Use of chemotherapy and radiotherapy in UK ’10 to 15 years behind leading countries’

The use of chemotherapy and radiotherapy in the UK lags behind comparable countries and people wait too long for treatment, research has found.

Two new studies part-funded by Cancer Research UK and published in the Lancet Oncology show people in the UK are treated with chemotherapy and radiotherapy less often than in Norway, Canada and Australia.

The research was carried out by the International Cancer Benchmarking Partnership and is the first to examine treatment differences for eight cancer types across three continents.

Investigators looked at more than 780,000 people diagnosed between 2012 and 2017 with a range of cancers (oesophageal, stomach, colon or rectal, which is commonly known as bowel cancer; liver, pancreatic, lung and ovarian cancer).

The studies found:

• Fewer colon cancer patients in the UK (29%) were treated with chemotherapy compared to Canada (34%), Norway (31%) and Australia (34%). The same was true for oesophageal cancer – in the UK – 43% were treated, compared to Canada (49%), Norway (53%) and Australia (53%).
• Fewer ovarian cancer patients in the UK (59%) received chemotherapy compared to Canada (67%), Norway (72%) and Australia (73%). The same was true for pancreatic cancer patients (27% in the UK), compared to Canada (41%), Norway (44%) and Australia (47%).
• Fewer stomach cancer patients in the UK (34%) were treated with chemotherapy compared to Canada (43%), Norway (47%) and Australia (50%). This was also true for liver cancer patients in the UK (15%), compared to Canada (24%), Norway (20%) and Australia (28%).
• For radiotherapy, fewer lung cancer patients in the UK (33%) were treated compared to Canada (41%), Norway (46%) and Australia (45%). The same was true for oesophageal cancer (31% in the UK), compared to Canada (59%), Norway (53%) and Australia (54%).
• Countries with better cancer survival typically had higher use of chemotherapy and radiotherapy and shorter waits to start treatment. In one example, the five-year survival for stage three colon cancer was higher in Norway (71%), Canada (70%) and Australia (70%) than in the UK (63%).
• The five-year survival for stomach cancer was also higher in Norway (27%), Canada (30%) and Australia (33%) than in the UK (21%). Pancreatic cancer also saw better survival elsewhere (14% in the UK compared to 18% in Canada and Australia at 21%).
• Survival for lung cancer was also much higher in other countries. In Norway, it was 20%, in Canada 22%, Australia 21% and just 15% in the UK . Meanwhile, the five-year survival for ovarian cancer was higher in Norway (46%), Canada (40%) and Australia (44%) than in the UK (37%).
• Women were less likely to receive radiotherapy than men across the study. People aged 85 and over had around three times lower odds of receiving radiotherapy than those aged 64 to 74.
• Patients aged 85 and over had 20 times lower odds of receiving chemotherapy than those aged 65 to 74. This was particularly bad in the UK, with 2% of UK patients aged 85 and over receiving chemotherapy, compared to 8% in Australia and 14% in Ontario, Canada.

The studies also found the average time to start chemotherapy was 48 days in England, 65 in Scotland, 57 in Northern Ireland and 58 in Wales.

In New South Wales, Australia, the wait was lower at 43 days and 39 in Norway.

For radiotherapy, the UK fared even worse, with it taking 63 days to start treatment in England, 53 in Northern Ireland, 79 in Scotland and 81 in Wales.

In Alberta, Canada, the figure was 48 days and 53 days in British Columbia, while in New South Wales, Australia, it was 43 days.

Cancer Research UK said delays to begin treatment are partly the result of the UK Government’s lack of long-term planning on cancer in recent decades.

It said countries with more robust cancer strategies backed by sufficient funding have seen larger improvements in survival than in the UK.

It also said workforce and capacity shortages across the UK health system are barriers to delivering chemotherapy and radiotherapy.

Chief executive of Cancer Research UK, Michelle Mitchell (pictured), said: “The UK should be striving for world-leading cancer outcomes.

“All cancer patients, no matter where they live, deserve to receive the highest quality care.

“But this research shows that UK patients are treated with chemotherapy and radiotherapy less often than comparable countries.

“When it comes to treating cancer, timing really matters. Behind these statistics are people waiting anxiously to begin treatment that is key to boosting their chances of survival.

“We can learn a great deal from other countries who have stepped up and substantially improved cancer services.

“With a general election on the horizon, the UK Government has a real opportunity to buck the trends we see in this research and do better for people affected by cancer.”

Clinical lead for the International Cancer Benchmarking Partnership and an ovarian cancer surgeon, Dr John Butler, said: “For many aggressive cancers – such as ovarian, lung and pancreatic cancer, it’s vital that people are diagnosed and start treatment as soon as possible.

“Lower use of chemotherapy and radiotherapy in the UK could impact people’s chances of survival, especially for older patients.

“Although we have made progress, the last benchmark showed that cancer survival in the UK is still around 10 to 15 years behind leading countries.

“This study captures missed opportunities for patients in the UK to receive life-prolonging treatment.”

A Department of Health and Social Care spokeswoman said: “These figures cover only the period from 2012-2017. Since then, we have made significant investment in cancer diagnosis and treatment, including £162 million towards radiotherapy equipment and £2.3 billion to launch 160 community diagnostic centres across England, which will help us achieve our aim of catching 75% of all cancers at stage one or two by 2028.

“Cutting waiting lists is one of the Government’s top five priorities and we have treated record numbers of patients over the last year.

“Survival rates are also improving across almost all types of cancer and we will shortly legislate to create the first smoke-free generation – the biggest single public health intervention in decades.”

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