Cancer

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Background and Policy Context

Cancer ScreeningCancer is one of the two biggest causes of premature death in Wales.(Source: Designed to Tackle Cancer 2006). 
With our ageing population the demand for cancer care is increasing. For this reason tackling cancer is one of the Assembly Government’s top priorities.
 
In 1995, a report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales (known as the Calman-Hine Report) recommended a restructure of services to create a network of care in England and Wales to enable a patient, wherever he or she lives to be sure that the treatment and care received is of a uniformly high standard. Fundamental to this was the development of a structure of cancer centres in a hub and spoke arrangement with smaller cancer units.
 

The application of these principles in Wales was set out in the Cameron Report, 'Cancer Services in Wales' which laid down the foundation for the development of cancer services in Wales, with services based on three cancer centres. The report also stressed the pivotal role of specialist Multidisciplinary Teams (MDTs) in cancer care. 

The development of the National Cancer Standards (2005) helped to define the core aspects of the service that should be provided for cancer patients in Wales. These National Cancer Standards take account of the evidence-based Improving Outcomes Guidance series published by National Institute of Health and Clinical Excellence (NICE).

 
Designed to Tackle Cancer in Wales: A Welsh Assembly Government Policy Statement sets out the Assembly Government’s specific policy aims and strategic direction to tackling cancer. The policy is structured around the 4 themes set out in Designed for Life:

The services provided by the NHS and its partners must shift their emphasis now to one of promoting and protecting people’s health throughout their lives instead of focusing largely on treating a specific illness. Source: WHC (2006) 080 

What is the NHS in Wales doing about cancer?

Improving Prevention and screening

It is one of the Government’s key aims to reduce the incidence of cancer in Wales through primary prevention. In particular, to have comparable cancer incidence rates with the lowest European quartile by 2015. It is estimated that changes in diet and factors related to diet (including body mass and levels of physical activity) could reduce cancer incidence and mortality by between 30 and 40 per cent.

The main ways we prevent and reduce the impact of cancer include:

  • Changing those things that have been shown to have a direct causal effect on cancer rates and occurrence.
  • Detecting cancers as early as possible through improved public and professional awareness of symptoms.
  • Detecting cancers through cancer screening programmes

Health promotion & prevention are the responsibility of the Local Health Boards supported by the National Public Health Service. Preventative measures are relevant to a number of cancers including lung cancer, head & neck cancers and colorectal cancers. The major focus for health promotion in the community remains smoking cessation, which directly influences the incidence of a number of cancers, as well as other illnesses such as coronary heart disease and stroke. A key cancer-specific initiative is the Sun Awareness campaign.

Current health promotion strategies are more closely associated with Coronary Heart Disease prevention than cancer, however all the existing initiatives designed to promote healthy eating and exercise are relevant for cancer prevention and these links are being strengthened and highlighted.

The three screening programmes relating to cancer in Wales, Breast Test Wales, Cervical Screening Wales and  Bowel Screening Wales are managed by Public Health Wales.

Early detection and primary care

A report by the National Audit Office (Tackling Cancer in England: Saving more lives. 2004) observed that patients in England tended to have more advanced cancer at the time of diagnosis than some other countries, at least for breast and bowel cancer. Older people and those from deprived areas were more likely to be diagnosed with cancer at a more advanced stage. For a number of cancers, the survival rates for patients in Wales are poorer than most other countries in Europe (Source: Eurocare 4 – Lancet Oncology 8:8 August 2007).
 
Early referral has a role to play in the improvement of care for people with cancer, and in some cancers early referral may improve survival rates. In addition to its roles in prevention, support and long-term management of people with cancer, primary health care has particular responsibility for the early detection of cancer and the initiation of speedy referral to specialist services 

The National Audit Office recommended that the NICE Referral Guidelines for Suspected Cancer should be widely disseminated and acted upon, and that stronger joint working relationships between general practitioners and hospitals should be encouraged through the continued development of standardised referral procedures with feedback to general practitioners on appropriateness of referrals.
 

In order to improve survival, NHS Wales help to develop and support initiatives to promote the public’s awareness of significant signs and symptoms, so that patients present earlier to their GP. Some examples are:

Primary Care also plays a major role in the support and care of cancer patients including palliative care, and increasingly the move to longer term-survival, often termed as ‘living with your cancer’ .

Improved Access

The 2005 National Cancer Standards set standards over the length of time that patients should have to wait for the start of definitive treatment of their cancer with the aim of improving outcomes and increasing survival rates. NHS Trusts report on cancer waiting times and latest results are published on the Welsh Assembly Government's website.
 
Improving access is not just about reducing waiting times. It is about improving access to appropriate specialist clinical teams working with the best possible facilities and providing the best possible treatment and care. This includes state of the art technology and drugs. These need to be planned for efficiently and effectively and implemented promptly. NICE and the All Wales Medicines Strategy Group (AWMSG), working with the Cancer Services Co-ordinating Group (CSCG) and regional Cancer Networks, play a key role in supporting commissioners.

Better Services

Here the aim is to provide diagnosis, treatment, and rehabilitation and palliative care services for people with cancer that match or surpass the best in Europe in terms of quality. 

Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. The Healthcare Standards for Wales underpin clinical governance by ensuring that quality services are provided equitably, robustly and ethically across all settings. Clinical audit is at the heart of clinical governance. It addresses quality issues systematically and explicitly, by providing reliable information. It can, importantly,
confirm the quality of clinical services and highlight the need for improvement.

Successful clinical audit involves changing practice to meet the standards. Highlighting the need for improvement and changing practice to meet the standards is integral to improving healthcare.The roll out across Wales of the Cancer Information System Cymru (CaNISC) supports and enhances clinical audit.

The National Cancer Standards cover a number of cancers and also include standards for Specialist Palliative Care in relation to Cancer Services. They also detail the key elements of the diagnostic and treatment process that patients should expect to receive. These include requirements for patient centred care, the formation and work of local, network and supra-network level multidisciplinary teams (MDTs) as advised by NICE service guidance and clinical guidelines, adherence to and audit against nationally agreed clinical guidelines, and waiting times from referral or diagnosis to start of definitive treatment.

The regional Cancer Networks lead the process of mapping and assessing current services against the Standards and developing and implementing action plans to deliver  the shape of future service organisation.

Cancer research is a fundamental part of improving the quality of our services. The Wales Cancer Bank collects and stores cancer tumour, tissue and blood samples from all consenting patients with possible or confirmed cancer as a basis for future scientific studies. These studies will help to establish the causes of cancer, and help to identify new areas for treatment and selection of the best treatments for individual patients.

The Cancer Genetics Service for Wales (CGSW) is part of the All Wales Medical Genetics Service (AWMGS). Its remit is to assess the risk of cancer based on a patient's reported family history and to work with the relevant specialists to recommend further screening strategies where appropriate. 

The Wales Gene Park undertakes research for a better understanding of the role of genes in the development of cancer, as well as new methods of diagnosis
and treatment of the disease.

The Wales Cancer Trials Network also aims to make research a routine part of cancer services and to ensure that every patient who is eligible has an equal opportunity to take part in a research trial.

People with cancer need rehabilitation and supportive care.The Welsh Assembly Government published its policy on palliative care in 2003  A Strategic Direction for Palliative Care Services in Wales. The overarching aim is the development of a much more integrated service for patients between the statutory and voluntary sector. 

The NHS and partners in the voluntary sector are expected to implement the level of care outlined in the All Wales Care Pathway for the Last Days of Life.

 

Reports, Publications and Resources

Cancer statistics sources

Cancer Services

Cancer publications