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Macmillan finds cancer survival 'postcode lottery'

Friday 15 August 2014

“Cancer postcode lottery ‘costs 6,000 lives a year’,” reports The Times.

This, and similar headlines, are based on cancer survival figures compiled by Macmillan Cancer Support. The cancer charity’s report suggests that the proportion of people who die within a year of a cancer diagnosis is two-thirds higher in poor-performing areas, compared with high-performing areas.

These are shocking statistics, but it’s important to bear in mind that one-year cancer survival rates don’t give us the whole picture about the state of cancer care in England.

In a press release, MacMillan reports that around 6,000 more people could survive for at least 12 months after their cancer diagnosis if average survival across the whole of England matched the top 10% of local healthcare regions.

It identified areas such as Telford, Medway and Dagenham as having among the lowest cancer survival rates. Leafy Surrey, Dorset and Richmond had among the best cancer survival rates, according to the charity.

MacMillan suggests that the differences in survival could be explained by differences in waiting times for urgent referrals and start of treatment, which should be a set standard across the country. The charity calls for this “looming crisis” in cancer care to be addressed.

What does the MacMillan cancer survival report say?

MacMillan used data from the Office for National Statistics (ONS) and London School of Hygiene and Tropical Medicine to find the estimates for one-year survival for all types of cancer combined for all adults (aged 15 to 99) in 2011.

The average one-year survival for the whole of England was 68%. This means that roughly two-thirds of all people in England diagnosed with cancer survived for 12 months after they were diagnosed, and a third of people died by 12 months. In the 10% of regions with the best one-year survival rates in the UK, one-year survival was almost three-quarters, at 71%.

What is the reason for the differences in one-year cancer survival?

Macmillan Cancer Support suggests that the difference could be explained by how quickly patients are diagnosed and treated.

Its report says that the areas with the poorest survival rates are, on average, failing to meet one of the key NHS waiting time targets. These targets aim to ensure patients begin treatment as soon as possible, following an urgent referral from their GP. The target is that 85% of people with cancer start treatment within 62 days of an urgent GP referral. The average for the worst 20% local healthcare areas in 2013/14 was 83.1%, compared with 86% in the best 20% of healthcare areas.

The statistics from the ONS were already adjusted for age, cancer type and the effect that general deprivation has upon life expectancy. This means that the effects of deprivation should be having little influence on the differences in cancer survival by region. This appears to be the case, as one of the seven most deprived areas has better survival than the average in England, while one in three of the most affluent areas have poorer survival than average.

However, the failure to meet urgent referral time targets is only one possible explanation for these figures, and it cannot be proven from this data.

It is not possible to explore all the possible reasons for the differences from this overall data, or know whether there may be particular differences according to type of cancer, patient age or other characteristics. For example, average one-year survival for cancer overall for a particular region may be only 62%, but survival for any one person with a particular type and stage of cancer may be much higher (or lower) than this, depending on their circumstances.

It is also worth noting that these survival statistics tell us the proportion of people who survive to one year after diagnosis, but they don’t provide us with a full picture of the overall survival or prognosis following cancer diagnosis. Improved one-year survival could be due to earlier diagnosis, but we don't know whether this necessarily equates to better overall outcomes or people living longer.

However, it's likely that the sooner a cancer is detected after it develops, the better the outcome, but we know that this is not always the case. It could sometimes be the case that the person lives longer with the cancer diagnosis, but their overall survival time following development of the cancer may not always be altered. This is known as “lead-time bias”.

With these limitations in mind, the findings still highlight an important need to explore and address the reasons for differences in cancer survival across the UK, and the possibility that urgent referral times are not being met nationwide.

What do the experts say about cancer survival?

Juliet Bouverie, director of Services and Influencing at Macmillan Cancer Support, says: “This analysis shows an inexcusable postcode lottery, which is responsible for 6,000 people dying needlessly within 12 months of being diagnosed with cancer every year. It’s a no-brainer – when patients have to wait longer for diagnosis and treatment, their chances of surviving are significantly reduced.

“It is also a disgrace that our survival rates continue to lag behind other European countries. Failure to act now will see us fall further behind. All the Westminster political parties must make cancer a top health priority ahead of the general election and commit to reducing the number of people who are diagnosed late.”

Sean Duffy, National Clinical Director for Cancer at NHS England, is quoted in The Daily Telegraph as saying: “While cancer survival rates have improved in recent years, we know there is still wide and persistent variation, which means we need to do more if our cancer survival rates are to match the very best in Europe. The earlier cancer is diagnosed, the better the outcome for the patient, and we know more needs to be done to make this happen across the board.”

Analysis by Bazian
Edited by NHS Website