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National service frameworks and strategies

Improving outcomes: a strategy for cancer

Key facts about cancer

  • More than one person in three will develop cancer at some time in their lives, and one in four will die of the condition.
  • In England, more than 250,000 people are diagnosed with cancer every year, and around 130,000 die from it. Currently, about 1.8 million people are living with and beyond a cancer diagnosis.
  • Despite improvements in survival and mortality in recent decades, cancer outcomes in England remain poor when compared with the best outcomes in Europe.
  • Cancer can develop at any age, but it is most common in older people – more than three out of five new cancers are diagnosed in people aged 65 or over, and more than a third are diagnosed in those aged 75 or over.
  • The proportion of cancer patients entering cancer clinical trials and studies is more than double that in any other country, including the US.

Improving outcomes: a strategy for cancer was published in January 2011 and sets out the coalition government's ambition to drive up England's cancer survival rates so that an extra 5,000 lives can be saved every year by 2014-15.

Improving outcomes for people with cancer is not just about higher survival rates. It is also about improving patients' experience of care and the quality of life for cancer survivors. The strategy was backed with funding of more than £750 million over four years, setting out plans such as:

  • promoting lifestyle changes to reduce cases of preventable cancers
  • increasing the uptake of cancer screening, introducing new programmes and expanding existing screening programmes where there is evidence to justify them
  • increasing early diagnosis of cancer to improve the scope for successful treatment
  • improving patient experience and support for cancer survivors
  • ensuring that all patients have access to the best possible treatment, care and support
  • £450 million of the £750 million will be used to improve early diagnosis

This funding is:

  • giving GPs increased access to – and support in – interpreting key diagnostic tests
  • supporting GPs in commissioning cancer services
  • covering the increase in testing and the treatment costs in secondary care as more people are diagnosed
  • supporting the Be Clear on Cancer campaigns, which raise awareness about the signs and symptoms of cancer and encourage people with symptoms to see their GP

The third annual report of Improving outcomes: a strategy for cancer was published in December 2013. It reports on:

  • significant developments in cancer screening – particularly on the first phase of introducing bowel scope screening (BSS)
  • activity to promote earlier diagnosis of symptomatic cancers through the Be Clear on Cancer campaigns and the associated work with primary and secondary care
  • progress in ensuring better access to the best possible treatment for all – for example, through improved access to intensity modulated radiotherapy (IMRT)
  • significant developments in the collection and reporting of new datasets and the analysis of information to drive improvements and keep patients informed

The report noted that it was too early to be able to assess progress against the ambition to save an additional 5,000 lives per year by 2014-15. This would halve the gap between the survival estimates in England and those in the best countries in Europe. However, we do know that:

Much more needs to be done to maximise the scope to save lives, including among the rarer cancers. Work continues:

  • to tackle lifestyle factors – such as smoking – responsible for more than a third of cancers
  • to improve uptake of screening among disadvantaged groups
  • to build on the Be Clear on Cancer campaigns and the growing evidence of their effectiveness
  • to ensure there is sufficient endoscopy capacity to meet the needs of the bowel screening programme and symptomatic patients
  • to tackle variations in access to treatment – for example, to provide comparative data on radiotherapy and chemotherapy to enable those with low levels to consider whether action is needed
  • to keep a focus on the treatment older patients receive

Inequalities in access and outcomes still need to be tackled. The strategy made clear that the ambition to save an additional 5,000 lives every year by 2014-15 could not be met without narrowing the equalities gap. 

The report notes good progress on targeted interventions for certain groups in the Be Clear on Cancer campaigns, as well as efforts to address lower treatment rates in older patients. 

However, there is still much to do to narrow the equalities gap where some groups continue to report a worse experience, particularly around patient experience.

Prevention of cancer

More than half of all cancers could be prevented if people adopted healthy lifestyle choices, such as:

Cancer screening

Cervical screening

The NHS Cervical Screening Programme in England saves up to 4,500 lives every year. As part of the programme, women aged between 25 and 49 are invited for free cervical screening every three years, and women aged 50 to 64 are invited every five years. Women over the age of 65 are invited if their previous three tests were not clear or if they have never been screened.

The NHS has introduced HPV testing into the routine screening programme for women with low grade abnormalities and women who were previously treated for cervical abnormalities. This not only provides a far more personalised service for women, but takes hundreds of thousands off surveillance, saving the NHS an estimated £16 million per year.

Public Health England is now piloting HPV testing as primary screening, where an HPV test is performed on a woman's sample before the traditional cytology test. This is likely to provide an even more personalised and cost effective service. Cancer Research UK estimates it will prevent a further 600 cervical cancers a year.

Breast screening

The NHS Breast Screening Programme saves an estimated 1,300 lives each year. More than 95% of women who had invasive breast cancer detected by screening are alive five years later.

The NHS Breast Screening Programme provides screening every three years for all women in England aged 50 and over. Currently, women aged between 50 and 70 are invited routinely and women over the age of 70 can request free screening every three years. As part of a major research trial, the eligible age range for routine breast screening is currently being extended to women between the ages of 47 and 73.

The Be Breast Aware leaflet was produced in partnership with Cancer Research UK. It encourages women to know what changes to look for and report them to their GP as quickly as possible to provide the best opportunity to successfully treat the cancer.

In 2012 the Independent Breast Screening Review (IBSR) looked into the benefits and risks of breast screening (PDF, 1.41Mb). It concluded that breast screening in the UK saves 1,300 lives a year and should continue, but there were issues of significant over-diagnosis and over-treatment associated with screening.

Bowel screening

The NHS Bowel Cancer Screening Programme is one of the first national bowel screening programmes in the world and the first cancer screening programme in England for both men and women.

All men and women aged 60 to 74 are sent a self-testing kit (faecal occult blood, or FOB, test) every two years. People aged 75 and over can request a free kit to use by telephoning 0800 707 60 60. Currently the programme detects around 3,000 cancers every year.

It is planned to role out the FOB test programme to men and women aged 55 by 2016. It is estimated this will save up to 3,000 lives a year.

Ensuring better treatment

To improve cancer outcomes, it is essential that all cancer patients receive the best treatments available at the highest quality standards. Huge improvements have been made in treating cancer over the last few decades. This is partly the result of major radiotherapy commitments such as the Radiotherapy Innovation Fund (PDF, 1.33Mb) and proton beam therapy (a different form of radiotherapy), and the success of the Cancer Drugs Fund.

Other factors are the growth of the enhanced recovery programmes, along with the continued importance of cancer peer review. There has also been a major increase in the use of effective new treatments approved by NICE, as well as reductions in waiting times.

Waiting times

Currently, all patients referred with suspected cancer by their GP have a maximum wait of two weeks to see a specialist. This also applies to all patients referred for investigation of breast symptoms, even if cancer is not initially suspected.

Cancer patients should wait no more than 31 days from the decision to treat to the start of their first treatment. It is also expected that any subsequent surgical, drug or radiotherapy treatments will be delivered within 31 days.

All patients should wait a maximum of 62 days from their urgent GP referral to the start of their treatment. This 62-day standard also includes all patients referred from NHS cancer screening programmes (breast, cervical and bowel) and all patients whose consultants suspect they may have cancer.

You can find more information in our guide to waiting times

National cancer surveys and initiatives

National cancer patient experience surveys highlight variations reported by cancer patients and areas where trusts can make improvements. There have now been three annual surveys and NHS England is set to run the survey for a fourth time. Download the Cancer Patient Experience Survey: Insight Report and League Table 2012-13 (PDF, 820kb).

In addition, the National Cancer Survivorship Initiative aims to improve the quality of life for the 1.8 million people living with and beyond a cancer diagnosis in England. We are also seeing improvements in end of life care.


The 3 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Pessy mystic said on 24 September 2013

Waiting times - 1/8/13 CT scan shows 8mm lung nodule
30/8/13 - after numerous phone calls I was given the scan result and asked for the CT to be referred to the lung team who had said they'd reconsider surgery if it grew from 4mm in Oct 2012. 12/9/13 referral is made to the lung team and PET scan done 18/9/13. As at 24/9/13 no treatment decisions have been made and no result of PET scan provided to me.
Choice - I've repeatedly said I'd prefer to have news straight away by email or 2nd choice by phone or voicemail but the NHS has an obsession with cancer news being given face to face meaning long delays to see a consultant and excess anxiety in the waiting period. I'm imagining that the PET scan shows the cancer has spread meaning lung surgery is not deemed appropriate now I know my case isn't on the list for the next Multi Disciplinary Meeting on 27/9/13. You cannot be actively involved in treatment decisions when you are denied the information needed to make any decision - its hugely stressful when the decisions are all out of your own hands anyway- I wanted the nodule cut out last year but I did not have that choice either. A doubling in diameter of a sphere is an 8 fold increase in volume. With a tumour doubling rate of 100 days my tumour will have doubled in size from the CT of 1/8/13 to the date I'm told what has been decided to do about it if anything. "Wait and see" from 2012 means wait for it to grow and let my family see it kill me - that was definitely not my choice

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Pessy mystic said on 31 August 2013

I agree with Greek Goddess that there is a hole in this system. I had bowel cancer last year and a 4mm nodule in the lung showed on the CT scan. I was initially told this would be monitored every 3 months. 10 months after the last scan it is now 8mm diameter so has grown from being the size of a ball bearing to the size of a marble. Recent scan was on 1st August 2013 but I had to chase for the results which I was given verbally yesterday. As there hasn't been any specialist referral yet to the lung clinic that I'm aware of then I guess the "2 week wait" hasn't even started ticking by yet and as there has been no decision to treat it then the 31 day wait won't be running either. I'd better ask my GP to refer me so that these wait times will then apply. There's no point in having these wait times if the spirit of them is defeated by a failure to refer to a specialist or to make a treatment decision in the first place

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Greek Goddess said on 22 February 2013

What about when you are already a cancer patient, have been referred by one consultant at one hospital (St Marys Isle of Wight) to another consultant at another hospital (QA Portsmouth) to then be told although you already have a possitive diagnosis of metastasized cancer, from prostate to bone, you now have to wait over 8 weeks to see the specialist? Meanwhile you are worried sick, have already battled 2 different types of cancer (prostate followed by unrelated throat & lymph) in the last 2 years, to be told you have to wait. Seems to me there's a big hole in the system when this can happen. If the referral had gone direct from GP to QA the patient would have been seen by now. And I am told by the hospital it's because of lack of consultants. Not that they can't employ them...they just aren't employing them. Apalling.

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Page last reviewed: 27/01/2014

Next review due: 27/01/2016


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