In order to address these challenges healthcare leaders need to focus on streamlining IT workflows as a priority.

There are several promising technologies that healthcare leaders should deploy immediately:

• Automated data validation tools built into systems that check for completeness, accuracy, and consistency as data is entered in real time. This prevents bad data from the start.

• Natural language processing and clinical text analytics tools that can extract structured data from unstructured physician notes and documentation to eliminate manual data entry.

• Patient engagement apps and wearable devices that collect patient-generated health data and integrate it with provider systems for more holistic records.

• Predictive analytics and risk stratification tools that help identify high-risk patients for proactive care based on more reliable data profiles.

• Machine learning techniques like data imputation that can intelligently fill in missing data points in records to complete the view.

• Improved interoperability and common data models like FHIR that enable seamless health data sharing across platforms.

• Stronger data governance frameworks and data quality rules enforced systemwide.

With the right technology investments and data governance, healthcare organisations can tap into cleaner, more complete data assets to inform and improve care.

Summary

Cancer performance in England is a national stain on the leadership of the NHS. The recent Healthwatch Report highlights how administrative processes are a significant factor in outcomes. This is unforgivable.

Undoubtedly staffing shortages in key positions within specific regions are having an impact. However, these shortages fail to explain the 20% reduction in performance in the last 5 years.

Proven strategies to improve performance coupled with enhanced administrative support to track patients and use of increasingly time-saving technology should be a key focus of policy makers in the short term, whilst longer term clinical shortages are addressed.