Health: Cancer

Earl Howe Excerpts

Monday 20th May 2013 Lords Chamber

[Lord Saatchi]

To ask Her Majesty’s Government in what proportion of deaths recorded as caused by cancer is the actual cause of death the treatment of cancer.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

The Office for National Statistics publishes national cancer mortality data annually. Data are collected where cancer has been recorded as the cause of death, but not on treatment for cancer as the cause of death. I therefore regret that I am unable to provide this information.

[Lord Saatchi]

My Lords, I thank my noble friend for that reply. The point of this Question is that there is no answer to it. Since I tabled the Question, I have received an estimate from within the medical profession that last year 15,000 people in Britain were killed by cancer treatment rather than by cancer. We do not know whether 1% or 100% of patients die as result of the treatment; what we do know is that cancer drugs do such damage to the immune system that the patient is helpless to resist fatal infections such as MRSA, E. coli or septicaemia. Does my noble friend agree, as I think he has, that the official statistics for the UK cannot distinguish between cancer death and treatment for cancer death? Is this not because the ONS, under WHO guidelines, records only the single underlying cause of death? In other words, it does not record the sequence of causation, sometimes known as the sequence of conditions, that led to the death. This is supposed to be the era of big data. Will my noble friend review the limitations of cancer mortality statistics in order to assist scientists and doctors to have the information to move forward innovation towards a cure for cancer?

[Earl Howe]

My Lords, I agree that it is important to have more information on the effect of cancer treatments on mortality. New data collections which will provide more detail in this area are under way. The systemic anti-cancer therapy dataset will enable better information to be collected about deaths after the delivery of chemotherapy, and the cancer outcomes and services data set will provide information in respect of death after surgical treatment. However, it is important to make one point here: it can be hard to identify the precise cause or sequence of progression of factors resulting in death, particularly for those with end-stage cancer or who are particularly frail and are experiencing physical deterioration. I do not think that it can ever be a precise science.

[Lord Campbell-Savours]

My Lords, what about the circumstances where a person awaiting treatment in a congested cancer clinic is surrounded by patients who are coughing and spluttering? There will be consequential effects on immunity for those being treated. It may well be the drop in immunity that kills the patient, not necessarily the original cancer.

--- Later in debate ---

[Earl Howe]

My Lords, the noble Lord makes a good point. When recording the cause of death on a medical certificate of cause of death, doctors are required to start with the immediate, direct cause of death and then go back through the sequence of events or conditions that led to death until they reach the one that started the fatal sequence. This initiating condition will usually be selected as the underlying cause of death according to the International Classification of Diseases coding. However, that does not mean that someone with a primary cause of death of cancer will not have pneumonia, or whatever it happens to be, recorded somewhere on the death certificate.

[Lord Patel]

My Lords, does the Minister agree that as we progress with the current research into the molecular tagging of drugs that have the same molecular make-up as the cancer itself and nanomedicine we will be better able to target cancer tissue while leaving normal tissue alone? That will save lives lost to the complications related to treatment.

[Earl Howe]

My Lords, I agree, and I am confident that over the years ahead we will see a much greater emphasis on stratified medicine, particularly if we can relate treatments to genomic data.

[Baroness Jolly]

My Lords, everyone—families, statisticians, managers and, indeed, researchers—wants accurate death certificates. What are the arrangements to monitor the recording of death as part of clinical governance?

[Earl Howe]

My noble friend has raised a very live issue because consultation will begin shortly on the Government’s plans to reform the governance relating to death certification. The proposed reforms will simplify and strengthen the process for death certification by appointing local medical examiners to provide independent medical scrutiny of the cause of death for all deaths not subject to coronial investigation. The medical examiner will improve the accuracy of information recorded on medical certificates of cause of death because the process will include a review of medical records and consideration of the circumstances leading to death.

[Baroness Symons of Vernham Dean]

My Lords, does the Minister agree that some forms of cancer, particularly the leukaemias and, within those, acute myeloid leukaemia, need a very aggressive form of chemotherapy in order to maintain life and that that necessarily includes the very high risk of infection through blood poisoning or diseases affecting lung capacity? Where the only alternative to very aggressive forms of chemotherapy is the certainty of death, does not the noble Earl agree that these forms of chemotherapy remain enormously important in the treatment of cancer?

[Earl Howe]

My Lords, for many patients, that is so, but of course the decision whether to administer aggressive forms of treatment must be one for the individual patient in consultation with his or her clinician.

[Lord Ribeiro]

My Lords, we have 11 cancer registries in the United Kingdom and Public Health England is due to merge eight of the English cancer registries with the National Cancer Intelligence Network this year. The United States and Sweden have national registries, and the benefit of that is that they are able to establish not only the diagnosis and causation but also the impact of treatment on patients and provide much more information to improve the quality of outcomes for patients. Is it not time that we had a national registry, mindful that independence for Scotland may put this at some risk?

[Earl Howe]

My noble friend raises a very important issue. I agree that it is important to draw together as much information as we can about causes of death from across the country. However, I am advised that the question of whether a cancer-related death can be attributed to the underlying disease or to the treatment cannot be answered comprehensively from information collected as part of the death certification process or the cancer registration process or, indeed, a combination of both. However, as I hope my previous answer indicated, I am sure that this is a developing science.

[Baroness Brinton]

My Lords, the Minister has kindly explained the tracking of the causes of death. What advice is given to doctors about recording dementia, which is often excluded when somebody has died of cancer? In the case of my late father, it was possible to get it added, but I suspect it may also be one of the reasons why dementia is underrecorded in this country.

[Earl Howe]

My noble friend asks a very good question. I will write to her on the specific question of dementia. I understand that the completed medical certificate of cause of death is given to the bereaved family which will present it to the registration service to register the death. The registrar will check that the doctor has completed the certificate fully, so it could then be open to the family to question anything that is not quite right on the certificate.