Cancer Strategy

Debate between George Freeman and Nicholas Dakin

Thursday 22nd February 2018 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to follow the hon. Member for North Warwickshire (Craig Tracey), who reminds us of the importance of using the expertise and knowledge we have in the system to accelerate improvements in outcomes.

I thank the hon. Member for Basildon and Billericay (Mr Baron), who I know is disappointed not to be here, for securing the debate and for his time and dedication in chairing the all-party parliamentary group on cancer so well and so impressively over the past nine years.

This debate focuses on the cancer strategy and the current challenges it faces. It is important to reflect on the positives, too. In the space of my lifetime, the progress on understanding, diagnosing and treating cancer has been remarkable. In the 1950s, there was limited knowledge of cancer and of the associated risk factors, the NHS had only recently emerged and there was no co-ordinated plan to treat cancer. We have come a very long way since those early days.

Cancer survival rates have doubled in the UK since the 1970s, which is a real credit to the countless health professionals, researchers, volunteers, charities and, of course, patients who have pioneered progress and who continue to do so every day. It is because of them that we are where we are today, where a person in the UK is more likely to survive cancer than to die from it.

However, massive challenges remain. My constituent Maggie Watts came to see me after losing her husband, Kevin, to pancreatic cancer in 2009. It is her fault that I have ended up as chair of the all-party parliamentary group on pancreatic cancer—thank you, Maggie. Kevin’s mother died of pancreatic cancer 40 years earlier, and the shocking thing is that Kevin’s chances of survival were no better than his mother’s. In most parts of life, the world has moved on rapidly in 40 years, but it has not done so in that part. In fact, at less than 7% in the UK, pancreatic cancer has the worst five-year survival rate of the 20 most common cancers, with the UK ranked 26th out of the 27 EU countries, according to the Association of the British Pharmaceutical Industry. Sadly, pancreatic cancer is on course to become the fourth biggest cancer killer by 2026, so action is needed now.

[George Freeman]

Does the hon. Gentleman agree that, if we are to tackle such cancer outliers, it is vital that, as well as the great research we do in the UK, we make sure that the NHS is better at adopting and taking up innovative medicines? A large part of the accelerated access review, the genomics programme and the informatics programme is about making sure that the NHS is capable not just of doing the research but of enlightened procurement to take up more quickly the drugs that work.

[Nic Dakin]

Absolutely, and I will come on to that later.

As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who introduced the debate so well, pointed out, we are now almost halfway into the five-year implementation plan of the Government’s cancer strategy for England. At this mid-point, there are concerns about the rate of progress being made, and the workforce plan is not yet as effective as we would wish.

For example, as the Royal College of Pathologists has said, it can take up to 15 years to train a pathologist. Pathology services are unable to recruit to vacant posts today, and it is anticipated that a third of consultant histopathologists will retire in the next five years, which is just one example of the challenges we face.

The lack of workforce capacity must be addressed to change survival outcomes for pancreatic cancer patients. It would be good if the Minister were able to update us on what his Department is doing to prioritise workforce planning and to provide the funding needed, based on England’s cancer workforce plan.

Fast access to quick and accurate diagnostic tests is also crucial. Many pancreatic cancer patients are diagnosed too late, when surgery—the only curative option—is no longer available. The early diagnosis inquiry by the all-party parliamentary group on pancreatic cancer, “Time to Change the Story,” heard anecdotal evidence from a healthcare professional that a CT scan can be done quite quickly but that the report can sometimes take 10 weeks. It would be helpful if the Department were able to respond to the recommendations of the all-party group’s report and to update us on the progress being made in that area.

The diagnosis of not only pancreatic cancer but other cancers, such as blood cancer, can be complex because symptoms such as back pain or tiredness are often misunderstood or misdiagnosed. Delays in blood cancer diagnosis can have a major impact on a patient’s quality of life and overall outcome, and earlier diagnosis would make a difference for many, but not all, blood cancers. To change this, recommendations for early diagnosis in the cancer strategy should be reviewed to ensure that all people with blood cancer are benefiting from early, accurate diagnosis. GPs could be encouraged to ask for a simple blood test for people displaying one or more blood cancer symptoms.

Diagnostic techniques also have the potential to guide what treatment options are likely to be effective. Last month, NICE provisionally rejected the use of five tumour profiling tests to guide treatment decisions on whether patients with a particular type of early breast cancer should also receive chemotherapy following surgery, reversing its previous guidance recommending Oncotype DX as an option. This goes to the heart of the point made by the hon. Member for Mid Norfolk (George Freeman) about using genomics effectively and precisely. Breast Cancer Now is concerned that this could be a backwards step for some breast cancer patients, especially in the context of the current cancer strategy’s welcome ambition to enable more personalised treatment.

[George Freeman]

Does the hon. Gentleman agree that on this subject of accelerated, earlier diagnosis and treatment, the work of the Institute of Translational Medicine in Birmingham, led by Professor Charlie Craddock, and the Cure Leukaemia team, working on blood cancers, has written the playbook on how we do early diagnosis? They have pulled in £200 million of free drugs for NHS patients by doing accelerated access.

[Nic Dakin]

There is some wonderful work going on, and this goes back to what the hon. Member for North Warwickshire said about the need to grab this wonderful work and move it forward, and not be held back by frameworks that are not quick enough to move with the times.

The ability to personalise treatment based on tumour profiling, which would allow many women to avoid the gruelling side effects of chemotherapy, is an essential part of improving patient care and has the potential to reduce costs associated with chemotherapy—that is a win-win. It can also give both clinicians and patients invaluable reassurance that they may safely not have chemotherapy, thus reducing overtreatment. NICE has not communicated clearly enough the reasons behind provisionally rejecting the future use of the Oncotype DX tumour profiling test, as it is unclear whether this is a result of additional clinical evidence, the cost or a combination of both. Will the Minister ask NICE to clarify the clinical and economic drivers behind the recent provisional rejection of tumour profiling tests to guide treatment decisions in a specific group of breast cancer patients?

The cancer strategy calls on Public Health England to continue to invest in “Be Clear on Cancer” campaigns to raise awareness of possible symptoms of cancer. Symptom awareness is a big challenge in terms of pancreatic cancer, as well as other cancers. A ComRes poll carried out by Pancreatic Cancer UK in 2017 found that 35% of adults in the UK would not be worried if they had a few of the potential symptoms of pancreatic cancer. Last year, Public Health England launched an exciting regional pilot on vague abdominal symptoms, including persistent diarrhoea, bloating and discomfort. Although the results for the campaign were positive, it has not yet been rolled out nationally. I would be keen to know when the Minister plans a national roll-out of the vague abdominal symptoms “Be Clear on Cancer” campaign.

In conclusion, much has been done and much is happening, but there is much more to do. Cancer alliances have a significant role to play in delivering effective change, and many are clearly making a difference. Workforce planning, early diagnosis and greater symptom awareness are key areas where we need to up our game as we move into the second half of this five-year cancer strategy.