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CANCER IN SCOTLAND: ACTION FOR CHANGE

INTRODUCTION

CANCER TOUCHES ALMOST EVERYONE AT SOME TIME IN THEIR LIVES. PRACTICALLY EVERYONE KNOWS SOMEONE WHO HAS HAD OR IS SUFFERING FROM CANCER. EACH YEAR, MORE THAN 26,000 SCOTS ARE DIAGNOSED AS HAVING CANCER AND 15,000 PEOPLE DIE FROM IT.

The Scottish Cancer Group (SCG) was established and met for the first time in September 1998, tasked with providing leadership, direction, advice and guidance for cancer services in Scotland. As Lead Clinician for Cancer Services in Scotland, I was invited to Chair the Group.

The Group agreed that among the issues to be tackled were quality assurance of cancer services, the provision of chemotherapy across Scotland, radiotherapy facilities and the availability of cancer genetics advice.

• Quality Assurance was pursued in collaboration with the Clinical Standards Board for Scotland. Definitive standards for 4 cancer services including core principles applicable to all cancers were drawn up and the Clinical Standards Board for Scotland (CSBS) is now undertaking a series of visits to assess services against these standards.
• An assessment of chemotherapy needs was carried out to establish the baseline to aim for equity of access to chemotherapy drugs through Managed Clinical Networks (MCNs).
• A strategic review of radiotherapy equipment and capital planning led to a managed equipment replacement programme across Scotland which has proved very successful.
• Building on the 1998 Cancer Genetics Report further guidance was prepared and issued to NHSScotland to support the implementation of cancer genetic services for those predisposed to breast, ovarian and colorectal cancer.

Building on the multidisciplinary team ethos prevalent in cancer services, regional MCNs have been set up in the North and South East of Scotland and restructuring by the West network is currently underway. Groups of clinicians with an interest in individual tumours have met informally in various parts of Scotland for many years. They are now being formalised within this regional advisory structure.

Close links have been maintained with the Scottish Intercollegiate Guidelines Network (SIGN), 4 national clinical cancer guidelines have been published and we will continue to maintain this successful collaboration.

Survival from cancer in Scotland has improved significantly over the last 25 years. New and better treatments are becoming available each year and, provided cancer is diagnosed at an early enough stage, the better are the chances of improved outcomes. More and more people are living with cancer. And that is the key - living with cancer. As the numbers of people developing cancer rise we also predict that fewer people will die from it. More people will need palliative care and other support services, more people will need information individual to their needs.

We must continue to tackle the enormous challenges cancer presents. Smoking is the main cause of cancer, especially of the lung. Lung cancer is one of the biggest killers of men and women in Scotland. One thing which would change (significantly) for the better our predictions of cancer incidence over the next 10 years would be if people were to stop smoking. Lifestyle in general, such as diet and exercise are also important, but smoking cessation is the key to real improvements.

Our National Health, a plan for action, a plan for change set out a significant programme of work for the Scottish Cancer Group providing new challenges for the future. The implementation of the aims and objectives set out in this document will be a joint effort, between the Health Department, the NHS Boards and everyone who works with cancer related services throughout NHSScotland. This will be guided by a restructured Scottish Cancer Group.

We are aiming for a future where patients and their relatives and carers are at the heart of the healthcare and support services - involved not just in receiving care but in planning and developing that care. Achievement of the goals set out in our cancer strategy will take energy, innovation and determination by all concerned.

Thanks to the dedication, commitment and enthusiasm of everyone working in cancer services, much has been achieved since the Scottish Cancer Group was established 3 years ago. We have come a long way and provided care, comfort and hope to many with cancer but we also acknowledge that there is more to be done. Through this continued commitment and enthusiasm we will implement this strategy and secure real and lasting improvements in services for people with cancer.

Dr Harry Burns
Lead Clinician for Cancer Services in Scotland
Chairman, Scottish Cancer Group

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