Oesophageal Cancer

Debate between Steve Brine and Mike Weatherley

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.