Blood Cancer

Baroness Laing of Elderslie Excerpts

Friday 23rd November 2018 Commons Chamber

[Henry Smith]

I am grateful for the hon. Gentleman’s intervention, and I pay tribute to him for his contribution to this debate and for raising this matter in this place just yesterday. I absolutely endorse what he says about the importance of transplantation.

Last week, the APPG held its latest meeting on the timely topic of ensuring that patients have access to the best drugs and treatments, ahead of the publication of the NHS plan. In recent months, there have been some significant decisions regarding treatments for blood cancer on the NHS. In September, CAR—chimeric antigen receptor—T-cell therapy was approved for entry into the cancer drugs fund by the National Institute for Health and Care Excellence and NHS England to treat children and young people with relapsed acute lymphoblastic leukaemia. CAR-T therapy is a new type of therapy that modifies a person’s infection-fighting T cells to better spot and kill cancer cells. It could offer people with certain hard-to-treat blood cancers the chance for long-term survival, or even a cure.

I was pleased to question my right hon. Friend the Prime Minister at Prime Minister’s questions about CAR-T therapy following the NHS England announcement. I continue the call I made that day for the Government to ensure that a focus on blood cancer awareness, diagnosis and prevention will continue into the future. With that in mind, will the Minister update the House on when people with blood cancer are likely to benefit from CAR-T treatment and on whether the health system is ready for this type of personalised medicine?

Additionally, NHS England changed its mind recently and allowed ibrutinib to be used for patients with chronic lymphocytic leukaemia after three years’ remission. The development of new drugs is ongoing. Bloodwise estimates that over one third of all indications for which drugs are funded on the cancer drugs fund are for blood cancer, which highlights not only the challenges we face, but the potential to help.

In January, the APPG launched its inaugural report, “The ‘Hidden’ Cancer—The need to improve blood cancer care.” Key to this is the word “hidden”. Blood cancer is known as the hidden cancer because although patients may indeed be receiving or waiting to start treatment, they may not be displaying any obvious or visible signs of ill health.

I am careful to try to refer to patients and their support networks, especially in this context, as the impact of diagnosis on a patient’s family must also be considered, especially when children are involved. This is particularly the case for patients on so-called watch and wait. That is typically an option only for people with few or no worrying symptoms, whose quality of life and prognosis will not be affected by delaying treatment, and it is recommended for those with blood cancers or related conditions that are stable or slow-growing. However, if someone has been told that they have cancer and, at the same time, they know that they will literally watch and wait to see when they are in a position to begin treatment, it is understandably disconcerting, to say the least. Patients on watch and wait told the APPG inquiry that specific emotional support was required to help them to come to terms with what was happening. Approximately 27,000 people with blood cancer are currently on watch and wait in the UK. To put this in context, that is 13% of those living with blood cancer.

Turning to mental health, anyone with experience of living with cancer or supporting a friend or family member who has done so will know of the dedication of NHS staff and health workers in seeking to do all that they can to provide support. However, it is vital that these staff are given the tools to ensure that patients are fully equipped mentally through the psychological support that they receive. Our APPG report recommended:

“Patients should have access to the full range of emotional and psychological support services throughout their treatment, for themselves and their families”.

The Government have put mental health on a par with physical health. As such, I would be grateful for the Minister’s assurances that blood cancer patients will receive the psychological support that they need after diagnosis, during treatment and after it has been completed.

I congratulate the hon. Member for Alyn and Deeside (Mark Tami) again on his Adjournment debate yesterday on psychological support after cancer treatment. By working together on a cross-party basis, it has become powerfully apparent to me that we can make a significant difference. Indeed, I have mentioned that only last week, the blood cancer APPG held its latest meeting on access to drugs and treatments for patients. We were fortunate to be joined by MPs, charity representatives and, of course, patients, one of whom said something that has remained in my mind. She said that patients

“don’t know if they’re living or dying”.

That highlights succinctly and powerfully the importance of this work and the importance of patients, politicians, cancer charities, the Department of Health and Social Care and the wider national health service in ensuring that patients are supported as well as treated.

One of the most striking passages of our APPG report referred to the long-term nature of blood cancer, and how it is different from solid tumour cancers. Respondents to our inquiry found that the term “living beyond” blood cancer was irrelevant. They will probably never live without blood cancer—it will remain part of their life—and very few of those patients have access to the recovery package. Indeed, one respondent even said that they did not know what the recovery package was, which is a point of concern. The recovery package assists patients after their cancer treatment has ended so that they can seek to return to their normal life.

I welcome the fact that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine) recently reiterated that

“the recovery package is being commissioned and delivered in full or in part by many Clinical Commissioning Groups and providers across England”.

He continued:

“NHS England’s aim is to accelerate the process to ensure full implementation by 2020 so the package will be available to all cancer patients across the country regardless of location.”

He also stated that NHS England was

“building up a picture of current provision to help target future work to support rollout.”

I should be grateful for clarification from the Minister for Health on how support for blood cancer patients is included in this analysis.

Turning to data collection, the inclusion of blood cancer in a range of data collection initiatives will help policy makers to gain a greater understanding of the condition and how patients can be supported. For example, clinical commissioning groups and cancer alliances do not group blood cancer into a single disease area, unlike the national cancer patient experience survey, which means that blood cancer currently receives less attention and therefore fewer resources. The inclusion of blood cancer in the cancer dashboard, which only covers breast, colorectal, lung and prostate cancers, would be a step forward for patients.

Earlier this year, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester, said in a written answer:

“A second iteration of the dashboard is being considered by the National Cancer Transformation Board with a wider ambition to include rarer cancers and cancers with a lower incidence, such as blood cancers, as the dashboard develops.”

May I ask when we may expect such a development to come into effect?

GP surgeries are a vital part of the NHS. Like all MPs, I receive correspondence from my constituents on the subject of access to GPs. Indeed, in the NHS plan, we need enhanced support for doctors and their capacity to see patients every day, both in Crawley and up and down the country. While the A&E in Crawley Hospital was closed under the previous Government, Crawley Hospital urgent care centre is now open 24 hours a day, seven days a week. I urge the Minister to ensure that hospital services continue to come back to sites such as Crawley Hospital, while at the same time ensuring that the resources are in place to enable our constituents to access their GP, not on the other side of the town or county, but in their own local area.

GPs need more assistance to detect and flag up blood cancer. A GP will see, on average, eight cases of cancer per year, only one of which will be blood cancer. The number of GP visits needed before a cancer diagnosis is significantly higher for blood cancer patients than for people with other forms of cancer. Someone with cancer will of course want to be diagnosed the first time they see their GP with symptoms, but one in six blood cancer patients needed to visit their GP three, four or even more times before diagnosis. Only one in 42 breast cancer patients required such regular visits to be diagnosed with their condition.

In the wider debate, the numbers and the statistics are important. Not far shy of a quarter of a million people are living with blood cancer in the UK, and one in 19 people will develop blood cancer at some point in their lives. In Crawley there were fewer incidents of blood cancer than either breast or prostate cancer, but there were more blood cancer deaths than from either of those other forms of cancer. The challenges are immense. Blood cancer is the UK’s fifth most common cancer, and the third biggest cancer killer. However, there are reasons to be positive. Over a period of almost four decades, from 1971-72 to 2010-11, 10-year survival rates for leukaemia, one of the most common groups of blood cancer, increased from 7% to 46%. Among children, the figure has trebled to 81%.

In all those figures are the individuals who live with blood cancer, who care for family members who are patients, or who are advocates on behalf of those affected by the condition. My constituent Bill Bedford was diagnosed with myeloma in September 2016. He has undergone a stem cell transplant operation and is now fortunately in remission. Bill is one of many patients who are seeking to give something back. He has undertaken a 310-mile cycle ride, from London to Paris, to raise funds for Myeloma UK. Seven-year-old Ebonie Musselwhite, also from Crawley, was diagnosed with acute lymphoblastic leukaemia two years ago. About 650 people are diagnosed with ALL each year in this country, half of them children. Crawley Fire Station and Crawley Lawn Tennis Club are just two of the local organisations that have held fundraising events to help contribute to the cost of support for Ebonie. Angus Rowland, a young man living just outside Crawley, was diagnosed with acute myeloid leukaemia in 2010. Sadly, he died in May 2011, just 14 and a half years old. The Angus Rowland Forget-Me-Not Walk and Run took place in October, just outside Crawley, to raise funds for Bloodwise in Angus’s name.

I said at the APPG report launch that we could not just stand there and be pleased with what we had published in our first report. Rather, it must form the basis of a continued programme of work to effect lasting change. To people living with blood cancer right now, who may be on watch and wait, who may be undergoing treatment, or who may have only just been diagnosed, 1 say this: there are people in Parliament who are on your side, and we will stand up for you. We want to help, and we will keep the pressure on the Government and the NHS. To those who may have undergone treatment, who may be having treatment now, or who simply want to ensure greater support for blood cancer patients, my message is simple: contact your local MP and ask him or her to contact the Department for Health and Social Care, NHS England and local clinical commissioning groups. Let us continue to raise awareness, so that blood cancer is no longer the hidden cancer.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am delighted to welcome back to the Dispatch Box the Minister, Mr Stephen Hammond.