Cancer: the other side

I wrote on Friday about the huge advances we have made in cancer survival rates. But this article from the Guardian highlighting the audit of services by Macmillan Cancer Care shows how much further we need to go in securing early diagnosis. 

Cancer care in Britain has been dubbed a national shame, and despite many people with the disease living longer, patients are being denied a dignified death, according to a leading charity.
Too many people are diagnosed too late, are shown a lack of compassion during their care and feel abandoned after treatment, said Ciarán Devane, chief executive of Macmillan Cancer Support.
His damning verdict accompanied the charity's first state of the nation report which condemns UK governments for lagging behind western European countries and others on cancer survival rates.
"Any notions that cancer care in the UK is 'fixed' are rubbished by our findings," said Devane. "While the NHS does amazing things every day, it is a national shame that our cancer survival rates are among the worst in Europe, that patients are being treated with a lack of dignity, or being denied a 'good' death.
"Cancer patients no longer either simply get cured or die. Many live a long time but struggle with serious health problems," said Devane.
"With the number of people living with cancer set to increase, political parties must ask themselves – how will we cope with these growing numbers when we cannot even meet the needs of many people today? … With a UK cancer crisis looming, we must take action now."
Macmillan's report says one in three (32%) people with cancer die within a year of diagnosis, suggesting for many diagnosis is too late, and lambasts lack of information and support for patients and shortages of specialist cancer nurses. It says there is lack of compassion towards some patients when they are at their most vulnerable. Significant numbers of those with cancer "experience long-term physical, emotional, financial and work issues".
Calling for a shift in funds from hospitals to community care, the charity calls for government focus on reducing late diagnosis, priority for patients' experiences alongside clinical matters and to let patients spend their final days in the place of their choosing and with free social care.
Macmillan points to the disparity in patients' wishes on where they want to die, shown in its own online survey in 2010, and where they do die, as recorded for England and Wales in 2012 by the Office for National Statistics. Thus while 73% of those with cancer want to die at home, more than a quarter elsewhere, and less than 1% in hospital, in reality only 30% die at home, 32% elsewhere and 38% in hospital, the report says.
It cites evidence from the British Journal of Cancer that one in four cancers in England are diagnosed via emergency admission to hospital, rather than through screening or GP referral, rising to half all cases of pancreatic and nearly two-thirds of brain or central nervous system cancers.
It also says that there is "a shocking postcode lottery" within the UK over survival rates, treatment and care for those with cancer.
The report also points to research on cancer survival published in the Lancet medical journal three years ago, for colorectal, lung, breast and ovarian cancer in Australia, Canada, Denmark, Norway, Sweden and Britain.
It was persistently lower in Denmark, England, Northern Ireland, and Wales, particularly in the first year after diagnosis and for patients aged 65 years and older.
The proportion of people with lung cancer dying within a year of diagnosis in the UK was 70%, compared with 65% in Denmark, 61% in Norway and 56% in Sweden.
The Department of Health in England said: "We want the UK to be the best place in the world to survive cancer. We have invested £750m over four years to support early diagnosis and improve access to screening and have already seen significant improvements in some cancer survival rates.
"The recent cancer experience survey has shown high levels of satisfaction with the care and compassion shown to patients. However, the NHS always works to improve standards. We are starting a review looking at the issue of choice in end-of-life care."