‘Leveling up’: what should this mean for cancer? – Cancer Research UK
Today the UK government set out its ‘leveling up’ plans, how it will help parts of the country being left behind in many ways to catch up on a range of measures, including health.
An important starting point will be to address cancer disparities across the country.
We’ve written before about how people in more deprived areas are more likely to get cancer, have more difficulty accessing cancer services, and are less likely to survive their cancer.
The government’s plans today have shown a number of positive signs. There was a commitment to tackling key drivers of health inequalities like smoking and obesity – both of which increase cancer risk – and cancer itself as a major cause of poor health. There are also positive signs regarding research.
However, although the intentions are good, we are still missing important details.
So what should the government do next to improve cancer control?
Tackling the unequal burden of cancer
About 4 in 10 cancer cases are caused by preventable risk factors, including smoking and obesity. Smoking rates are much higher in the most deprived areas, which has a major impact on health. Smoking alone accounts for around half of the difference in life expectancy between the most and least deprived groups in England.
Unfortunately, at present, the government is a long way off its target of a smoke-free England by 2030. But worse still, for the most deprived group, that milestone will not be reached until the mid-2040s. .
A recent report by Action on Smoking and Health and Cancer Research UK showed that years of cuts have contributed to variation in the quality and accessibility of stop smoking services. Local authorities who have had to cut these services, and which now depend on the NHS, were the most likely to report negative impacts from the pandemic.
How can the government solve these problems? A good start would be to publish a prominent and well-funded tobacco control plan for England. Funding for this could come from the introduction of a ‘smoke-free fund’, which would force the tobacco industry to pay for tobacco control measures and help people quit, but above all without letting them influence them. how the money is spent.
Obesity is another risk factor for cancer, and there are variations too. Evidence shows that obesity disproportionately affects people in the most deprived areas and contributes to significant health disparities. The environment in which people live is a significant challenge here, with the less healthy option often being the easier and cheaper choice.
There is clear evidence to take action to prevent childhood obesity. Obese children are five times more likely to be obese as adults, putting them at higher risk of developing 13 different types of cancer.
The government has shown promising signs, such as committing to restrict the marketing and promotion of junk food in 2020. But 2 years on, this crucial legislation risks being watered down by industry-led amendments. The UK government cannot afford this to happen.
Zooming out, a strong public health system is essential to tackling the unequal burden of cancer across the country. Budgets have fallen in recent years, affecting important efforts such as weight management and alcohol treatment services, and these services are in desperate need of a financial boost.
Giving everyone the best chance of beating cancer
There are also serious differences between different parts of the country in how easily and quickly patients can access services important to cancer care – and, unfortunately, patients’ chances of surviving their cancer. .
An important example is the lack of GPs to quickly offer an appointment to anyone who needs it. In England – where the UK government runs the NHS – primary care in the most deprived areas is relatively underfunded and contracted out compared to less deprived areas. And with more than 6 in 10 cases diagnosed after a referral to a GP, any variation could have important implications for cancer diagnosis.
Unfortunately, efforts over the past 30 years to reduce these geographic disparities have only scratched the surface. If we don’t act now, the gap will only widen, hampering efforts to “level” the country.
There are also significant regional disparities in diagnostic capacity, with patients in some parts of the country waiting much longer than others for key diagnostic tests. For example, endoscopy services – which help diagnose diseases such as oesophageal, stomach and bowel cancers – have been impacted by the pandemic, but not at the same rate. Some regions, such as the North West, have seen a greater increase in wait times and have been slower to recover.
Once patients have been diagnosed with cancer there may also be variations in treatment depending on where they live, for example in the case of lung cancer there is regional variation in the proportion of patients receiving a treatment with curative intent, ranging from 64% to 86%.
Addressing this regional variation could transform the outlook for many cancer patients. To continue with lung cancer as an example, if we level all regions of England to match the best performing area, we estimate that around 2,300 additional lung cancer patients each year in England could be diagnosed at the earliest and most treatable stages.
The NHS in England recently set out its strategy to tackle inequalities, which has focused on improving cancer outcomes and improving the health of communities most in need. The government’s upgrade plan also repeated positive commitments made in last year’s spending review to invest in new “one-stop” diagnostic centers in the community.
But the biggest hurdle in tackling geographical differences in access and capacity to NHS services is the chronic shortage of NHS cancer workers across the country.
Three months after the government promised to outline how it will invest in growing the oncology workforce, but we are still awaiting clarification on this. The longer we wait, the longer it will take to make progress in our cancer outcomes.
Placing cancer at the heart of the upgrade
Just last week, Health Secretary Sajid Javid pledged a new ‘war on cancer’, aimed at ‘drastically improving outcomes for cancer patients across the UK’.
Today’s announcement on the upgrade offered many positive signs that addressing inequalities in smoking, obesity and cancer could be a central pillar of this work.
But with much of the detail still to come – including in a plan to tackle health disparities due from the government later in the spring – it’s clear we need to know more about how the level will help us achieve our goals of improving cancer outcomes.
The challenge for the Secretary of State is to seize this opportunity and make the upgrade truly meaningful for the one in two of us who will have cancer in our lifetime.
Matt Sample is Head of Policy at Cancer Research UK