Cancer patients not getting right care, say doctors

Senior doctors responsible for monitoring cancer care in England and Wales are concerned failings in NHS services are contributing to up to half of patients are not getting the right treatment for some cancers.

In evidence provided to the BBC, the National Cancer Audit Collaborating Centre (NatCan) highlighted particular problems with prostate, kidney and colon cancers.

The expert group said it had found significant variation between hospitals and warned the problems accessing nationally-recommended treatments were putting lives at risk.

It carries out audits across nine major cancers – responsible for 80% of cases – and has found shortfalls across a range of different cancer types and stages.

Figures shared with the BBC show:

• 30% of patients with high-risk prostate cancer do not get curative treatment with either surgery or radiotherapy, with performance varying between 20% and 43% across different services
• 34% of stage three colon cancer cases do not get chemotherapy within three months of surgery – at some hospitals the numbers exceed 60%
• 50% of stage four renal cell carcinoma patients, a type of kidney cancer that has spread to other parts of the body, do not get drug treatment – with performance varying between 20% and 85%

NatCan said while a minority of patients would be choosing not to have treatment themselves and others may not be well enough, that could not fully explain the scale of the shortfall or variation between hospitals.

Governments in both nations say improving services is a key priority and England is in the process of drawing up a new cancer strategy, which ministers say will revolutionise services.

Ian Pattison’s case highlights the value of getting the right treatment. He was diagnosed with high-risk prostate cancer in 2020, at the age of 65.

It had started spreading to nearby organs and he was offered the nationally-recommended treatment of hormone therapy and radiotherapy for his particular type of cancer.

He said the treatment was brutal but, now aged 70, his cancer is in remission and he is enjoying life.

Mr Pattison, from Durham, said: “I was lucky that I live close to a specialist cancer centre in Newcastle where I could get the best treatment.

“It was hard going through it all and coping with the side effects but I am so thankful I got the treatment.

“I feel fit and well. I love walking, spending time with my family and looking after the grandchildren.”

But Prof Ajay Aggarwal, clinical director at NatCan, which is run by the Royal College of Surgeons (RCS) for NHS England and the Welsh government, said it was concerning so many patients were not getting the recommended treatment, adding that the variation was hard to understand.

“We need to do better,” he said. “With cancer, we often hear people talking about what the next breakthrough is but, the fact remains, using what we have better could make a huge difference. It would extend and save lives.”

Prof Aggarwal said there were likely to be several reasons for the problems and variation, including some services unfairly assuming older patients could not cope with treatment, as well as problems with staffing and capacity.

He said there was evidence of smaller hospitals not always referring patients on to specialist centres where they can get treatment but added that even some of the big centres were coming up short for some cancers.

But the problems, he added, were not uniform with treatment rates for some cancer types much better.

RCS president Tim Mitchell said echoed the concerns, saying: “The NHS has access to world-class cancer treatments and care, but inconsistent delivery means far too many patients miss out.

“At worst, this may mean some patients are needlessly dying or in unnecessary pain.”

And cancer charities said tacking the failings was arguably more important than reducing waiting times.

Eve Byrne, from Macmillan Cancer Support, said the findings were “quite staggering”, adding that tackling the variation should be the “number one priority” in the forthcoming national cancer strategy.

“Getting the best care to give you the greatest chance of survival should not come down to which hospital you attend or where you live in the country,” she said.

Ms Byrne said patients should get the right care for their particular type of cancer, no matter where they are.

“We are concerned that people from deprived, rural or ethnically diverse communities could be losing out in particular,” she said.

Amy Rylance, from Prostate Cancer UK, said patients were effectively being denied their “best chance of a cure”, adding: “This needs to change now.”

NHS England cancer director Prof Peter Johnson said: “We know that patients’ experience of cancer treatment does vary too often – and we are working hard to address this.”

And a Department of Health and Social Care spokesman said: “Patients should be able to access the cancer care they need regardless of where they live and we are committed to addressing health inequalities as we rebuild the NHS.”

A new cancer strategy is expected to be published in the second half of the year, which Health Secretary Wes Streeting has said will revolutionise services.

A Welsh government spokeswoman said it was working with the NHS to “plan, deliver, recover and improve cancer services”.

She said the audit highlighted areas where further work was needed.