Pancreatic Cancer

Stephen McPartland Excerpts

Monday 8th September 2014 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure as always to speak with you in the Chair, Mr Chope. I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on the excellent way he opened the debate and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) on working with my hon. Friend to secure the debate and his very moving contribution. I join them in congratulating Mrs Maggie Watts on gaining more than 106,000 signatures for the petition. Anyone who takes or promotes petitions through social media will know what a mountain 100,000 signatures is to climb.

Mrs Watts started the e-petition to help to push pancreatic cancer higher up the political agenda, to raise the disease’s profile and to encourage more funding and research into it. That is certainly starting to happen with the debate today. As Mrs Watts has said,

“pancreatic cancer has been neglected both in terms of funding and awareness for way too long.”

The fact that her husband stood

“no better chance of survival in 2009 than his mother did in 1969 demonstrates completely how little progress has been made.”

As the petition states, pancreatic cancer is the

“5th leading cause of UK cancer death, with the worst survival rate of all cancers”.

Yet, as we have already heard, it receives only about 1% of the research spend. Further, the five-year survival rate of less than 4%, as we have heard,

“hasn’t improved in over 40 years, whilst survival rates for other cancers have.”

It is worth looking at those survival rates. The current survival rate for bowel cancer is 54%; it was 22% in 1971. The current survival rate for breast cancer is 84%; it was 56% in 1971. For prostate cancer, to which I recently lost a friend, the current survival rate is 81%; it was 31% in 1971. From those figures, we can see that pancreatic cancer lags behind. Clearly, as has already been discussed, more funding and more public awareness are vital so that progress can be made, both in earlier detection, to which hon. Members have already referred, but, ultimately, in better survival rates.

Pancreatic cancer is termed the silent killer. As we have heard, many of its symptoms mirror other, less critical illnesses. We have also heard that GPs may not recognise these early enough, looking first at other possible causes, resulting in lost time before diagnosis. That is serious because in many cases the prognosis will be terminal by then. It is quite a disturbing fact that deaths from pancreatic cancer did not just stay the same but increased between 2002 and 2013, while deaths from most other cancers declined.

It is clearly difficult that the signs and symptoms of pancreatic cancer can be late occurring and non-specific. As my hon. Friend the Member for Scunthorpe said earlier, these non-specific symptoms may lead to patients being treated or investigated for other more common illnesses, such as gallstones, before a diagnosis of pancreatic cancer is made. This in turn can mean significant delays in diagnosis and treatment, including potential curative surgery. As we have heard—I am sure we will come to this point and put more questions to the Minister on it—we are talking about patients whose symptoms and diagnosis do not fit our system. Our system needs to change, so that these patients get the investigations and diagnosis they want.

[Stephen McPartland (Stevenage) (Con)]

Is the hon. Lady as shocked as I am that apparently 48% of people are diagnosed with pancreatic cancer following an emergency admission, as opposed to following a referral from their doctor or following a screening?

[Barbara Keeley]

Yes, indeed I am. As is always the case in these debates, I was coming to that point. We have had an excellent briefing from Pancreatic Cancer UK, which says that there are symptoms that lead patients to visit their GPs. As the briefing said:

“If patients can present at an earlier stage and GPs are better trained and supported to identify and investigate the possible signs of pancreatic cancer, more people will be diagnosed at a stage when curative surgery is still an option.”

The NHS England cancer patient experience surveys have shown that more than 40% of pancreatic cancer patients visit their GP three or more times before being referred to hospital. I found examples in case studies that were many more times than that. Some people, as in the tennis ball example mentioned by my hon. Friend the Member for Scunthorpe, went to GPs 10, 15 or 16 times. That is not acceptable. By comparison, figures show that 75% of all cancer patients combined are referred to hospital after only one or two visits to their GP. That is as it should be for this dreadful disease.

The hon. Member for Bracknell (Dr Lee), who is no longer in his place, spoke about the difficulties for GPs. Pancreatic Cancer UK found in a survey it conducted that, although most GPs could list one or two of the symptoms of pancreatic cancer, half of GPs were not confident that they could identify the signs and symptoms of pancreatic cancer in a patient. All these facts underline the need for better awareness of pancreatic cancer. Leading charities want to see a campaign based on the specific symptoms of pancreatic cancer.

The briefing reminds us of the need to challenge perceptions of pancreatic cancer as a disease affecting small numbers of elderly, male patients. Although it is true that incidence increases with age and the majority of cases are reported in older patients, it may be that they would be younger if the diagnosis and investigations were better. However, about 25% of cases still occur in people under the age of 65. We have heard examples concerning people in their 40s. The disease affects men and women equally.

Pancreatic cancer awareness month in November, which the hon. Member for Redditch (Karen Lumley) referred to, will help raise awareness. We know the awareness-raising value of storylines such as the one in “Coronation Street” with Hayley Cropper, which developed the pancreatic cancer that led to the character’s death and helped to create a great upsurge in internet traffic, inquiries and donations to pancreatic cancer charities. Like my hon. Friend the Member for Scunthorpe, I pay tribute to Julie Hesmondhalgh for her support for campaigns and for the petition that led to the debate. We need to see much more of that.

We have had excellent briefings for the debate, but I wanted some insight into treating pancreatic cancer. I asked a doctor working in palliative care. He described his thoughts and his experience of treating patients with pancreatic cancer in these words:

“The issue is not only one about cure rates but that pancreatic cancer presents a massive challenge to the health service in terms of the consequences of this awful disease.

The symptom burden in patients with pancreatic cancer is both substantial in the number of patients affected but also in the intensity of those symptoms.

From the research, 75-80% of patients present with pain at initial presentation. Of these, 44% of the patients admitted to a palliative care setting have severe pain.

Because of the anatomy of the pancreas, many of these patients will have infiltration of the coeliac plexus causing neuropathic pain which is often difficult to treat and may require complex pain interventions including nerve blocks.”

Another important factor is, of course:

“Pain is linked with depression and anxiety…it underlines the importance of treating pain.

Whereas, overall, advanced cancer patients…have a 30% chance of developing major depressive illness this rises to 50% for pancreatic cancer one of the highest instances of depression for any cancer.

The incidence of obstruction of the bile duct is common requiring hospital admission for stenting in the last months”—

and weeks—

of life when patients would rather be at home.

In short, not merely in terms of survival and early diagnosis is pancreatic cancer a major health issue, it constitutes a major burden of symptoms and distress for patients and their families, requiring careful, sensitive integrated care between primary care, hospital staff, oncology and palliative care services.”

Low awareness of pancreatic cancer among GPs and the public, late diagnosis and poor survival rates are not the only issues we have to deal with. Even after people are diagnosed, there is a huge burden of symptoms for the NHS to treat. Those symptoms can mean misery, depression, pain and surgical complications for the patient with pancreatic cancer. As the Minister will know, not all patients are able to benefit from the type of careful, sensitive, integrated care that has been described as what they need. It is clearly an aspiration for the health service, but it is not always achieved.

There is much to do, and the Minister has already been asked to take several actions, but I will ask her, too, because we should all press those points. What action could the Minister take, and what action is she taking, to boost public awareness of pancreatic cancer? It is vital that its symptoms should be better understood by the general public. What can she do to boost awareness among GPs and other medical professionals of pancreatic cancer signs and symptoms? As we have heard and will repeatedly hear, survival rates remain stubbornly low, and mortality rates have been increasing even as they fall for other types of cancer. Will she consider ensuring the development of specific awareness campaigns through appropriate media? The success of the “Coronation Street” story underlines the importance of that for all aspects of the campaign. What action will she take to end the state of affairs in which a patient can be pictured as a tennis ball? What can be done to give GPs more direct access to CT scans or ensure that patients with symptoms that could be pancreatic cancer have all the appropriate investigations in a more timely way?

As my hon. Friend the Member for Scunthorpe and the all-party group have said, it is time to change the story. I hope that the debate will ensure that change takes off, from today.

--- Later in debate ---

[Grahame M. Morris (Easington) (Lab)]

Thank you for calling me, Mr Chope. I apologise for not being present for the whole debate; I meant no discourtesy to colleagues. I wanted very much to speak in the debate. I begin by congratulating my good and hon. Friend the Member for Scunthorpe (Nic Dakin) and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who made a very moving contribution. I also thank the Backbench Business Committee and, indeed, all the volunteers. I had the pleasure of meeting Maggie Watts, but there are also many hundreds of others working in charities and as volunteers who have campaigned so effectively on this issue; they have helped secure the signatures to get this debate on what is very often a forgotten and neglected form of cancer.

I know that there are time constraints, but there are some specific issues that I want to raise with the Minister. I will just make some general points and then move straight to my questions. We know from earlier contributions that pancreatic cancer is not an uncommon cancer. My understanding is that by the time this debate has concluded, three more people will have lost their lives to the disease.

We heard in the contribution from the hon. Member for Basildon and Billericay (Mr Baron) that the UK still lags behind most other European countries when it comes to cancer survival rates. To be fair, there have been significant improvements in cancer treatments across the board in recent decades, but as we are aware the rates for pancreatic cancer, at 5.2%, have virtually stood still in the past four decades, so this is not a criticism of the current Minister or the present regime—the present Government.

The very nature of pancreatic cancer contributes towards poor survival rates. I do not intend to go over the arguments put so eloquently earlier about the difficulty of getting a proper diagnosis and the lack of an effective pathway to make the necessary early referrals. However, one thing that I am concerned about—I want to put this point to the Minister—is this. Yes, it is very important to have awareness campaigns, and I pay tribute to the campaigners who have brought this subject to Parliament today, but if we are to have real progress, there need to be improved treatments as well. Pancreatic cancer receives just 1% of the National Cancer Research Institute partners’ research spend. That equates to £625 per death.

[Philip Davies in the Chair]

I fully understand that we one cannot equate such things in financial terms, but that compares with almost £3,500 per death on breast cancer, the campaign against which receives much more public attention. If we as politicians—I am talking about all politicians; this is not a criticism of the Minister or the Government—are serious about improving survival rates for pancreatic cancer, our rhetoric must be backed up with firm action on the allocation of resources.

We have heard that relatively few treatment options are available for patients with pancreatic cancer, and research into the development of new drugs and treatments is key if we are to bring survival rates for pancreatic cancer down towards those of other common cancers. Over the past week or so, the case of the little boy Ashya has been in the news, and we have heard about the terrible circumstances and trauma that his parents went through in being unable to access the advanced radiotherapy that they felt was an appropriate form of treatment for their son. The hon. Member for Lancaster and Fleetwood has already referred to the potential of advanced radiotherapy. Forms of the treatment such as NanoKnife and CyberKnife, which can target tumours very precisely with intense bursts of radiation, may be particularly effective for some, although not all, pancreatic cancer patients.

I know that the Minister is sick of me going on about advanced radiotherapy, but we are not doing as much as we should to develop the evidence base for the treatment. I fully understand that it is not suitable for all types of cancer, or even for all types of pancreatic cancer; there are a number of different forms. The National Institute for Health and Care Excellence insists that before it allows routine use of the treatment, particularly in the NHS, there must be an evidence base.

Many of the cancer charities that I have spoken to have argued that, as a matter of urgency, the technology for advanced radiotherapy must be verified. I make an appeal to the Minister on that. Patients already receive advanced radiotherapy for other cancer types, and the treatment is available for private patients. I fully understand that we need to have an evidence base and see what is effective in different circumstances. Until research into advanced forms of radiotherapy for the treatment of pancreatic cancer is increased and the viability of the technology can be properly verified—until we actually grasp the nettle and fund the research and the trials—NHS patients will continue to miss out.

[Stephen McPartland]

The hon. Gentleman and I have debated radiotherapy and chemotherapy several times. I am proud that my NHS hospital trust was given the first CyberKnife by a wealthy donor, so it has the evidence required for advanced techniques and advanced radiotherapy. I sound a note of caution, however. My constituents have to make a 60-mile round trip to access that treatment. We have just opened a chemotherapy unit that can be used by someone who has cancer in Stevenage, but if they receive radiotherapy they often have to make a 4,000-mile journey over the course of their treatment. Although patients can have advanced radiotherapy, the difficulty is accessing that treatment.