The Pharmaceutical Journal Vol 267 No 7169 p510-525
13 October 2001

BPC 2001 summary

Closing the gaps in cancer care in order to save lives

Many thousands of lives could be saved by closing the gaps that exist in cancer survival rates across the country, said Professor DAVID KERR, University Hospital, Birmingham. A study conducted in the West Midlands revealed that five-year survival for breast cancer varies between 55–59 per cent and 70–74 per cent in different localities.

Some of the difference can be explained by the stage at which patients with cancer present to their doctor. “Education about presenting early when the cancer is still treatable is needed,” he said. This difference in early detection also goes some way to explain lower cancer mortality rates in the United States, compared with the United Kingdom, where people present earlier and can be treated differently. In addition, a postcode lottery of drug treatment exists. “If a decision is made that a drug is worthwhile, it should be available to all,” he said.

The Government had introduced its national cancer plan last year in an attempt to improve cancer services. New targets have been set, including a maximum of one month’s waiting time from diagnosis to treatment for all cancers by 2005.

“However, the Government has a habit of saying what it wants but not how to get there,” Professor Kerr said. He noted no pharmacist is on the cancer taskforce and suggested that the profession should consider lobbying to get pharmacists on to such central organisations.

The key to delivering improved treatment is bringing together all members of a multidisciplinary team for case conferences. Again, pharmacists are commonly missing from such discussions, he said. “This seems ridiculous to me. Pharmacists need to play a role in specialist teams.”

Norman Lannigan, Edinburgh, commented that there are differences between the English and Scottish cancer plans. The Scottish plan clearly defines the roles of pharmacists in, for example, chemotherapy or providing support for patients, whereas the English plan does not.

Level of evidence

Nicholas Wood, Essex, asked Professor Kerr about the level of evidence needed to justify the use of drugs considering the limited funds available for purchasing drugs.

Professor Kerr replied that he would not argue the case for a drug unless there was strong evidence from randomised controlled clinical trials. It was harder to argue the case for drugs based on the fact that they had a slightly better side effect profile, he added. Once the National Institute for Clinical Excellence recommends use of a drug, there is a duty to provide it, but the difficulty occurrs when strong trial data is present but NICE has not yet appraised the drug. To be told to wait for NICE’s decision is difficult, he said.

The Cancer Services Collaborative (CSC) is an organisation that aims to improve experience and outcomes for patients with suspected or diagnosed cancer by optimising the system of care delivery. It is working on five key areas: access, patients flow, patient and carer satisfaction, clinical effectiveness and capacity and demand.

In terms of access, Professor Kerr explained that the booking system for appointments for patients with consultants is often inflexible. The CSC suggests that this could be redesigned by, for example, using e-mail to save time.

Patient and care satisfaction can be improved by providing patients with recordings of their consultations.

“Patients only retain 10 per cent of the information provided in a consultation so providing them with a tape to take away is popular and is a simple way to improve communication,” he said.

Back to Top