Cancer care in the future

16 Aug 2017

In April of 2015 I was privileged to be appointed as national Clinical Director for Cancer to work with national cancer team members in implementing the UK strategy, “Achieving World Class Cancer Outcomes”.

I was first introduced to cancer care as a medical student on the wards of Manchester hospitals, where I witnessed huge variations in care and attitudes, prevalent at that time.

Later, working in Lancashire, I saw the wider impact on families and some of the difficulties of diagnosis as I shadowed and learned from experienced, compassionate GPs. Over the years cancer has also affected my family and close friends with an impact going far beyond the medical aspects of treatment.

These experiences shaped much of my later career, convincing me, firstly, that we could prevent many cancers by organised efforts to support people and communities, and, secondly, that we should be managing cancer services to ensure specialist care, including palliative and supportive care, is available to all.

If our efforts at prevention and treatment are successful, then by 2030 we expect the number of people alive in England, following a cancer diagnosis at some point in their lives, to reach 3 million – a 50% rise from the 2015 figure of 2 million.

Cancer care has improved hugely since I became a doctor. New more effective treatments have been introduced with fewer side effects. Many cancers are preventable through lifestyle changes and improvements in early detection methods. Genetic factors for cancer risk and also response to treatment are becoming understood in detail, making it increasingly possible to personalise care.

One example is our understanding of the so called BRCA mutations, more common in Ashkenazi Jewish people and linked to certain cancers.  Where people from an Ashkenazi background have a family history of breast or ovarian cancer they should discuss the possibility of genetic testing with their GP. For further advice you can contact a support organisation, for example Chai Cancer Centre. At a national level the NHS has also provided specific funds for improving cancer care. For example, over a two-year period we have £130 million earmarked to replace and improve radiotherapy machines. We also have over £200 million to help local cancer services improve cancer diagnosis and care, including follow-up support.

Other initiatives include a national Cancer Drugs Fund which has expedited the adoption of new cancer drugs by between four and six months.

National action alone cannot fully achieve the objectives of the strategy but it can set the framework for local action. Across England there are now 19 areas where NHS organisations come together with patients, voluntary sector organisations and local authorities to make sure the national strategy is implemented locally.

With the NHS facing unprecedented financial pressure, we must also develop new mechanisms for funding cancer care, finding creative ways to work with voluntary, charitable and commercial organisations.

As well as my national role, I continue to work in the NHS as the Medical Director of The Christie Cancer Centre in Manchester and also, recently, in a large group of teaching hospitals –Imperial College Healthcare in West London. I see the challenges and opportunities for cancer care across all parts of the health service. If we are to realise the outcomes called for in the national strategy, all parts of the health system must work together within the national framework.