Oesophageal Cancer

Julian Lewis Excerpts

Monday 23rd February 2015 Commons Chamber

[Mike Weatherley]

My hon. Friend makes a very important point that I was not going to cover, and I thank him immensely for doing so.

Crucially, as with many other types of cancer, the outcome of oesophageal cancer depends on how advanced it is when it is diagnosed. The reason not many people can have surgery is that by the time a difficulty in swallowing is recognised, the tumour has become fairly large and has spread. As my hon. Friend pointed out, the surgeons see most people when they are already too late for curative treatment, which makes it difficult to identify survival rates for each individual stage of the disease.

What measures would I like the Minister to consider? Let me make six points. First and, I think, most important, we should make the process of seeing the doctor much easier. No one should be put off from making an appointment at the first available opportunity. Access to evening and weekend GP clinics remains patchy at best, and, as we know, that has a knock-on effect on A and E departments.

Secondly, we should make every effort to improve testing at the point of contact with GPs, and to ensure that there is rapid follow-up access to hospital diagnostic tests. Giving some GPs direct access to hospital specialist tests such as endoscopies and CT scanning would speed up the process of diagnosis.

Thirdly, we should educate patients so that they recognise the symptoms of oesophageal cancer. That will lead to earlier detection of cancer, which in turn will lead to higher survival rates. A good oesophageal awareness campaign is currently running on television.

Fourthly, 1 believe there are some “quick wins” which, if implemented, could speed up processes, remove inefficiencies and save money. For example, at the moment if someone is referred for a chest X-ray and the findings are abnormal, the results go back to the consultant or GP and the person has to have another appointment before they can be referred for an additional test, such as a CT scan. If a chest X-ray was found to be abnormal and the person was then referred straight for a CT scan, it would save on unnecessary GP or consultant appointments, and ensure that when the person is seen, their GP or consultant has all the information they need to make a diagnosis and set out next steps.

Fifthly, another factor in poor care is that it is almost invariably because of pressure on specialists due to the volume of work. When campaigns are announced by the Government, they create a surge in demand, which causes problems for medical staff because they cannot cope with the high volume of work. I would like the Minister to consider allocating extra resources for endoscopy. Targets and high outputs mean that patients are treated as statistics rather than as individuals. Take this quote, for example, from an upper-GI surgeon:

“I get lists of potential 62 day target breaches with no details of the patients themselves. We see about 20 patients in two hours in our cancer clinic on the one morning we have for these appointments—that equates to just six minutes per patient. In order to give patients dignity and respect, most doctors would need an hour per patient to talk them through their diagnosis, treatment and surgery.”

Here is a similar point direct from another specialist surgeon:

“I fully support the ‘Action Against Heartburn’ organisation emphasising the need to take seriously symptoms of persistent heartburn and dysphagia, and not having more and more medications without investigation.”

This will increase demand on endoscopy services significantly, as well as CT scanning, which of course would need extra funding to cope. However, the increased detection of early disease will enable more minimally invasive endoscopic therapy, avoiding surgery and saving money.

[Dr Julian Lewis (New Forest East) (Con)]

I recently had the advantage of an intensive briefing on oesophageal cancer from Professor Tim Underwood, a specialist at Southampton general. My hon. Friend may be interested to know that it is developing a technique that would enable the discovery of the cancer cells earlier and without an endoscopy being carried out. Research is constantly going on to try to remedy the very problem that he has identified so clearly.

[Mike Weatherley]

I thank my hon. Friend for that intervention, and my surgeons have made similar points to me. Clearly the tools are available to do that.

The sixth strategy I recommend is greater hospice care to provide end-of-life care away from hospitals that supports people and allows them to spend their final weeks and days in a place of their choice, rather than in a hospital bed.

I hope that this short Adjournment debate has two positive outcomes. The first is an increased awareness of this cancer, with many more people detecting problems earlier. If we can save lives through early detection, that has to be a good thing. The second is a commitment to additional specific resources. Of course this would mean more money being allocated, and I am well aware that there are huge conflicting demands on limited budgets, but part of this could be achieved by a quicker, more efficient diagnostic procedure. Our radiotherapy capacity is far short of what we need and access to the latest advanced techniques to spare normal tissues is limited—although I would stress again that, as my hon. Friend the Member for New Forest East (Dr Lewis) said, we do have diagnostic tools to deal with this disease and change outcomes, so it is not a huge step to save more lives.

I look forward to hearing the Minister’s comments and, hopefully, Government determination to be on the patient’s side in treating this particular cancer. We really do need to improve on just 15% of patients living longer than five years once diagnosed.