Pancreatic Cancer

Tuesday 2nd April 2019 Westminster Hall

14:15

[Nic Dakin (Scunthorpe) (Lab)]

I beg to move,

That this House has considered treatment for pancreatic cancer.

I pay tribute to the hon. Member for Winchester (Steve Brine), who was an outstanding Health Minister and who I am sure will continue to make significant contributions to the fight against cancer. I thank members of the all-party parliamentary group on pancreatic cancer and associated charities for their work, and people watching on the Parliament channel for their interest and support.

It is time to up our game on the diagnosis and treatment of pancreatic cancer. Full marks to campaigners such as Ali Stunt of Pancreatic Cancer Action, who was inspired after surviving the cancer herself to set up a charity that focuses on improving early diagnosis in particular. We need even more people like Ali, with her determination and passion, to ensure we can make a difference. Once diagnosed, there is an urgent need for access to faster treatment for people who have pancreatic cancer.

[Mr Ivan Lewis (Bury South) (Ind)]

I thank my hon. Friend for ensuring that this issue is brought to the attention of the House. Does he agree that, while there is a great emphasis on early identification of pancreatic cancer and we all share the concern that identification should come as early as possible, the speed of treatment is every bit as important? Does he agree that we have some way to go before we can be satisfied with that speed of treatment for most patients with pancreatic cancer in this country?

[Nic Dakin]

My hon. Friend is right: speed of treatment after diagnosis is an issue, and I will emphasise that in my speech.

Pancreatic cancer is the quickest-killing cancer: only one in four people survive a year and fewer than 7% of those affected in England will survive for five years or more. Those are appalling statistics, and they have not improved in this country in decades.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman, who has been a spokesman for pancreatic cancer treatment and many other things in this House. I always look to him personally for his lead in these things. In the background reading I did before the debate, I saw that the latest findings showed that overweight 50-year-olds have a 25% higher chance of having pancreatic cancer. I never knew that before. That not only shows the need for people to be aware of how their weight affects their long-term health, but is a red flag that the number of pancreatic cancer patients could rise. If being overweight can lead to pancreatic cancer, we must ensure that appropriate treatment is available for that rising number,.

[Nic Dakin]

The hon. Gentleman is exactly right; the more we learn about this disease, the more we can try to do things to prevent it and to support people so that they can get early diagnosis and treatment. The chances of survival for Kevin, the husband of my constituent Maggie Watts, were no better than those of his mother, who died of the same disease 40 years earlier. Yet other countries are doing much better; Belgium and the USA have double the survival rates of the UK. We need the Government to work with the fantastic pancreatic cancer charities—Pancreatic Cancer UK, Pancreatic Cancer Action, Pancreatic Cancer Scotland and the Pancreatic Cancer Research Fund—as well as other stakeholders to deliver a step change in outcomes for pancreatic cancer.

[Henry Smith (Crawley) (Con)]

I congratulate the hon. Gentleman on securing this important debate. Sadly, in January my former caseworker died of pancreatic cancer, so I saw the sudden impact of the condition and how quickly it can affect people, as the hon. Gentleman has eloquently set out, as well as the poor survival rates. What particular lessons does he think this country can learn from Belgium, the United States and other countries where outcomes and survival rates are better?

[Nic Dakin]

I pay tribute to the work that the hon. Gentleman has done on blood cancers in particular, and other cancer awareness issues such as this. He is right that we must learn the lessons from elsewhere, and hopefully I can demonstrate that there are things we can do to help us to catch up, once the diagnosis is in place, and get faster treatment.

One of the things that frustrates campaigners such as Maggie is the danger of accepting that little can be done after a diagnosis of pancreatic cancer. There is a sense of nihilism about this disease. Maggie’s optimistic initiative in response to her situation is called “Hope is Contagious”, and it should energise us all to redouble our efforts. No one should be written off.

Paul Kenny is a pancreatic cancer sufferer who has contacted me on Twitter, saying he has a “slim chance” of seeing his next birthday, but adding:

“Hopefully future generations of sufferers will be prevented or given better prognoses.”

Paul is right—we can do so much better, and we must.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

My hon. Friend is making a powerful speech that will resonate with many people, including my own family. My lovely mother-in-law, Jean Buck, had stomach pains and was misdiagnosed with pancreatitis. She was sent home from hospital on a diet of bread and water. When back in hospital, she suffered a heart attack and slipped into a coma. Only then did the hospital suspect pancreatic cancer, but it was too late to operate, because she needed to breathe unaided and sadly she could not. That left my father-in-law, Maurice, my husband and his brother and sister with the heartbreaking decision of whether to end her life support—a decision that will haunt their grief forever. Does my hon. Friend agree that earlier diagnosis is key not only for those who are suffering, but for those left behind?

[Nic Dakin]

I thank my hon. Friend: in sharing that personal story, she makes a powerful argument about the need for better early diagnosis. Sadly, the story that she tells is the familiar one of undiagnosed general symptoms eventually, in an emergency, being diagnosed as pancreatic cancer. Very often, it is then too late to take action to address the illness. However, I want to focus on the fact that when we do diagnose early, we need to act early to cure people, because that is an area where we can certainly up our game.

At the moment, only one in 10 pancreatic cancer patients receives potentially curative surgery and only two in 10 receive chemotherapy, meaning that a massive seven in 10 people receive no treatment at all. That has to change. Last month, I delivered to the House a petition signed by an incredible 100,600 people supporting Pancreatic Cancer UK’s campaign to “Demand Faster Treatment”. They are asking for pancreatic cancer to be recognised as a cancer emergency and for people to be able to access treatment within 20 days of diagnosis in order to have the best chance of survival.

That ask is based on the latest evidence and best practice from existing fast-track models for operable and inoperable patients. Those models show that treating people with pancreatic cancer within 20 days increases the number accessing surgery by 20% and the number accessing chemotherapy by 25%. Those are significant improvements. Fast-track surgery will allow more people to access life-saving treatment, and we know that the survival rate is 10 times higher for those receiving surgery. The 100,600 people who signed the petition believe that those models should be the basis of a national optimal pathway for the diagnosis and treatment of pancreatic cancer to ensure that people with the disease can be treated within 20 days.

I want to be clear that I am not talking here about early diagnosis, important though that is—hon. Members’ interventions have underlined that—and I welcome the focus of the Government and NHS England on early diagnosis of all cancers. That can only be a good thing and it will help. However, there are currently many people with pancreatic cancer who have been diagnosed early enough to receive treatment but, unacceptably, do not receive it. That is the issue that I am focusing on today.

For example, more than half of people with stage 1 and stage 2 pancreatic cancer die within a year, and almost half of them, 42%, do not receive any active treatment at all—neither surgery nor chemotherapy. The data suggests that those patients are not prioritised and have not been treated as an emergency. Unfortunately, all the evidence shows that the Government’s current and proposed waiting times are not fast enough for people with pancreatic cancer. A one-size-fits-all approach is not improving, and will not improve, survival rates for pancreatic cancer.

It was disappointing that the recently published interim report of the clinically-led review of NHS access standards did not take the opportunity to propose a differentiated target for pancreatic cancer. If we really want to transform outcomes, it is high time that we had differentiated targets, including a 20-day treatment target for pancreatic cancer.

Behind the statistics are real people. We have heard about some of them today, and their stories help us truly understand the missed opportunities and devastating consequences of the current system. No one did more to mobilise people to sign the petition and help make the case for faster treatment than Erika Vincent. In February 2018, Erika was diagnosed with stage 4 pancreatic cancer, yet despite its advanced nature, she was made to wait two months for treatment—something that she described as psychological torture for her and her family. While she waited, her cancer spread, bringing her more pain and complicating the care that she would eventually receive. Erika believed that the delays to her treatment reduced the time she had left with her family. She chose to spend much of that time championing the need to treat pancreatic cancer as an emergency, believing, as I do, that pancreatic cancer patients cannot afford to wait. Sadly, Erika passed away just weeks before the petition calling for faster treatment—a petition that she had done so much to assemble and put together as part of a campaign—was presented to the House.

Erika’s story stands in stark contrast to that of Liz Oakley. When Liz was diagnosed with pancreatic cancer in January last year, it took just 12 days for her to be scheduled for surgery—the only cure for pancreatic cancer. Liz had already survived breast cancer twice. She is both a testimony to the remarkable progress that has been made in the treatment of other cancers and living proof of what is possible for patients with pancreatic cancer.

There is a compelling case for treating pancreatic cancer as a cancer emergency and for creating optimal fast-track pathways. Far too many people have been lost to this disease too early. For far too long, pancreatic cancer has been forgotten, neglected, written off. The Government can commit today to changing that. Will the Government look at developing optimal pancreatic cancer pathways? Will they evaluate rolling out fast-track surgery models across England? Will they commit to the ambition of allowing people with pancreatic cancer to access treatment within 20 days of diagnosis by 2024?

Thankfully, we have seen huge changes for other cancers. Lung cancer is a good example. Back in 2005, the national lung cancer audit showed that patients with operable lung cancer were not referred for surgery, and it was shown that the surgery rate could be tripled in a cancer network within one year. Between 1985 and 2005, there were just 3,000 operations a year; that increased to 7,250 in 2016. That is inspirational. It shows what we can do. It shows what we can achieve when a cancer is treated as a cancer emergency, as pancreatic cancer must be now. Hope is contagious. Let us make it happen.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 4.34 pm.

16:18

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Scunthorpe (Nic Dakin) for the articulate and passionate way in which he made his case. He has a long history of campaigning on this issue, and long may he continue. We know that we need a conscience when it comes to driving improvements throughout the health system, and it is always instructive to hear people’s experiences. I thank the hon. Gentleman for all the work that he does in chairing the all-party parliamentary groups on cancer and on pancreatic cancer.

I am very grateful to the hon. Gentleman for sharing the stories of Ali Stunt, Maggie Watts and Erika Vincent, because we need to remember that we are not talking about some vague disease that happens to other people; it happens to real human beings and their lives are incredibly affected by our failure, or otherwise, to take action in these spheres. They also inspire us. The fact that Erika Vincent dedicated so much of her final days to raising awareness is inspirational, and we would be very poor if we did not take action following that.

I also thank the hon. Member for South Shields (Mrs Lewell-Buck) for sharing her family story. Again, she illustrated that this can happen to any one of us. When we are in a position to do something about it, we must act.

No one will be surprised that tackling cancer is a major priority for the Government. We have presided over year-on-year increases in survival rates, so that today they are at the highest levels recorded. However, we should not rest on our laurels and be complacent. That is good progress, but we must do better—our ambition is to do better.

Last October, the Prime Minister announced a package of measures with the aim of detecting three quarters of all cancers at stages 1 or 2 by 2028. These measures will see improvements to our screening programmes and new investment in state of the art technology, to further improve diagnosis and boost long-term research and innovation.

That represents the cancer element of the NHS long-term plan, published in January, which sets out how we will achieve our ambition of 55,000 more people surviving cancer for five years in each year from 2028. Colleagues will be aware that the Secretary of State is placing considerable emphasis on prevention, so we need to look at what else we are doing, in terms of screening and research, to tackle these issues. All of that is to be commended, but we must not be complacent. We can learn from the examples of Belgium and the USA, where much greater advances have been made.

The hon. Member for Scunthorpe reminds us all that survival rates for certain cancers remain stubbornly low, including for pancreatic cancer, which is the least survivable of all cancers and so merits special attention. As he alluded to, late diagnosis is a key reason for that. We know that less than a quarter of people have their cancer diagnosed at stage 1 or 2, compared to half of people for all other cancers.

The new early diagnosis ambition represents a huge opportunity to change that for three reasons. First, the ambition must apply to all stageable cancers, including pancreatic cancer. NHS England is working with Pancreatic Cancer UK and others on how we can adjust the current national measure of early diagnosis to include pancreatic cancer for the first time.

Secondly, within that headline measure, the Government are committed to publishing regular data on individual cancers. We need to be transparent about how we are performing in this area, so that we can identify which cancers we are tackling in terms of early diagnosis, and which need more attention. That will provide a powerful catalyst for all the charities to come together and work with NHS England to deliver that change.

[Nic Dakin]

I thank the Minister for the serious and thoughtful way in which she is responding to the debate. Does she think that there is an opportunity to look at a 20-day target for moving from diagnosis to treatment, which would make a real difference to this cancer?

[Jackie Doyle-Price]

Indeed. I will come to that point, if the hon. Gentleman bears with me.

I would like to highlight the other unsurvivable cancers that suffer from late diagnosis, which, as well as pancreatic cancer, include cancer of the stomach and oesophagus. We must ensure that we also focus on those cancers.

The focus of the hon. Gentleman’s speech was that pancreatic cancer should be treated as a cancer emergency. Pancreatic Cancer UK’s recent demand for faster treatment set the ambition to treat pancreatic cancer within 20 days from diagnosis by 2024. The hon. Gentleman mentioned Liz Oakley. The fact that she had treatment within 12 days shows that it can be done. We should embrace that level of ambition. While we recognise that great achievement and advance, we should ensure that that is the experience across our national health service.

What I will say does not quite meet the hon. Gentleman’s request, but I think he will welcome the direction of travel. NHS England will shortly be introducing a faster diagnostic standard of 28 days for all cancer patients, including those with pancreatic cancer. That will mean that every patient can expect a definitive diagnosis—yes or no—within 28 days. Taken together with the 62-day referral to treatment standard, all patients should expect to start their treatment within 34 days of diagnosis.

I know that is not quite the target that the hon. Gentleman set me, but if we can ensure the whole system works to that efficiency, we will make great strides in tackling this. I cannot emphasise enough that we should never lack ambition in how far we are prepared to drive improvements. That standard of treatment within 34 days is the maximum, but I expect trusts always to treat patients according to clinical need and to prioritise those needing urgent treatment, such as Liz Oakley, who received treatment within 12 days.

We welcome Pancreatic Cancer UK and all other stakeholders working with the pancreatic cancer clinical community to develop practices to shorten the time before treatment even further. It is important that we continue that dialogue, not just to be reactive, but to build confidence, because poor survival rates are well understood. We do not want people to be diagnosed and automatically think that there is no hope. There is always hope, and our NHS services must ensure that people understand that.

NHS services for pancreatic cancer have improved significantly in recent years. I am grateful that the hon. Gentleman accepted that. In the spirit of demanding more, it is always good to look at how far we have come. I thank him for that. There are now clearer diagnostic pathways. Decision making is done by specialist multi-disciplinary teams.

16:26

Sitting suspended for a Division in the House.

16:30

On resuming—

[Jackie Doyle-Price]

I will try to remember where I left off.

Obviously, cancer treatment plays a big part in our long-term plan for the next 10 years, which sets out positive developments at every stage of the pancreatic cancer pathway. Clearly, we need to look at issues such as prevention, as we have mentioned, but the plan also signals a shift towards more risk-based approaches to screening. We will begin to test family members of cancer patients where they are at increased risk. Data suggests that 10% of pancreatic cancer cases are inherited, so screening can be a big tool with which to combat the disease.

Primary care networks will play an important new role in supporting GPs to build on the doubling in referral volumes that we have seen since 2010. Rapid diagnostic centres will provide a new referral route for patients, particularly those who go to their GP with vague symptoms, and will ensure that they get checked out quickly and accurately. From next year, many more newly diagnosed cancer patients will be offered genomic testing to help to inform their treatment planning. We will continue to invest in safer and more precise treatments, including immunotherapies, to improve survival rates. We are completing a massive upgrade of radiotherapy services across England, which will increase the support that patients can access. Finally, the plan reaffirms our commitment that every person diagnosed with cancer will have access to personalised care, including a needs assessment, a care plan and health and wellbeing support.

I will quickly say something about research. In 2017, Pancreatic Cancer UK and four other charities launched the less survivable cancers taskforce, which represents all cancers with stubbornly poor survival rates and calls for improvements in research. My hon. Friend the Member for Winchester (Steve Brine) spoke at the taskforce’s launch and put the Government’s full support behind it. Research into innovative medicines and treatments is extremely important. We accept that there is an unacceptable research funding gap, with less survivable cancers receiving five times less research funding than more survivable cancers, which we need to address. Cancer Research UK has prioritised increasing research into hard-to-treat cancers, including pancreatic cancer, but more needs to be done.

In closing, I reiterate that, as a Government, we have made considerable progress, but there is much more to be done. I am grateful to the hon. Member for Scunthorpe and all hon. Members who have taken an interest in the debate. I know that they will hold the Government’s feet to the fire to ensure that we carry on making real improvements in treating and supporting people with pancreatic cancer.

Question put and agreed to.

Resolved,

That this House has considered treatment for pancreatic cancer.