Still waiting for a UK cancer plan that truly delivers

The UK Government was due to publish the next version of the 10-year cancer plan for England in the summer of 2022 with the aim of improving cancer outcomes to match the best in Europe. However, recent political turmoil has resulted in no clear date for when the plan will appear. Given the considerable challenges on health care in the UK, we call on the new Prime Minister, Rishi Sunak, to break this inaction and publish a fully detailed plan as a matter of urgency.

As long ago as 2007, The Lancet Oncology raised concerns about the UK’s status as a poor performer in cancer care compared with other European countries, and we stressed the importance of an effective cancer plan. At that time, we had published results from the EUROCARE-4 studies showing that cancer survival in the UK was lower than many European countries. 15 years later and little has changed—indeed, a Policy Review written by the International Cancer Benchmarking Partnership (ICBP) and published by The Lancet Oncology in November, 2022, reports similar findings. The study highlights that high-income countries with dependable, long-lasting cancer policies supported by robust implementation and funding, have the greatest improvements in cancer survival, which emphasises the importance of an effective national cancer strategy. The results also show how English cancer services have lost ground: first, with England achieving just seventh place out of ten jurisdictions for consistency of cancer policies between 1995–2014; second, how the role of the UK National Cancer Director was reduced to a part-time advisory post in 2013; and third, how the National Cancer Action Team and 23 regional cancer networks were disbanded and consolidated into a less focused organisation, also in 2013.While it is important to note that survival for many cancers in England has improved between 1995–99 and 2010–14, it is concerning that the comparison with the best outcomes worldwide is not favourable and the rate of improvement over time is also not in line with that achieved in other countries. In fact, improvements in UK cancer survival continue to be much lower than those in Denmark, Ontario (Canada), and New South Wales (Australia) with just New Zealand, Wales, and Northern Ireland faring worse among the jurisdictions included in the ICBP report. Furthermore, Denmark, which in 1995 had the lowest cancer survival, now has the highest increase in survival after achieving a political consensus on its cancer policies and an appropriate level of financial investment and implementation, in sharp contrast with England where policies have changed frequently depending on the direction of political winds.England is not alone within the UK. All four devolved nations are struggling. The reasons for this are complex and are hindered by each nation developing its own independent cancer plan, seemingly in isolation of each other. Clearly, no cancer plan is effective if it is neither financed nor implemented, and the National Health Services across the UK continue to be underfunded, badly managed, and face multiple staffing crises.There are huge discrepancies in survival for patients with cancer in England depending on where they live, leaving them vulnerable to a so-called postcode lottery for cancer care. A major contributing factor is that the number of patients being treated within 2 months of a referral is well below the English national target of 85%. In September 2022, figures released by NHS England showed the worst delays in 3 years, with only 64% of patients beginning definitive treatments within 62 days. In Scotland, Wales, and Northern Ireland, comparable figures were just 79%, 57%, and 42%, respectively. These systems-based problems exist on a more granular scale, too: for example, cetuximab is available in Wales and Scotland, but not in England; and in 2021, only 30% of patients with cancer diagnosed in one district in north London received a first round of chemotherapy within 2 months of referral while just 6 miles away in a district in east London, 95% of patients received their first treatment within this timeframe.

A fully funded and implemented national cancer plan driven by engaged leadership has the potential to transform lives. The UK’s devolved nations have failed to meet this challenge and are now lagging far behind their stated ambition to offer world-class cancer care. Inconsistent political commitment, partisan squabbling between nations, and a lack of leadership on the provision of cancer services, which require a holistic, coordinated, and long-term vision, has contributed to the current situation. The UK’s new Prime Minister must not waste any more time in closing the cancer divide. There are now far too many lives depending on it.

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