David Rees MS argues that our response to cancer mustn’t be forgotten as priorities shift to deal with Covid-19.
Mention the words “Single Cancer Pathway” to someone on the street and they may look at you blankly.
But within the NHS in Wales, those words could spark a revolution in early diagnosis of cancer and, crucially, save more lives.
Every single one of us has been touched by cancer in some way, either ourselves or a loved one. It’s hardly surprising when you consider that 1 in 2 of us is likely to develop cancer at some point in our lives.
Every year, around 19,300 people are diagnosed with cancer in Wales and, sadly, there are around 8,800 cancer deaths. It’s Wales’ biggest killer and continues to have a tremendous burden on our NHS and society.
There is reason for optimism, however. Cancer survival has doubled since the 1970s, so that today, around half of us survive our cancer for ten years or more.
But we know that we can, and must, do better. International studies, like the International Cancer Benchmarking Partnership, continue to see Wales perform poorly in comparison to similar nations. If we could catch up with the best countries, many more lives could be saved.
There are rarely such things as silver bullets. But the evidence is clear that diagnosing more cancers at an earlier stage, when they are more treatable, offers the best hope for improving survival.
Thankfully, this is a mission that unites the Welsh Government, NHS Wales, cancer charities and others, all of whom have made early diagnosis a key priority. The Single Cancer Pathway is an example of translating this priority into practice.
Cancer waiting times have been a useful measure to monitor the performance of diagnostic services in the NHS, but they’re not perfect. They only tell us the speed that someone moves through the system, not the stage that their cancer is detected.
And the traditional cancer waiting time metrics fail to adequately capture the experience of all patients through diagnosis, tending to focus on those who present to their GP with the more obvious “red flag” symptoms – like a persistent cough, change in bowel habits, lump, etc – who are then referred for urgent tests.
“The expectation is that patients will begin their treatment within 62 days of their cancer being suspected… This ambitious system is UK-leading.”
That’s where the Single Cancer Pathway is different. Introduced in June 2019, this bold and innovative approach to cancer waiting times seeks to capture the most accurate picture of patient experience during a diagnosis for cancer.
By starting the clock at the point of suspicion rather than at a GP referral, all cancer patients will have their diagnosis journey measured for the first time. The expectation is that patients will begin their treatment within 62 days of their cancer being suspected.
This ambitious system is UK-leading and it is right that the Welsh Government and NHS Wales are applauded for their decision to introduce the Single Cancer Pathway.
At the same time, we know that a new cancer waiting time target won’t be sufficient on its own to diagnose more cancers earlier. This was demonstrated in the early Single Cancer Pathway results, which showed performance to be fairly stable around the 75% mark, meaning a quarter of patients are experiencing waits of longer than 62 days.
But the power of the Single Cancer Pathway lies in its potential to change the way we think about diagnosing cancer. It should create the environment in which the most difficult questions can be addressed, including on capacity in diagnostic services, dealing with gaps in the workforce, and improving patient pathways.
It links together cancer screening, public awareness of cancer, how GPs and secondary care work together, and new innovations such as rapid diagnostic clinics. The Single Cancer Pathway might be one piece of the puzzle, but it’s the one that can connect to all the others.
That opportunity was abruptly halted by COVID-19. The pandemic is the greatest threat and challenge to our NHS, and cancer has not been immune to this. I have heard many experiences of people whose cancer tests and treatments were in some way affected by COVID-19. It has caused considerable anxiety and, most worryingly, concerns that cancer survival could be negatively affected.
At this point, it is important for me to thank those staff across NHS Wales whose efforts have sought to maintain cancer services as much as possible in the most difficult of circumstances. The past eight months have been like no other for them and without their hard work, the adverse impact on cancer patients would have been even greater.
A backlog of cancer diagnoses has now built up, in part resulting from the 18,000 fewer urgent cancer referrals between March and August compared to the same period last year. These people will still have their cancer symptoms and, in some cases, undiagnosed cancer.
Cancer services are starting to recover, whilst also dealing with a second pandemic wave, and we know it will take some time for this backlog to be addressed.
All of this makes the purpose of the Cross Party Group on Cancer as important as it has ever been. We need to keep cancer high on the agenda, especially during these difficult times. That’s why we launched an inquiry at the start of the year to examine the implementation of the Single Cancer Pathway and offer recommendations on the next steps to see it achieve its bigger ambitions in earlier diagnosis of cancer.
Today, we launch our report – The Single Cancer Pathway: next steps to achieve earlier diagnosis in Wales. I’m grateful to the local health boards, cancer charities, academics, industry and, most importantly, people affected by cancer who have contributed to this work.
Our report offers a roadmap for how the Single Cancer Pathway can reach loftier heights than just being a new way to measure cancer waiting times. Among our recommendations, I want to pick out two that will be critical.
“While the Welsh Government have announced their intention to develop a successor to this plan, no further detail has yet been forthcoming.”
Firstly, we must see a COVID-19 cancer recovery plan published, detailing how diagnostic services will be supported to reduce the cancer backlog. This will require COVID-secure ‘green’ sites to shore up capacity and maintain services. Adequate COVID testing for staff and patients is necessary to sustain such sites.
Alongside this, a wide-ranging mass-media communications campaign is needed to encourage people with concerning symptoms to seek help from their GP, as well as provide reassurance that people can be seen and treated safely.
While that tackles the short-term, secondly, we need to address the long-term transformation required for cancer diagnostics. The Cancer Delivery Plan 2016 was meant to end this year. While the Welsh Government have announced their intention to develop a successor to this plan, no further detail has yet been forthcoming.
A new comprehensive cancer strategy, with the Single Cancer Pathway as a central component, is essential to drive this transformation agenda forward.
Our report, and its recommendations, is intended to be a constructive contribution to the future of cancer care in Wales. My hope is that when we look back in years to come, we will be able to recognise the Single Cancer Pathway as a pivotal moment.
We must never lose sight of the importance of improving earlier diagnosis and cancer survival – the prize is simply too great.
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Photo provided by Cancer Research UK.