The UK government’s proposal to roll England’s long run plan for cancer into one strategy covering all major conditions, equivalent to heart problems, chronic respiratory disease, dementia, mental health conditions, and musculoskeletal disorders is “a catastrophic decision that can cost lives,” warn experts in The BMJ today.

Professor Richard Sullivan on the Institute of Cancer Policy, King’s College London and Dr Ajay Aggarwal on the London School of Hygiene & Tropical Medicine say the choice “jettisons many years of world consensus that, to deliver inexpensive, equitable and top quality cancer care, dedicated cancer plans are required.”

Cancer is the one largest reason behind death within the UK and some of the serious healthcare burdens for societies. Delivering effective and equitable care requires the coordination of an in depth array of interlocking cancer specific pathways, they write.

The English NHS, for instance, has 60 radiation therapy centers, 50 prostate cancer surgery centers, 163 bowel cancer centers, and 176 chemotherapy units, not including the specialized diagnostics which might be only available at chosen hospitals.

The strategic direction and coordination of all these services requires each a cancer specific plan and an array of operational tools to cope with problems with centralization and variation in practice to avoid inequalities in access and outcomes, they explain. Cancer can also be extremely costly for health systems, patients, and wider society.

They argue that the present plan to subsume England’s long run plan for cancer right into a generic chronic disease strategy “is completely inconsistent with internationally accepted benchmarks set by the World Health Organization and followed by all other member states.”

They acknowledge the necessity to strengthen primary and social care, together with ensuring parity of attention to other chronic diseases, but say subsuming cancer into an overall non-communicable disease agenda “simply signals that cancer is not any longer a political priority or reflects a government not willing to cope with its complexity and escalating costs.”

A protracted term plan for cancer is more critical than ever after over a decade of declining funding for cancer services compounded by the covid-19 pandemic, they add. Such a plan must cope with the post-pandemic realities of backlogs for care: sicker patients with more advanced cancers and big deficits in cancer specific workforce.

They note that national cancer audits in England and Wales report wide variations in access to essentially the most effective cancer treatments and in quality of care.

These quality gaps “reflect systemic and structural problems across multiple and complicated cancer pathways that may only be tackled by an evidence driven dedicated cancer control plan that considers the important thing determinants of cancer outcomes – specifically, workforce, infrastructure, quality assurance, and health service delivery,” they conclude.

Source:

Journal reference:

Sullivan, R & Aggarwal, A., (2023) Proposal to scrap England’s long run plan for cancer. The BMJ. doi.org/10.1136/bmj.p326.