< Previous | Contents | Next >

CANCER IN SCOTLAND: ACTION FOR CHANGE

Deprivation and cancer

The links between cancer and deprivation are well recognised. The most deprived areas in Scotland are associated with the highest risk of being diagnosed with cancer and the lowest chance of survival. These effects are substantially more pronounced for particular types of cancer such as the tobacco- and alcohol-related cancers of the head and neck, lung and oesophagus and stomach (Figure 4).

Survival from cancer

Compared with the rest of Western Europe, the incidence of and mortality from cancer in Scotland are high. Examination of outcomes for particular types of cancer almost always shows low survival in Scotland (and the rest of the UK) compared to other western European countries.

This is partly due to the fact that Scots have more cancers such as lung cancer, which are less susceptible to treatment and have a poorer outcome. Other factors influencing the outcome of cancer care include the extent of disease at the time of diagnosis and co-existing illness which in turn may influence the effectiveness of treatment. Apparently poorer outcomes may be attributable in part to different registration methods and systems for measuring outcomes.

The outcome for an individual patient is determined by where the cancer develops and how it behaves. Table 1 shows the wide variation in the five year survival rates across different types of cancer. Survival of men with cancer of the pancreas is currently only 3.6%, but, for testicular cancer 93.5% and for women with malignant melanoma 91.4%, there has been great improvement over the last 20 to 25 years (Figure 5).

Overall, however, and in contrast to the increasing incidence of many cancers, deaths from cancer are falling. More Scots are being diagnosed with cancer but fewer under the age of 75 are dying from it. This is due to improving survival rates following better treatment. Even so, there is real scope for continuing improvements over time.

Predicting the future

Cancer Scenarios: an aid to planning cancer services in Scotland in the next decade provides a foundation for forward planning over the next decade. These projections indicate a likely continuing downward trend in mortality over the next 10 to 15 years of 17% for men and 11% for women under 75 years of age (table 2). This difference is mainly due to lung cancer mortality, which will decline to a greater extent in men than in women largely due to the greater reduction in smoking among men compared to women.

Table 2: Projected mortality rates¹ in those aged under 75 during 2000-2014 compared to those observed in 1995-1999

¹Truncated age-standardised rates per 100,000 person-years of risk (European standard population)
²1-(ESR_1995-99/ESR_2010-14)
³Based on historical trends only.
⁴Based on historical trends + adjustments for new interventions.

By the implementation of new interventions for diagnosis and treatment identified in these scenarios it is predicted that reductions in mortality as high as 24% for men and 18% for women might be achieved.

But securing improvements in cancer survival rates requires continuing efforts on many fronts, not just in treatments. Better awareness and prevention, earlier diagnosis and better, faster treatment all have a part to play in reducing both the incidence of cancer and the deaths it causes.

CANCER CARE IN SCOTLAND

The burden of cancer is clear from the facts and figures presented above. How this impacts on the lives of Scots and on the services they need from primary, secondary and tertiary care need to be carefully examined and effective planning set in place if we are to deliver patient focused services providing the best care possible.

Historically, the options for managing cancer were much more limited than they are today. There were relatively few drugs effective against the disease and most cancers were treated with surgery and radiotherapy. Few patients saw a specialist in cancer care and medical treatment of cancer was in its infancy. Today, the situation has changed dramatically. In the last ten years, changes in patterns of treatment, hospitalisation and prognosis as well as changes in the risk of developing cancer have led to significant alterations in the use of resources. In the last ten years day case treatments for cancer have increased approximately six-fold, and the number of patients treated has risen by 20%.

Many more cancers are responsive to treatment and nowadays some cancers, such as cancer of the testis, are curable in almost all cases. We also now have a much better understanding of the growth of tumours and the way they behave. As a result, more and more patients need to be seen by specialists in chemotherapy and radiotherapy as well as surgery and the other disciplines that have always been involved in cancer care.

But, this growth in knowledge and expertise in how to treat patients has not always been matched by a sufficient growth in facilities and staff. The main reasons for this are:

• investment by the NHS in Scotland in modern equipment has not kept up with technological developments
• where equipment is old and unreliable, breakdowns cause additional delay and anxiety for patients and staff alike
• previously inadequate workforce planning to maintain and develop services in response to demand growth
• subsequent recruitment and retention difficulties especially within some specialist areas
• services have not been reorganised to ensure that patients are dealt with quickly and sensitively.

Doctors, nurses and others who treat patients are hard pressed and often find themselves with insufficient time to spend talking to patients, their carers and families, all of whom need time and support to understand the diagnosis and all its implications. They also need help to sort out the questions that are important to them, and all of the members of the healthcare team need to be available with time to answer them.

Despite this, there is evidence that the care of patients in the NHS in Scotland is of a high standard, achieved through the dedication and hard work of everyone in the Service.

Under the internal market, for many years Health Boards and Trusts avoided investing in costly developments. As a result, Cancer Centres, almost all of which serve patients from several different Health Board areas, have often found it difficult to get agreement from all contributing Boards to the funding of equipment and significant new services.

We are determined that Scots with cancer will have equitable and rapid access to modern effective treatment (see Chapters 4 and 5) and putting this right will need additional funding and new approaches to planning and delivering services.

Work to achieve this has already started:

• NHSScotland will be run as a truly national health service
• the internal market has been abolished
• unified NHS Boards will be in place by 30 September 2001
• planning for cancer services will be regionally, or for rarer cancers, nationally based. Regional Cancer Advisory Groups (see chapter 9), working with relevant NHS Boards, will plan investment in services and staff on the basis of regional clinical need.

Our National Health, a plan for action, a plan for change clearly set out our commitment to securing real change within NHSScotland through record levels of funding to be invested over this and the next 2 years. The health budget is due to rise from £5.9 billion in 2001-2002 to £6.7 billion in 2003-04. NHS Boards are expected to ensure that this money is invested wisely and particularly to secure improvements in priority areas. Cancer is a priority for the Scottish Executive. It is also a priority for NHSScotland. By maximising the resources available this increased investment will mean properly staffed, modern and effective services will be provided for people with cancer.

We also pledged to bring forward this, our cancer strategy for Scotland. Succeeding chapters set out our strategy for the next 5 to 10 years not only to provide swifter, better, diagnosis, treatment and care but also, importantly, our aims to prevent more cancers from occurring.

< Previous | Contents | Next >