Major overhaul of care services needed as number of cancer survivors soars

By The Press Association29th September 2015News EnglandCancer, Care Standards, End Of Life Care, News England, Older People

A major reorganisation of care services is needed to cope with soaring numbers of cancer survivors, experts have said.

By 2030, the number of people living with cancer in the UK is predicted to double from two million to four million.

Meeting the extra demand will mean shifting responsibility away from cancer specialists and allowing GPs to play more of a role, according to a report.

In the next 20 years, the number of oncologists in high-income countries such as the UK is expected to grow by only a quarter.

Professor Greg Rubin, from the University of Durham, who led The Lancet Oncology Commission report, said: “It is too simplistic to assume that providing more oncologists is the solution. It is the way that health care providers work together that holds the key to meeting this need.

“Hospitals, primary care doctors and other community partners need to be better co-ordinated for after-care, survivorship, and end of life care, so that patients receive good quality care, outcomes improve and inequalities are reduced.”

Up to now managing cancer in high-income countries had mainly focused on life-saving or prolonging treatments delivered in hospital, while the role of primary care had been “seen as marginal”, said Prof Rubin.

He added: “With the growing emphasis in recent years on early diagnosis and on the patient experience during and after treatment, the vital role of primary care doctors has become clear.”

Prof Rubin went on: “With an ageing population and a rapidly increasing number of cancer survivors, the primary care cancer workload will increase substantially over the next 10 years. Our challenge is how to prepare primary care doctors as the cornerstone in prevention, early detection, survivorship and palliative care.”

The report said cancer patients and their families wanted care that was accessible, close to home, continuous and co-ordinated. Yet in many countries primary care doctors were given no formal cancer-managing role either during or after treatment. Also, they were often bypassed when palliative care was needed.

Evidence from the US showed that long-term cancer survivors who regularly saw both primary care doctors and oncologists were more likely to have all their requirements met, said the report.

Other research from the UK, Canada and Australia found that integrated after-care of cancer sufferers improved patient satisfaction and did not affect rates of cancer recurrence or survival.

The authors set out a range of measures to improve co-ordination between primary and secondary care and to ensure that GPs had the skills to fulfil a cancer-management role.

These included better access to diagnostic tests underpinned by comprehensive guidelines, improving education and support, building new models of shared care between GPs and oncologists, greater communication with specialists, easy referral back to hospital care and robust monitoring systems.

Public awareness campaigns were one way to help prevent patients delaying visits to their GPs, the report added.

A lung cancer awareness campaign in England with the strapline “been coughing for three weeks or more? Tell your doctor” led to a 67% increase in people of all ages visiting their GPs with a cough.

Around 90% of people with cancer make a GP their first port of call when seeking help, highlighting the need for primary care professionals to make confident cancer diagnoses at earlier stages of disease, said the experts.

Prof Rubin said: “Primary care doctors are expert generalists who provide continuous and comprehensive care to patients and their families, and do this in the context of the patient’s social and domestic circumstances. As such they have much to offer people with cancer, and should be enabled to do so.”