The reality behind improving cancer survival rates April 2014 Cancer’s unequal burden – The reality behind improving cancer survival rates
• Foreword • Executive summary • The reality behind improving cancer survival rates • Improving survival outcomes • Conclusion • References
3 Cancer’s unequal burden – The reality behind improving cancer survival rates
in these areas has the potential to significantly reduce the overall cost of cancer care as well as greatly improving the lives of those with cancer.
Routes from Diagnosis, developed in Survival rates for some cancers have soared over the past 40 years in England. partnership with strategy consultancy In the early 1970s, overall median survival time for all cancer types – the time Monitor Deloitte and Public Health by which half of people with cancer have died and half have survived – was just England’s National Cancer Intelligence i ii Network (NCIN), also shows us one year . Now it is predicted to be nearly six years , testament to the good work the value of linking and analysing of the NHS and advances in diagnosis, treatment and care. But there is a grim routinely collected NHS data. Only by reality hidden behind these numbers. combining data from cancer registries with hospital records have we been able to produce such a powerful picture of what happens to people New research led by Macmillan These new figures are taken from our after they are diagnosed with cancer Cancer Support reveals what happens groundbreaking Routes from Diagnosis and which groups of people in to people in England after they are research programme, which links particular need more support. diagnosed with cancer in more detail routinely collected NHS data to show than ever before. The findings are a what happens to people after they This insight could not have come at a stark reminder of just how heavy a are diagnosed with cancer in more more important time. Political parties burden cancer is for many people. detail than ever before. The findings across the UK are preparing for For example, we know that lung cancer from the first phase of Routes from national elections in 2015 and 2016. has a particularly poor prognosis, with Diagnosis, summarised in this report, By 2020, there will be three million fewer than one in three people living show that cancer still leaves a cruel people living with or beyond cancer in for a year or more after diagnosisiii. legacy for far too many people. We the UK, and almost one in two of us Our new figures show one in five simply cannot afford any complacency will face cancer in our lifetimes. Many people with lung cancer die within when it comes to improving cancer people will have to cope with cancer just one month of diagnosis. care. And the good news is that we without the practical or emotional know delivering the right interventions support they need. The more we People who develop breast or prostate after a cancer diagnosis can make a understand about what happens to cancer may have a better overall significant difference to people’s long- people after they are diagnosed, the prognosis – these cancers have the third term outcomes. more urgent the case for taking action and fifth highest five-year survival rates becomes. Measuring success by one- ‘This insight of the 20 most common cancersiv – but NHS leaders must ensure every person and five-year survival rates is simply surviving does not necessarily mean with cancer receives the best treatment no longer enough. We must see the could not living well. Our research shows only available, regardless of their age or reality – and the people – behind one in five women with breast cancer where they live. GPs must use every the numbers. have come and one in four men with prostate tool at their disposal to improve early cancer will survive both long-term and diagnosis. And every person diagnosed at a more in good health. The remaining long- with cancer in the UK must receive term survivors have to cope with other a ‘Recovery Package’ of care and important serious health conditions such as heart, support, to help reduce the burden of kidney or liver disease, get another other health conditions and prevent Ciarán Devane, time.‘ type of cancer, or their cancer spreads cancer recurrence. This may sound like Chief Executive, or comes back. an expensive undertaking, but investing Macmillan Cancer Support
4 5 Cancer’s unequal burden – The reality behind improving cancer survival rates
• Many people with cancer have other • These initial results from Routes serious health conditions that make from Diagnosis make the case for their cancer harder to treat and action to improve cancer care more reduce their overall quality of life. urgent than ever. NHS leaders must People with cancer also have an ensure every person with cancer increased risk of developing certain receives the best treatment available, other conditions. For example, regardless of their age or where they women with breast cancer who live. GPs must use every tool at their survive at least five years after disposal to improve early diagnosis. diagnosis have a 40% increased risk And every person diagnosed with of having a serious genitourinary cancer in the UK must receive a condition and a 30% increased ‘Recovery Package’ of care and risk of being diagnosed with a new support, to help reduce the burden cancer. Men with prostate cancer of other concurrent health conditions • Cancer’s unequal burden summarises • The richness of the data allows us to who survive at least five years after and prevent cancer recurrence. key findings from the first phase of break down the survival outcomes of diagnosis have a 60% increased risk the Routes from Diagnosis research people with cancer into more than of having a serious genitourinary programme, which shows what 20 detailed survivorship profiles for condition, a 60% increased risk of happens to people with one of four each cancer type, describing length having a serious digestive condition cancer types (breast, prostate, lung of survival as well as the extent to and a 30% increased risk of being or brain/central nervous system which people experience a range diagnosed with a new cancer. (CNS) cancer) after they are of other serious health conditions. diagnosed with cancer, in more • The cost of inpatient hospital detail than ever before. • These profiles show us that only treatment for cancer varies one in five (20%) women diagnosed considerably even between people • Led by Macmillan Cancer Support with breast cancer, and one in four with the same type of cancer, in partnership with strategy (25%) men diagnosed with prostate depending on how long they survive consultancy Monitor Deloitte and cancer, will survive both long-term and their overall health. The cost Public Health England’s National and in good health. The remaining breakdowns suggest that shifting Cancer Intelligence Network (NCIN), long-term survivors will experience people towards better survival the first phase of Routes from a range of other serious health outcomes could save the NHS a Diagnosis provides a retrospective conditions, have their cancer spread considerable amount of money. analysis of almost 85,000 cancer or come back, or get another type For example, improving outcomes patients’ interactions with the NHS of cancer. for just 100 men with prostate in England over a seven-year period cancer could reduce the cost of ‘Many people with (2004–2011). • One in five (21%) people with lung hospital treatment by £800,000. cancer die within one month of cancer have other • Routes from Diagnosis combines being diagnosed. Fewer than 1% data from cancer registries with will survive long-term and in serious health inpatient hospital records and good health. conditions that make clinical insight to map the journey of these cancer patients from • Survival for people with brain or their cancer harder to diagnosis to death or continued CNS cancer varies widely depending survival, therefore identifying on which specific type of cancer they treat and reduce their which groups of people need have. Fewer than 2% of people with the most support and where to glioblastoma will live for seven years overall quality of life.‘ target interventions to make the or more, compared with almost most difference. two in three (64%) people with meningioma and more than four in five (87%) people with nerve sheath cancer. 6 7 Cancer’s unequal burden – The reality behind improving cancer survival rates
Detailed survival breakdowns
By linking data from cancer registries around 180 women in the study – How well do we understand what happens to people after they are diagnosed and hospital records, Routes from live for at least seven years after with cancer? Crude measures such as one- and five-year survival rates are Diagnosis has enabled us to break diagnosis despite their cancer having useful but they present only a snapshot of a highly complex picture. To deliver down the survival outcomes of spread throughout their body by the people with cancer into more than time it is diagnosed. Three in four improvements in cancer care we must understand more about survival outcomes, 20 detailed survivorship profiles and (75%) of these women are aged under the overall health of people with cancer and the cost of their cancer treatment – eight simplified profiles for each cancer. 65 and they are generally in better and new research led by Macmillan Cancer Support enables us to do just that. In this report we highlight just a sample health than average for women with of these profiles – for the full picture, breast cancerviii. see the main report, Routes from Diagnosis: The most detailed map Prostate cancer This report, Cancer’s unequal burden, Around 140,000 people are diagnosed of cancer survivorship yet. Only one in four (25%) men with summarises key findings from the first with one of these types of cancer each prostate cancer will survive both long- phase of the Routes from Diagnosis year in the UK, representing around Breast cancer term and in good health. More than research programme, which brings 40% of all new cancer diagnoses. Only one in five (20%) women half (55%) will live for at least seven together expertise from the charitable, Breast, lung and prostate cancer diagnosed with breast cancer will years after being diagnosed, but private and public sectors to show are the first, second and third most survive for both at least seven years around one in five (19%) will survive what happens to people after they are commonly diagnosed cancers in the after diagnosis and in good health, this long-term and have one or more diagnosed with cancer in more detail UK respectively, while brain/CNS defined as the initial treatment for of a range of other serious health than ever before. cancer is the ninth most commonv. their cancer being successful and not conditionsvii. Around one in 10 (11%) needing hospital care for a range of will survive for seven years or more but Led by Macmillan in partnership with The relative five-year survival rate other serious conditions apart from find that their cancer comes back or strategy consultancy Monitor Deloitte is over 80% for breast and prostate their cancer. Although more than two spreads, or that they get another type and Public Health England’s National cancer, around 15% for brain cancer in three (69%) women with breast of cancer. Cancer Intelligence Network (NCIN), and around 10% for lung cancerv. The cancer will live for at least seven years the first phase of Routes from Diagnosis findings from Routes from Diagnosis, after being diagnosed, more than one Around one in 12 (8%) men with provides a retrospective analysis however, reveal the stark reality hidden in four (29%) will survive this long but prostate cancer die within a year of of almost 85,000 cancer patients’ behind these simplistic survival rates have one or more of a range of other being diagnosed despite the cancer interactions with the NHS in England and make the case for action to serious health conditions, such as heart, never spreading beyond the prostate. over a seven-year period (2004–2011). improve cancer care more urgent kidney or liver diseasevii. Around one in Four in five (82%) of these men are than ever. five (19%) will survive for seven years or aged 75 or over. Around one in eight The patients studied in this first phase more but find that their cancer comes (13%) men with prostate cancer who of the programme have one of four back or spreads, or that they survive at least one year after diagnosis common cancer types: get another type of cancer. will find that their cancer spreads.
• Breast cancer A small proportion of women with Lung cancer • Prostate cancer breast cancer – 3.2%, or around One in five (21%) people with lung • Lung cancer 850 of the women in the Routes from cancer die within just one month of • Brain or central nervous system Diagnosis study – die within a year of being diagnosed. More than half (56%) (CNS) cancer being diagnosed despite the cancer die within six months of diagnosis, and never spreading beyond the breast almost three in four (73%) die within or nearby tissue. More than two in a year. At least three in 10 (30%) will three of these women (70%) are aged die within six months of diagnosis and 75 or over. Conversely, a very small spend at least a quarter of their final proportion of women – 0.7%, or months in hospital.
8 9 Cancer’s unequal burden – The reality behind improving cancer survival rates
Survival profiles
* ‘My dad was told he had highly malignant and quickly spread How long people with cancer live after diagnosis suspected lung cancer throughout the brain, making them in July, then when the almost impossible to remove surgically. Up to one year One to seven years Seven years or more diagnosis was confirmed In contrast, almost two in three (64%) we found out it had already people with meningioma and more than four in five (87%) people with spread to all of his organs. nerve sheath cancerix will survive at He died in October, just least seven years after diagnosis. Cancer three months later. It was Almost one in four (23%) of those with returns or Good meningioma and one in three (34%) health devastating. He never spreads of those with nerve sheath cancer will complained or spoke survive this long and in good health. % much about how he felt, 6 Ill health 25% but this was a man who did not want to die‘
Breast cancer 69% Tessa, 44, from Surrey
Just one in 20 (5%) people with lung Cancer cancer live for at least seven years returns or spreads after diagnosis, however most people Good who survive this long will have one Ill health or more of a range of other serious ‘This research makes the invisible, health health conditions or will find that % visible. We can now see the long- 12 their cancer comes back or spreads, 33% or that they get another type of cancer. term burden of cancer and the 55% Fewer than 1% will survive long-term and in good health. knock-on effect it has on a Prostate cancer Prostate person’s health. Fortunately Three in 10 (31%) people with lung cancer die within six months of there are low-cost solutions, diagnosis despite the cancer never spreading beyond their lungs. such as keeping active during Six months to treatment and receiving a one year One month Brain/CNS cancer or less Survival for people with brain or CNS cancer ‘Recovery Package’, cancer varies widely depending on 5% which can make a huge One to which specific type of cancer they have. six months 23% More than half (55%) of people with difference to the long-term glioblastoma die within six months
Lung cancer Lung health of cancer survivors.‘ of being diagnosed, and more than 73% one in three (38%) will survive just this short amount of time and spend more Professor Jane Maher, than a quarter of their final months in Joint Chief Medical Officer, hospital. Fewer than 2% will live for *Proportions may not add up to 100% due to rounding. Ill health = having at least one of a range of serious health conditionsvii seven years or more. Glioblastomas are Macmillan Cancer Support
10 10 11 Cancer’s unequal burden – The reality behind improving cancer survival rates
Our comparisons show that women People with brain/CNS cancer who The burden of morbidities with breast cancer who survive at least survive at least five years have around five years after diagnosis have a 40% an 800% increased risk of having increased risk of having a serious another serious condition affecting genitourinary condition, such as the nervous system, such as epilepsy, Many people with cancer have other This comparison group are likely to fertility issuesx. They also have a 30% meningitis or spinal abscessesxiii. serious health conditions that make be in poorer health than the general increased risk of being diagnosed with their cancer harder to treat and reduce population as they have required another cancerxi. The small proportion of people with their overall quality of life, known as some form of hospital treatment, glioblastoma who survive at least five morbidities. People with cancer also so the increased risks affecting those Men with prostate cancer who survive years after diagnosis have a high risk of have an increased risk of developing with cancer are probably even higher at least five years after diagnosis have being diagnosed with another cancer, certain other conditions after diagnosis. than shown. a 60% increased risk of having a which may be caused by the long-term serious genitourinary condition, effects of radiotherapy. To investigate this further, we compared a 60% increased risk of having a the risk of having other serious health serious digestive condition such as conditions for those with cancer to an anal or rectal fistula, and a 30% a similar group of people who had increased risk of being diagnosed received treatment in hospital for a with another cancer. health condition in general. Many of these increased risks are likely to be related to the long-term effects Prostate of cancer treatment, particularly where cancer people have received radiotherapy to 60% the pelvic area. People with lung cancer who survive at least five years have a 200% increased Breast risk of having a serious respiratory cancer condition, such as emphysema or 67% chronic obstructive pulmonary disease ‘As well as coping with (COPD), and a 300% increased risk of the long-term effects of Brain/CNS xii cancer being diagnosed with another cancer . breast cancer treatment, 66% The reasons why people with lung I’ve been back and forth A heavy burden cancer are at a greater risk of another to hospital for scans Proportion of people with cancer than people with breast or different types of cancer who prostate cancer could include long-term because I developed an also have or develop at least damage caused by smoking among ovarian cyst. I also have Lung one of a range of other serious cancer those who have smoked, and the fact osteoarthritis and hip health conditionsvii that some lung cancer patients who dysplasia. I’ve been trying 77% smoked before they were diagnosed continue to smoke after they to help myself by going are diagnosed. swimming regularly, but I find life pretty difficult some days.‘
Fiona, 46, from Shropshire
12 13 Cancer’s unequal burden – The reality behind improving cancer survival rates
These findings suggest that giving Cost of treatment people better survival outcomes could save the NHS a considerable amount of money. The cost of providing care and treatment for cancer is increasing year- on-year as our population grows and people live longer. By addressing issues Average cost of inpatient Figures from Routes from Diagnosis such as morbidities, delays in diagnosis hospital treatment per person for show that the cost of inpatient hospital and cancer recurrence, we can up to seven years post-diagnosis treatment for breast, prostate, lung improve care for patients, improve their and brain/CNS cancers is more than outcomes and save the NHS money. in England £1bn each yearxiv. This only represents treatment given to people who are admitted to hospital as inpatients, so Better care, cheaper care? Breast cancer the total cost of treating these four Potential reduction in cost of hospital Brain/CNS cancer £10,200 cancers in hospital, the community treatment from improving outcomes for or primary care combined will be 100 people with cancer (crude estimate £13,200 substantially higher. only; excludes any costs associated with improving outcomes) The cost per person varies considerably depending on their survival profile. Unsurprisingly, people whose cancer spreads or comes back cost more to treat than those who survive a similar amount of time but whose cancer doesn’t spread or recur. More unexpectedly, when people have other Prostate cancer – stopping serious health conditions as well as cancer spreading or coming back, or another cancer cancer, the cost of their care after developing, in 100 men their first round of cancer treatment is Lung cancer Prostate cancer who survive at least seven often more than the cost of the cancer years from diagnosisxv: £7,900 £9,900 treatment itself. For example, women with breast cancer £800K who survive for between one and seven Lung cancer – stopping years after diagnosis and have one or cancer spreading or coming more other serious health conditions back, or another cancer developing, in 100 people incur treatment costs of around £4,500 who survive between on average in the first year after they one and seven years are diagnosed (when the bulk of their from diagnosisxvii: main cancer treatment will take place) compared with around £7,500 from £500K a year post-diagnosis onwards. For Breast cancer – preventing other more details on cost breakdowns, see serious health conditions in 100 women who survive at least seven the main report, Routes from Diagnosis: years from diagnosis without their The most detailed map of cancer cancer spreading, coming back or £390K survivorship yet. developing another cancerxvi:
14 15 Cancer’s unequal burden – The reality behind improving cancer survival rates
There is also evidence that some At Macmillan we believe that the older people with cancer may not be Recovery Package can help reduce receiving treatment because of their the burden of other serious health chronological age. A recent study conditions affecting people with cancer, found that women aged 85 or over in as well as helping to prevent their England are 80% less likely to receive cancer coming back or helping to Overall, cancer outcomes are continuing to improve in the UK. By 2020 only surgery for breast cancer than women diagnose recurrence earlier. around one in three (36%) breast and prostate cancer patients will ultimately die aged 70–74, after adjusting for the fact from their cancer, down from around two in three (67%) in the early 1990sxviii. that older women are more likely to Physical activity have poorer health. This is despite 26% Being physically active has clear However, outcomes still vary hugely by cancer type and, as the initial results from of breast cancer occurring in women benefits for people with cancer. Routes from Diagnosis show, simply surviving does not necessarily mean living aged 85 or overxx. An evidence review carried out for well. There is still a huge amount to do to improve survival outcomes for people Macmillan’s Move More campaign diagnosed with cancer in the past, today and in the future. At Macmillan we want everyone with showed that physical activity after cancer to receive the best available treatment for cancer can reduce the Some of the key things Macmillan lung cancer. The tool will be rolled out treatment, regardless of their age risk of recurrence for some cancersxxi. believes would deliver the greatest across England in 2014 and we urge all or where they live. The barriers that It can also help reduce the impact of improvements for people with cancer GPs to use it to aid early diagnosis. prevent people getting treatment – long-term consequences of treatment in terms of survival are as follows: which may include age discrimination and having other health conditions as well as inadequate assessment as well as cancer. Physical activity • Earlier diagnosis ‘GPs only have around methods, postcode lotteries and can also benefit people with cancer • Access to the best available 10 minutes with each patient, other factors – must be tackled now. during treatment by helping them treatment, regardless of age so it’s vital that they ask the maintain their physical fitness and or where you live in the UK Recovery Package improving self-esteem and mood. • A ‘Recovery Package’ of care right questions and can We know that too many people with and support for everyone quickly calculate someone’s cancer have unmet needs and concerns Macmillan is supporting people with diagnosed with cancer cancer risk. Macmillan hopes after the end of treatment. To better cancer to achieve more active lifestyles • Increased physical activity that our clinical decision support people after treatment, health throughout their cancer experience. and social care leaders must ensure For example, the Walking for Health Earlier diagnosis support tool will support GPs that everyone diagnosed with cancer scheme, coordinated by Macmillan and GPs have a vital role to play in to identify the symptoms of receives a ‘Recovery Package’ of care the Ramblers, offers short, free and ensuring that cancer is diagnosed at cancer and help to improve and support. This should include: friendly walks suitable for people living an early stage to give people the best cancer survival rates.‘ with cancer in Englandxxii. possible chance of survival and good • Holistic Needs Assessments and care outcomes. However, despite the fact plans at key points during treatment that by 2020 almost one in two of us Dr Rosie Loftus, and recovery will get cancer in our lifetimes, cancer Joint Chief Medical Officer, • A Treatment Summary, completed is still a relatively unusual condition for Macmillan Cancer Support at the end of treatment and sent to ‘Throughout my treatment I just an individual GP to encounter in their the patient and their GP tried to walk whenever I could, day-to-day practice. • A Cancer Care Review, completed even if it was only a little. After I Access to the best six months after treatment by the To help GPs decide which patients available treatment patient’s GP or practice nurse, to left hospital I carried on walking, to refer for further tests, Macmillan Postcode lotteries exist for some discuss the patient’s needs and the building up slowly. I now lead has developed computer software treatments that offer the best clinical possible long-term consequences of Walking for Health walks. It’s that integrates with a GP’s existing outcome, such as surgery for lung cancer and its treatment good for your mental attitude IT systems and alerts them when cancer. The likelihood of receiving • A patient education and support a patient’s symptoms may indicate surgery for lung cancer varies event such as a Health and and it helps you get out and cancer. The Electronic Cancer Decision significantly between different areas of Wellbeing Clinic, to help the patient meet people.‘ Support (eCDS) tool is being used England and Wales, even after taking work towards supported self- by GPs across England and currently various factors such as age, gender management and a healthy lifestyle, Ian, 61, from Surrey focuses on five cancer types, including and overall health into accountxix. including physical activity 16 17 Cancer’s unequal burden – The reality behind improving cancer survival rates
morbidities for those with cancer and to most effectively use the finite resources of the NHS and social care to meet people’s needs.
Every year, more and more people These initial results from the Routes from Diagnosis programme show how get cancer, and even cancers with important it is to look beyond simple survival rates when it comes to cancer. reasonably good survival rates inflict We now know, in more detail than ever before, what happens to people a heavy toll on the people they affect. As our political parties prepare for the diagnosed with four of the most common cancers in the UK and we can see UK’s upcoming national elections, which groups of people affected by these cancers need particular support. we hope that Cancer’s unequal burden reminds them just how urgently people with cancer still need their support. ‘These The finding that one in five people Although we have not done a detailed with lung cancer die within just one health economics analysis, we know stark month of diagnosis backs up previous that inpatient care is particularly research, which also showed people expensive and it is reasonable to figures with lung cancer in England were more assume that improving outcomes than 10 times as likely to die within for people with cancer and therefore make the a month of diagnosis as those with reducing the need for inpatient breast cancer, and people with lung treatment could reduce the overall case for cancer in England were twice as likely cost of cancer care. to die within a month of diagnosis as those with lung cancer in Swedenxxiii. Understanding what happens to prevention These stark figures make the case for people with cancer after diagnosis in prevention and earlier diagnosis more this level of detail should also enable and earlier urgent than ever. us to deliver care more efficiently. The techniques used in Routes from diagnosis For breast and prostate cancer – the Diagnosis can help us plan care most common cancer type for women pathways better and direct targeted more urgent and men respectively – we can see how interventions at the people who need desperately we need better support them most. The Routes from Diagnosis than ever.‘ after treatment ends. programme also clearly demonstrates the powerful benefits of linking In many cases, it costs a similar routinely collected NHS data. But there amount to treat people who survive are still gaps in our knowledge. cancer long-term in good health in a hospital inpatient setting as it does to The data we have on what other treat people who unfortunately only health conditions affect people with survive a short time. It often costs cancer so far only include those serious substantially less to treat those with the enough to be included in their inpatient best outcomes in hospital than those hospital records. We need data from who survive a moderate length of time other care settings, such as primary with other serious health conditions or care and outpatient clinics, to more whose cancer progresses. fully understand the true burden of
18 19 Cancer’s unequal burden – The reality behind improving cancer survival rates
References
iMacmillan Cancer Support. Living after diagnosis: Median cancer survival times. November 2011. viii31% of women who survive at least seven years despite presenting with metastatic breast cancer have Macmillan Cancer Support identified median survival times based on research by the Cancer Research two or more morbidities, compared with an average of 37% for all women with breast cancer UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine. http://www. macmillan.org.uk/Documents/AboutUs/Newsroom/LivingAfterCancerMedianCancerSurvivalTimes.pdf ixPlease note that in this context ‘brain/CNS cancer’ includes both malignant and benign tumours as (accessed March 2014) well as those of unknown behaviour (ICD-10 codes C70, C71, C72, D32, D33, D42, and D43)
iiMacmillan Cancer Support. Living after diagnosis: Median cancer survival times. November 2011. xSome of this increased risk could be due to the people in the Routes from Diagnosis programme Macmillan Cancer Support identified median survival times based on research by the Cancer Research already being treated in an inpatient setting, and being more likely to have another health condition UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine. http://www. diagnosed as a result of this level of care and monitoring macmillan.org.uk/Documents/AboutUs/Newsroom/LivingAfterCancerMedianCancerSurvivalTimes.pdf (accessed March 2014) xiOf those with breast cancer who were still alive five years from diagnosis, 3.8% had been diagnosed with a new primary cancer, compared with 2.9% of the comparison population who developed a iiiOffice for National Statistics (ONS). Cancer survival rates, Cancer Survival in England: Patients primary cancer. Diagnosed 2007–2011 and Followed up to 2012 http://www.ons.gov.uk/ons/publications/re- reference-tables.html?edition=tcm%3A77-320365 (accessed February 2014) xiiOf those with lung cancer still alive five years from diagnosis, 40% will have a respiratory morbidity, compared with 13% of the comparison population, and 33% will have developed a new primary ivOffice for National Statistics (ONS). Cancer survival rates, Cancer Survival in England: Patients cancer, compared with 8% of the comparison population Diagnosed 2007–2011 and Followed up to 2012 http://www.ons.gov.uk/ons/publications/re- reference-tables.html?edition=tcm%3A77-320365 (accessed February 2014) xiiiOf those with a brain/CNS tumour still alive five years from diagnosis, 25–27% will have a nervous system morbidity, compared with 3% of the comparison population vISD Scotland. Cancer Incidence in Scotland 2011 http://www.isdscotland.org/Health-Topics/Cancer/ Publications/data-tables.asp?id=839#839 (accessed February 2014). Welsh Cancer Intelligence xivThis figure refers to 2010 and reflects the cost to the NHS budget, i.e. what commissioners pay and Surveillance Unit. Cancer Incidence in Wales 2007–2011, http://www.wales.nhs.uk/sites3/ hospitals to provide the care based on the NHS National Tariff, rather than the exact cost to hospitals Documents/242/CancerIncidenceinWales2007_2011.pdf (Accessed July 2013). Northern Ireland of providing the care. The breakdown by cancer type is as follows: breast – £387m; prostate – Cancer Registry. Cancer Data 2010 http://www.qub.ac.uk/research-centres/nicr/CancerData/ £277m; lung – £270m; brain/CNS – £80m (Accessed July 2012). Office of National Statistics 2011 Cancer Incidence rates. http://www.ons. gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/no--42--2011/stb-cancer- xvThe average cost of inpatient hospital treatment in the first seven years post-diagnosis for men with statistics-registrations-2011.html (Accessed July 2013) and http://www.cancerresearchuk.org/cancer- prostate cancer who survive at least seven years from diagnosis whose cancer spreads or comes back, info/cancerstats/incidence/commoncancers/#Twenty or who develop a second cancer, is around £11,700, compared with around £3,700 for men who survive this long either in good health or with other serious health conditions but whose cancer does viOffice for National Statistics (ONS). Cancer survival rates, Cancer Survival in England: Patients not spread or come back and who do not develop a second cancer Diagnosed 2007-2011 and Followed up to 2012 http://www.ons.gov.uk/ons/publications/re-reference- tables.html?edition=tcm%3A77-320365 (accessed February 2014) xviThe average cost of inpatient hospital treatment in the first seven years post-diagnosis for women with breast cancer who survive at least seven years from diagnosis who have other serious health viiThe health conditions other than cancer that were included in the Routes from Diagnosis programme conditions but whose cancer does not spread or come back, and who do not develop a second are those that the programme’s clinical advisory group felt were clinically important for people living cancer, is around £8,600, compared with around £4,700 for women who survive this long without with each type of cancer, according to the following three inclusion criteria: common conditions likely other conditions and without their cancer spreading or coming back or developing a second cancer to be more prevalent for people with that type of cancer compared with the general population; common conditions likely to affect treatment decisions; or common conditions related to complications xviiThe average cost of inpatient hospital treatment in the first seven years post-diagnosis for people or long-term consequences of cancer or its treatment. The condition is then only included in the with lung cancer who survive between one and seven years from diagnosis whose cancer spreads or Routes from Diagnosis analysis if it is recorded in the patient’s hospital record (specifically their comes back, or who develop a second cancer, is around £13,700, compared with around £8,800 for inpatient Hospital Episode Statistics (HES) entry). Therefore although this list is comprehensive, it does those who survive this long either in good health or with other serious health conditions but whose not cover all reasons why someone with cancer would be admitted to hospital – having an accident, cancer does not spread or come back and who do not develop a second cancer for example, is not included. The full list of conditions is listed in the appendix of the main Routes from Diagnosis report 20 21 Cancer’s unequal burden – The reality behind improving cancer survival rates
xviiiMacmillan Cancer Support. Cancer mortality trends: 1992–2020. May 2013. http://www.macmillan. org.uk/Documents/AboutUs/Newsroom/Mortality-trends-2013-executive-summary-FINAL.pdf (accessed February 2013)
xixHealth and Social Care Information Centre. National Lung Cancer Audit: 2012 Patient Cohort. http://www.hscic.gov.uk/catalogue/PUB12719
xxLavelle K et al. Is lack of surgery for older breast cancer patients in the UK explained by patient choice or poor health? A prospective cohort study. British Journal of Cancer 2014; 110: 573–583
xxiMacmillan Cancer Support. The importance of physical activity for people living with and beyond cancer: A concise evidence review. 2011. http://www.macmillan.org.uk/Documents/AboutUs/ Commissioners/Physicalactivityevidencereview.pdf
xxiiwww.walkingforhealth.org.uk
xxiiiColeman et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population–based cancer registry data. The Lancet 2011; 377: 127–138. Data on one-month survival is on page 20 of the web appendix, http://download.thelancet.com/mmcs/journals/lancet/PIIS0140673610622313/ mmc1.pdf
22 23 When you have cancer, you don’t just worry about what will happen to your body, you worry about what will happen to your life. Whether it’s concerns about who you can talk to, planning for the extra costs or what to do about work, at Macmillan we understand how a cancer diagnosis can affect everything. No one should face cancer alone. So when you need someone to turn to, we’re here. Right from the moment you’re diagnosed, through your treatment and beyond, we’re a constant source of support, giving you the energy and inspiration to help you take back control of your life.
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