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CancerFeb 15, 2023

Experts call for separate cancer plan and warn against having a single strategy for major conditions

A long-term plan for cancer services is more vital than ever after more than a decade of declining funding has been compounded by the Covid-19 pandemic, according to an article published in The BMJ today (16 February).

In their editorial, Richard Sullivan, who is based at the Institute of Cancer Policy, King’s College London, and Ajay Aggarwal, from the London School of Hygiene & Tropical Medicine, outline what the plan should cover.

They argue it must deal with the post-pandemic realities of backlogs for care – sicker patients are exhibiting more advanced cancers and there are huge deficits in the workforce that is dedicated to treating cancer.

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Plan to subsume cancer into wider 'disease agenda' shows it is seen as a low priority

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Quality of care is patchy

Professor Sullivan and Dr Aggarwal note that national cancer audits in England and Wales report wide variations in access to the most effective cancer treatments and in the quality of the care provided.

These quality gaps ‘reflect systemic and structural problems across multiple and complex cancer pathways that can only be tackled by an evidence driven dedicated cancer control plan’, they argue.

It is crucial to consider the ‘key determinants of cancer outcomes’ such as workforce issues, infrastructure, quality assurance and health service delivery’, they note.

A single strategy covering all the major conditions – including cancer and MSK – will 'cost lives'


[The decision to have a single strategy] ‘jettisons decades of global consensus that, to deliver affordable, equitable and high quality cancer care, dedicated cancer plans are required [Richard Sullivan and Ajay Aggarwal]

The two experts also criticise a UK government proposal to roll England’s long-term plan for cancer into a single strategy covering all major conditions, such as musculoskeletal disorders. They describe the move as a ‘catastrophic decision that will cost lives’.

Under the proposal, other conditions will include cardiovascular disease, chronic respiratory disease, dementia and mental health, the authors note. The decision ‘jettisons decades of global consensus that, to deliver affordable, equitable and high quality cancer care, dedicated cancer plans are required’.

Bucking international benchmarks

Professor Sullivan and Dr Aggarwal argue that the current plan to subsume England’s long-term plan for cancer into a generic chronic disease strategy ‘is totally inconsistent with internationally accepted benchmarks set by the World Health Organization and followed by all other member states’.

While acknowledging the need to strengthen primary and social care, along with ensuring parity of attention to other chronic diseases, they suggest that subsuming cancer into an overall non-communicable disease agenda ‘simply signals that cancer is no longer a political priority or reflects a government not willing to deal with its complexity and escalating costs’.

Cancer is the single largest cause of death in the UK and delivering effective and equitable care is achievable through the proper coordination of an extensive array of interlocking cancer specific pathways, Professor Sullivan and Dr Aggarwal write.

The NHS in England has 60 radiation therapy centres, 50 prostate cancer surgery centres, 163 bowel cancer centres, and 176 chemotherapy units, while specialised diagnostics are only available at selected hospitals.

The strategic direction and coordination of all these services requires both a cancer specific plan and an array of operational tools to deal with issues of centralisation and variation in practice to avoid inequalities in access and outcomes, they explain. Cancer is also extremely costly for health systems, patients, and wider society, Professor Sullivan and Dr Aggarwal add.

To read the full version of the editorial – titled Proposal to scrap England’s long term plan for cancer doi: 10.1136/ bmj.p326 – visit: https://www.bmj.com/content/380/bmj.p326

Author: Ian A McMillan
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