Health: Cancer

Lord Freyberg Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Freyberg (CB)]

My Lords, I begin my speech with a startling fact: rare cancers accounted for 43% of cases in 2010, but 59% of cancer deaths. Let me repeat that: these less common cancers affect roughly four in 10 of new patients, but make up six in 10 of deaths. If we want to improve survival overall we have to improve our performance in these cancers, and our performance in caring for them is poor relative to international peers. Broadly speaking, in every case there is a 5% to 15% gap in the UK’s one year performance. In stark numbers, we kill one patient more for every 10 we treat. This cannot go on.

So what can we do to improve care in these cancers? First, we should publish risk-adjusted hospital survival by cancer so that patients have informed choice. These do not need to be put into the NHS dashboard if that will delay things. Patient advocacy groups can pick up the data and take them to their constituents.

Secondly, we should measure other important care quality outcomes, such as incontinence in prostate cancer. To give noble Lords a sense of the power of measurement, Germany recently introduced metrics in incontinence and impotence after prostatectomy. On average, about 50% of German patients are left incontinent, except in Hamburg, where the Martini-Klinik has been tracking its outcomes to drive internal performance improvements. Its rates are 6.5%—in other words, a national average of one in two men in diapers for the rest of their lives, versus one in 20.

Thirdly, we should streamline diagnosis and better connect primary and secondary care. The Government should be commended for putting one-year survival rates and emergency presentation data into the CCG dashboards, and these will drive local behaviours in this area.

Fourthly, we should centralise more services, especially specialist surgery. As an example, my sister’s cancer was in the chest cavity. Getting access for such thoracic surgery is highly complex and risky. General surgeons doing these sorts of procedures get worse outcomes than those who do them more often. It is like playing the piano; the more you practise, the better you get, yet we run shy of the necessary service reconfigurations to achieve this; and, without the data on hospital performance, one can see why. Patients can judge only convenience.

Fifthly, we should introduce national molecular testing for those cancers where there is no service incumbency, such as cancers of the upper digestive system or of the female reproductive system. We should use that patient volume to catalyse precision medicine trials in these diseases. They share the same genetic mutations as common cancer, and so, if pharma can recruit to trial, they will prove whether their drugs for common cancers work for these less common ones.

Sixthly, we must continue to collect rich clinical data on all patients with cancer out of routine care. This is essential in the emerging era of personalised molecular medicine. England has at the moment the largest and best cancer registration data collection service anywhere in the world. It is this rich clinical data linked to the molecular and genomic analysis that will allow us to understand both rare and common types of cancer. However, if we allow large numbers of individuals to opt out of the registries, then our hopes for improving care quality and finding treatments and cures for rare cancers will be lost for ever.

While some of these measures will cost money, some are cost-free. Public Health England, in the form of the National Cancer Intelligence Network, has hospital survival data, but we just do not publish them on. The Government have made a commitment to open data. This is an area where data can save lives. We must unlock Public Health England’s vaults and give the information to patients and doctors.