Oesophageal Cancer

Steve Brine Excerpts

Monday 23rd February 2015 Commons Chamber

[Mike Weatherley]

I could not agree more. Early diagnosis is one of the key recommendations that I shall be making.

It is clear that cancer is one of the leading causes of death, but there are risks for survivors as well. It is estimated that 2.5 million people are living with and beyond cancer, and we know that at least one in four cancer survivors face poor health or disability after treatment. Cancer of the oesophagus is the eighth most common type of cancer in the UK among men. Only 40% of those who are diagnosed with it will live for at least one year after the diagnosis, and, tragically, 85% will die within five years. Let me put that into a personal perspective. According to the statistics, if I survive for another four years, I shall be part of a very small minority of just 15%. When people ask why I am leaving Parliament after one term, I reply that one of the reasons is that, given such a high probability, there is a chance that I will not see out another Parliament, and that does make one think about other options.

[Steve Brine (Winchester) (Con)]

I congratulate my hon. Friend on raising this issue in the House. As ever, he is making a powerful speech. He will know—because he is living proof of it—that oesophageal cancer is curable if diagnosed early, and I know from all the work that has been done in connection with cancer, and particularly as a result of the interest that I have taken in the House over the years in the subject of breast cancer, that early diagnosis is the key. However, although timely and equitable access to diagnostic tests is hugely important, there is considerable evidence that access to referral for endoscopies is not as readily available in less affluent areas, and that treatments differ widely across the country. The equity of access for endoscopies from which my hon. Friend was so lucky to benefit is the key to early diagnosis, and hence to enabling many more people to survive oesophageal cancer.

[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.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Hove (Mike Weatherley) on both securing this debate and moving it in such a personal way and giving us an account of his own experience of this dreadful disease. I am sure his words will resonate with all of us who have listened tonight, and in particular the way he took us on that journey from the first difficult moments of diagnosis through to treatment. It was a vivid and thought-provoking, but also a heartening, account.

My hon. Friend is absolutely right to draw attention to the dedicated and inspirational NHS staff, who work so passionately up and down the country for their patients. How nice it was of him to take the opportunity to put that on record this evening; that was tremendous. Never is the debt of gratitude we owe the NHS staff felt more keenly than when we personally benefit from the care they provide, often at our most vulnerable and weak moments. They are, as he says, not just care-givers, but life-savers in those situations.

My hon. Friend rightly challenged us to do better in this area. Improving cancer outcomes is a major priority for this Government and, as the annual report on our cancer outcomes strategy last December showed, we are on track to save an extra 12,000 lives a year by 2015. That is the projection based on the figures to date. We all want to see the best possible results for all cancer patients, but he was right to highlight the fact that outcomes are particularly poor for patients with oesophageal cancer. I am aware, from all our debates, that this is an area in which we have not seen the sort of movement that we have seen with other cancers. Each year in England, about 7,000 people are diagnosed with oesophageal cancer and 6,000 people are diagnosed with stomach cancer. Those diseases cause around 10,200 deaths in England each year.

We had some exciting news recently: the NHS England cancer taskforce was announced on 11 January. NHS England announced that this new independent cancer taskforce would develop a five-year action plan for cancer services with the aim of improving survival rates and saving thousands of lives in England. The cancer taskforce has been set up to produce a new cross-system national cancer strategy to take us through the next five years to 2020, building on NHS England’s vision for improving cancer outcomes that was set out in the NHS’s “Five Year Forward View”. It was formed in partnership with lots of different cancer charities and other parts of the cancer community, along with other health system leaders, and it is chaired by Dr Harpal Kumar, the chief executive of Cancer Research UK.

The taskforce will cover the whole cancer pathway through prevention, diagnosis and treatment to provide support for those living with and beyond cancer and end-of-life care, as well as covering how all those services will need to develop and innovate. My hon. Friend was right to challenge us to look creatively at different ways of doing things, and that is exactly what the taskforce has been charged with doing. NHS England is assessing the opportunity for improved cancer care and will produce initial views by March—next month—with the new five-year cancer strategy to be published in the summer.

As my hon. Friend emphasised, early diagnosis is absolutely key. Tackling late diagnosis will be an important element if we are to achieve our ambition to improve cancer outcomes, which is why our cancer strategy invested £450 million during this Parliament in improving earlier diagnosis. As his own experience has attested, it can be difficult to diagnose oesophageal cancer, especially in its early stages. I congratulate him again on securing this debate and I hope that there is someone out there tuning into the debate who has heard his words. I am sure that they will help to publicise the message about taking notice of symptoms.

When symptoms do manifest themselves, it is often an indication that the cancer has developed. That is why early diagnosis is crucial. Just under 70% of people diagnosed with oesophago-gastric cancers at the earliest stage survive for at least five years. My hon. Friend has highlighted what it means in human terms for those who are diagnosed at a very late stage. It has been estimated that around 950 lives could be saved in England each year if our survival rates for oesophageal and stomach cancers matched the best in Europe, and that clearly has to be our aim: we have to do better.

NHS England has launched a major early diagnosis programme, working together with Cancer Research UK and Macmillan Cancer Support to test new approaches to identifying cancer more quickly. I hope that that programme will give my hon. Friend some encouragement, because it touches on some of the issues that he has mentioned. It will include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day.

[Steve Brine]

Southampton has been mentioned, as has my constituent Tim Underwood, who leads the team there. What the Minister is saying is absolutely right. Does she agree that regional centres such as Southampton—which do things that, quite rightly, not everyone does—are the key to providing regional areas of specialism to help us to do even better on the diagnosis and treatment of oesophageal cancer?

[Jane Ellison]

In a recent Back-Bench debate on cancer, mention was made of the tension that we all feel as constituency Members between the desire to have services nearby and the recognition that the expertise resulting from seeing lots of cancers, particularly the rarer ones, is really important to developing clinical excellence. We have to be clear that there are areas where concentrating excellence and clinical experience will save lives, and my hon. Friend perhaps highlights one such area. We often underestimate just how few cancers of any kind the average GP sees, and that is especially true of rarer cancers.

Let me go back to the different ways of looking at earlier diagnosis. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17. In 2013, Macmillan Cancer Support, partly funded by the Department, piloted an electronic cancer decision support—CDS—tool for GPs to use in their routine practice. It covers lung, colorectal, pancreatic, oesophagus and stomach, and ovarian cancers. Following the pilot, the CDS tool has been refined and is currently installed in more than 1,000 GP practices across the UK. It is designed exactly to deal with the point about helping people who do not see certain things very often with those diagnostics. Macmillan is working with software companies to adapt the CDS for different IT systems and make it available to GPs as part of their standard software offer.

I just wish to mention the Be Clear on Cancer campaign, which I am glad my hon. Friend the Member for Hove mentioned.