End of England's Long-Term National Cancer Plan: Costing Lives?

 Hello. I'm David Kerr, professor of cancer medicine at University of Oxford.

There was an interesting article I picked up recently in The BMJ , which was authored and led by a dear friend of mine, Professor Richard Sullivan, from King's College in London. Richard has been a friend for more than two decades and has played a great role nationally and internationally in cancer control in the most general sense.

He and some very senior oncologists in the UK have prepared this publication for The BMJ in which they called the government's decision to merge cancer with other chronic diseases — cardiovascular, respiratory, dementia, and mental health — putting it all into one basket of chronic diseases, a catastrophe for cancer services in the United Kingdom.

Their argument, which I think is entirely reasonable, is that if you look around the world, the World Health Organization has taken a lead in developing a framework for cancer control. Indeed, many of you who listen to Medscape have heard me talk about the work that we've done in sub-Saharan Africa, Iraq, other areas of the Middle East, and India in supporting cancer control.

I was, in the late nineties, one of the architects of the British National Cancer Plan. We have made great strides — there's no question about that. We had a government that was prepared to invest in cancer and that was prepared to understand the depth and the extent of the problem. The fact that our cancer survival figures internationally are lagging behind many of our European neighbors' set the scene for a significant investment in cancer services.

Despite almost two decades of investment, planning, and delivery by the health policymakers and the community of oncologists and cancer healthcare professionals, I still think that this plan is a bad idea.

Cancer stands alone in terms of the complexity of treatment, the multiple modalities involved, and the referral journey from primary care to secondary care, which of course is still not done in a timely fashion. There was some evidence to suggest that cancer patients in the United Kingdom present with somewhat later-stage disease than those of our neighbors, their cousins, and their brothers and sisters in the continent of Europe. There is work to be done there.

Despite the investment in cancer care, we have some worrying statistics suggesting a significant degree of unwarranted variation. We have talked about this in the past. All of us understand biological variation. We're genetically different; therefore, our response to treatments and drugs, and the phenotype and behavior of cancer, can depend on the genetics that we inherit from our parents and the environment in which we choose, or are forced, to live.

Unwarranted variation has to do with variations in access to the appropriate screening, treatment, and follow-up. There are some quite stark statistics that, despite successive cancer plans, unwarranted variation still looms large in the United Kingdom. If it looms large here, it will loom large even further elsewhere. This health equity gap, I think, dishonors us all.

One might say I would say that because I'm a cancer lobbyist, but I think that we have compelling evidence that, given its complexity, this policy seems to be swimming against the tide and against the general global direction of singling cancer out as a complex set of many diseases that require specific attention.

I'd be very interested in comments from your own experience, from your own country, and from those of us who work with me within the National Health Service. Do we think this is a good idea? Do we think we've had it too good for too long, as some of our colleagues might say from these other — one would argue — chronically underfunded chronic conditions?

Are we right to provide evidence and state that still we need to have a separate national cancer plan with milestones and deliverables that we, the community responsible, are held to account to deliver?

Please drop me a note and share your comments. As always, thanks for listening. For the time being, Medscapers, over and out. Thank you.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of  colorectal cancer  and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

https://www.medscape.com/viewarticle/988551