About the Less Survivable Cancers Taskforce: The six less survivable common cancers (lung, pancreatic, liver, brain, oesophageal and stomach) are responsible for half of all deaths and make up a quarter of cancer cases each year in the UK.
The five-year survival rate for the 80,000 people diagnosed with these cancers each year is only 14%. These cancers have not seen the same improvements in survival rates that other cancers have in the last forty years. The Less Survivable Cancers Taskforce (LSCT) brings together six charities representing patients from each of these cancers:
Introduction: The LSCT welcomes this inquiry to ensure that core NHS services are maintained during the pandemic and beyond. Since the outbreak of the pandemic, our six charities have been focused on providing patients with COVID-19 related information and support and are working closely with relevant colleagues in the NHS to provide this. We fully support NHS England, Public Health England and all frontline healthcare professionals in their work to combat COVID-19, protect those most vulnerable, and reconfigure other critical healthcare services.
People with one of the less survivable cancers are typically diagnosed late and have a poor prognosis. Where treatment is possible, either curative or life prolonging, this must be given as soon as clinically possible. It is therefore vital that people with symptoms, including vague symptoms, are encouraged to come forward to their GPs, and that there are fast diagnostic pathways and direct pathways into the new COVID-free cancer hubs for treatment.
We are concerned to hear of treatments being delayed or cancelled due to increased risks or the reduced capacity of the health service. People with less survivable cancers must not be de-prioritised or neglected because they are hard to treat.
1. Maintaining a focus on early diagnosis for all cancers, in particular the less survivable cancers, is vital.
The less survivable cancers are often hard to diagnose with patients presenting with vague and non-specific symptoms. Early and fast diagnosis is crucial for these cancers to allow treatment and increase survival rates. Before the crisis, late presentation of these cancers was a huge issue, for example over a third of liver cancer patients were diagnosed at A&E. Now cancer referrals from primary care have dropped 75% meaning that we are likely to see an increased number of patients coming through diagnosis at a more symptomatic/advanced stage.
Significant energy and resource is needed to ensure that people who have symptoms are encouraged to come forward, and are able to access timely diagnostic tests. Some of our member charities have continued to receive calls from people with ‘red flag’ symptoms who say they fear adding to the burden the health service is under the health service or NHS 111. The work that has begun on Rapid Diagnostic Centres (RDC) in Cancer Alliances should be seen as a complement to the cancer hubs and RDC models of care should be accelerated, wherever possible.
Endoscopy services may require additional planning because of the involvement of the patient’s lungs and airways, so may mean testing patients for COVID-19 beforehand and the wearing of PPE by staff in a COVID-free environment.
We are aware that treatment hubs for cancer, such as The Christie in Manchester, have been kept ‘COVID free’ to protect and reassure patients. We believe that it could be worthwhile investigating how patients with potentially cancer-related symptom can be seen and referred to centres which are similarly kept free of infection to encourage people to come forward when they experience cancer symptoms.
2. People with a less survivable cancer must have urgent access to treatment at the cancer hubs.
Cancer hubs are an essential solution to the challenges presented by the COVID-19 pandemic and it is vital that anyone diagnosed with a less survivable cancer is able to access treatment as a matter of urgency at a cancer hub. Delays will result in poorer clinical outcomes in most cases. For example, only 10% of people with pancreatic cancer are able to have surgery due to the late stage this cancer is generally diagnosed at. This shows the need for fast access to surgery before the cancer becomes inoperable.
NHSE prioritisation criteria for systemic anti-cancer therapy (SACT) is based on the survival gain for treatment. The survival gains for chemotherapy for the less survivable cancers are in the order of months and not years, therefore, it is likely any treatment and blanket resource prioritisation and rationalisation will impact people with a less survivable cancer disproportionally.
Surgery for these six cancers is invasive and complex and patients will often need to have access to intensive care beds in a COVID-free environment for recovery. A lack of ventilators and HDU/ICU beds (a knock-on effect from COVID-19) could result in a potential reduction in surgical capacity.
The reduction in presentations of people with cancer at the moment means that there may be a surge in new diagnoses in coming weeks or months. Cancer hubs, and diagnostic capacity, must be prepared for this potential increase in demand.
At all times, and especially now, discussions with patients are essential - they need to be informed as to their options and choices, although with the associated risks and benefits and agree with the treatment decision. Any deviation from the normal standard of care and the implications of this deviation must also be discussed and agreed with the patient.