As anyone who has experienced cancer symptoms knows, the waiting time between referral and diagnosis, let alone treatment, is agonising and even more so when the promised timing slips. This is a scenario being experienced by more and more people as the NHS battles the post-pandemic backlog. Cancer Research UK’s August figures make depressing reading – all four key targets that show how well the NHS is performing in its treatment of cancer were missed in June. One stands out in particular: the target of 62 days within which 85% of patients are to be diagnosed and their treatment started, has not been met since 2015.
As the charity points out, any delay in testing, diagnosing, and treating cancer not only causes considerable anxiety for individuals but also potentially impacts on their eventual recovery. It is against this background that the government has announced its intention to reduce the number of targets from nine to three. The new targets aim either to diagnose – or rule out – suspected cancer within 28 days of referral. If cancer is diagnosed, treatment should be started within 62 days of referral and, as a minimum, within 31 days of the decision to treat being made.
Focus on outcomes, not targets
Following this announcement that cancer waiting targets were being simplified, Professor Pat Price, a leading oncologist, delivered a robust critique of the government’s failure to invest in the NHS’s cancer diagnostic and treatment capacity. She broadly welcomed the reduction in the number of targets but noted that without a corresponding investment in staff, technology and equipment, such targets were meaningless. Indeed, as she pointed out rather starkly, four in ten people do not meet the 62 day target and every four week delay in starting cancer treatment translates into a 10% increase in the death rate. She and her fellow interviewee on Radio 4’s Today Programme, Dr Tom Rokes, agreed that without the ability to treat patients more quickly and better, focusing on targets rather than outcomes would result in failure and ‘failure, however you measure it, is still failure’.
Research study backs calls for new approach
This emphasis on having access to better capacity and equipment, along with the importance of embracing a new approach to diagnosing cancer has been underlined by news of a recent study where a cohort of men aged between 50 and 75 were screened for prostate cancer using both MRI and PSA tests. It showed that the MRI screening indicated significant signs of cancer in 48 men, half of whom had had a low PSA test. The PSA test is notoriously unreliable - which is why there is no national screening programme for prostate cancer – so the discovery that MRI screening could be a more reliable route to diagnosis is a major breakthrough. But if further research indicates it should be rolled out nationally, considerable investment in a network of new, easily accessible MRI machines will be required in order to implement a fully functioning, effective screening programme.
Earlier diagnosis leads to better outcomes
It is well established fact that the earlier cancer is detected, the greater the chances of recovery – on the assumption that the right diagnosis is made in the first place and the correct treatment prescribed. There are many centres of excellence dealing with cancer referral, detection, and treatment around the country. However, the challenges of delivering a faster, better service to an increasing number of patients is exposing the cracks in the system. Unless there is considerable investment in staff, diagnostic testing equipment, and new treatment methodology, patients will continue to face a lottery when it comes to early cancer care: ‘changing targets will not address the systemic challenges that face cancer treatment and care’ (Cancer Research UK).
The pressure on the health system has been extraordinary and the threshold for determining whether or not cancer treatment has been negligent has shifted. Nonetheless, if you feel you have been let down by those treating your cancer, please call me for a confidential chat to see if we can help.