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.