Cancer

Cancer is a condition where cells in an area of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue. This Cancer Research UK webpage provides further information.

In the UK, around 360,000 people are diagnosed with cancer every year. One in two people born after 1960 will be diagnosed with some form of cancer in their lifetime (Cancer Research UK).

In Surrey Heartlands CCG there were 559 new cancer cases per 100,000 population (based on 2018/19 PHE Fingertips data). 

Almost half of cancers are diagnosed at a late stage in England (Cancer Research UK, 2014). This means that the cancer is far along in its growth and may have spread to other areas of the body. We know there are over 200 different types of cancer, but do we do not know all the causes.

The Long-Term Plan for cancer

Ambitions: We will continue to transform cancer care so that from 2028:

• An extra 55,000 people each year will survive for five years or more following their cancer diagnosis;

• Three in four cancers (75%) will be diagnosed at an early stage.

The Surrey and Sussex Cancer Alliance (SSCA) response to the Long-Term Plan focuses on the following:

  • Prevention: reduce variation and inequalities in the delivery of prevention services across Surrey and Sussex in order to reduce the incidence of preventable cancers
  • Screening: raise awareness and improve accessibility of screening for bowel, breast and cervical cancers
  • Earlier & Faster Diagnosis: develop Rapid Diagnostic Services and work with our Primary Care Networks to deliver faster and earlier diagnosis
  • Treatment: continue to improve our world-class treatments and services for people with cancer
  • Personalised Care: develop personalised offer of services and support for people living with and beyond cancer

The role of primary care across the cancer pathway is vast:

Further information around the Early Cancer Diagnosis 2021-22 PCN specification and QOF QI can be found here:

https://www.england.nhs.uk/wp-content/uploads/2021/03/B0431-network-contract-des-early-cancer-diagnosis-guidance-21-22.pdf

Prevention and Screening

Experts estimate that more than 4 in 10 cancer cases could be prevented and by making simple changes to lifestyle you can significantly reduce the risk of developing cancer.

Screening is a way of identifying apparently healthy people who may have an increased risk of a particular condition and who will most likely benefit from it.

The NHS offers three types of screening for adults in England to help identify cancer at an early stage. These are:

  • Breast - is offered to women aged 50 to 70 to detect early signs of breast cancer. Women over 70 can self-refer via the NHS website
  • Bowel - a home testing kit is offered to men and women aged 60 to 74, with a planned lowering to 50. Those who have misplaced their kit or are 75 or over can ask for a kit every two years by phoning the free bowel cancer screening helpline on 0800 707 60 60
  • Cervical - is offered to women aged 25 to 64 to check the health of cells in the cervix. It is offered every three years for those aged 25 to 49, and every five years from the ages of 50 to 64.

Further details can be found on the NHS screening website.

Spotting cancer early means treatment is more likely to be successful. You can find out more about the common signs and symptoms of cancer on the NHS website and Macmillan Cancer Support 

Living With and Beyond Cancer

Improvements in the diagnosis and treatment of cancer mean that more people are living longer after a cancer diagnosis, but not everyone is living well.

Macmillan’s I've Finished Treatment webpage provides lots of advice on coping with life after cancer, and getting support. There are a number of support services available which can be searched on the Cancer Care Map website.

According to Macmillan Cancer Support Local intelligence England, Cancer Statistics in England for Surrey Heartlands CCG, the prevalence of people living up to 21 years after a cancer diagnosis at the end of 2015 was 35,770 and this figure is estimated to rise to 57,720 by 2030.

Statistics show that in an average GP practice of 8000 patients, there will be approximately 48 new cancer diagnoses per year and around 280 patients living with and beyond cancer. These patients will attend more frequently than other patients of same age and 50% will have still have unmet needs 12 months after diagnosis. Many cancer patients are living with cancer and other common long-term conditions.

By 2024, we want people in Surrey Heartlands to live healthy and fulfilling lives to reduce their risk of cancer. Should they be diagnosed with cancer we want people to be diagnosed as early as possible, to have prompt, high quality treatment and to feel fully supported throughout their journey to ensure the best chance of survival and recovery, whilst maintaining a good quality of life.

Across Surrey Heartlands, we have some positive cancer patient outcomes with 75.6% (2016) of patients surviving one year. We aim to improve one-year survival rates to 80% by 2024.

Surrey Heartlands also has high reported patient experience through the National Cancer Patient Experience Survey (2018) with an average patient rating of care of 8.9 out of 10. However, there remain areas that need to be improved to ensure equity of outcomes for all patients e.g. increased support after acute treatment finishes with high quality cancer care reviews.

To improve outcomes, Surrey Heartlands CCG is working with system partners on a range of projects to transform pathways to diagnosis, improve patient experience and implement the 28 day to diagnosis pathways.

We are also working with partners to improve the personalised care offer to cancer patients and their families.

Cancer Research UK 

Health Professional COVID-19 and Cancer Hub

https://www.cancerresearchuk.org/health-professional/diagnosis/hp-covid-19-and-cancer-hub#HP_COVID-193

Macmillan Cancer Support

Find tools, guidance and opportunities to support you in your role as a health or social care professional

https://www.macmillan.org.uk/healthcare-professionals

NICE 

Suspected cancer recognition and referral overview

https://pathways.nice.org.uk/pathways/suspected-cancer-recognition-and-referral

NG12 Suspected cancer: recognition and referral (2020)

 https://www.nice.org.uk/guidance/ng12

Practical guidance on best practice for cancer recognition and referral

https://cks.nice.org.uk/specialities/cancer/

NHS England

Cancer - Earlier diagnosis https://www.england.nhs.uk/cancer/early-diagnosis/

Rapid cancer diagnostic and assessment pathways (2018; updated 2019)

https://www.england.nhs.uk/publication/rapid-cancer-diagnostic-and-assessment-pathways/

NHS Confederation

Briefing - Early diagnosis and cancer treatment: how system working can help get the NHS back on track (2021) https://www.nhsconfed.org/publications/early-diagnosis-and-cancer-treatment

National Cancer Registration and Analysis Service (NCIN)

Awareness and Early Diagnosis

http://www.ncin.org.uk/cancer_type_and_topic_specific_work/topic_specific_work/awareness_early_diagnosis

Podcasts

https://anchor.fm/macmillan-primary-care-nursing-project/episodes/Episode-1-Managing-Cancer-as-a-Long-Term-Condition-What-does-Good-Practice-Look-Like-e8uahd

https://www.macmillan.org.uk/about-us/media-centre/talking-cancer-podcast.html

https://topmedtalk.libsyn.com/size/5/?search=macmillan

Cancer Care Reviews

Hints and Tips

https://www.powtoon.com/online-presentation/b4FcVYPk3PH/?mode=movie

10 Top Tips for Primary care: effective cancer care reviews

https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/ten-tips-primary-care-cancer-care-reviews

Video – creating a CCR in EMIS

https://www.youtube.com/watch?v=drjFy_JTZUo

Screening

An overview of the national screening programme from PHE

https://www.gov.uk/guidance/cervical-screening-programme-overview 

Digital information

https://www.gov.uk/guidance/nhs-population-screening-programmes-digital-information

Easy read

https://phescreening.blog.gov.uk/tag/easy-read-information/

Cancer screening and people with learning disabilities

https://www.gov.uk/government/publications/cancer-screening-and-people-with-learning-disabilities

Jo’s Cervical Cancer Trust Resources https://www.jostrust.org.uk/professionals

Safety-netting

CRUK

https://www.cancerresearchuk.org/health-professional/diagnosis/suspected-cancer-referral-best-practice/safety-netting

Macmillan – top tips for safety netting

https://www.macmillan.org.uk/documents/aboutus/health_professionals/primarycare/primarycare10toptips-safetynetting.pdf

Click here to view and book STH education & training for:

  • Funded Cancer Training
  • Lunch & Learn
  • Cancer Action Learning Sets in your area

Click here to see our Webinars on demand page (Clinical)

eLfh

Cancer in the Community

https://www.e-lfh.org.uk/programmes/cancer-in-the-community/

NHS Screening programmes

https://www.e-lfh.org.uk/programmes/nhs-screening-programmes/

The Changing Story of Cancer Online Learning Module

https://www.e-lfh.org.uk/programmes/the-changing-story-of-cancer/

Promoting physical activity in primary care

https://portal.e-lfh.org.uk/Component/Details/592074

Cancer conditions – Being Active

https://portal.e-lfh.org.uk/Component/Details/592074

Gateway-C

GatewayC is a free online cancer education platform developed for primary care professionals across England, aiming to improve cancer outcomes by facilitating earlier diagnosis and improving patient experience. https://www.gatewayc.org.uk

Macmillan Learnzone

Free learning resources, online courses and professional developmental tools from Macmillan Cancer Support

https://learnzone.org.uk

RedWhale webinars

Series of FREE webinars led by Macmillan Cancer Support and consultant oncologists to demystify some of the conundrums posed by cancer in primary care including:

  • Primary care Guide to Prostate Cancer
  • Lung Cancer in Primary Care
  • Pancreatic Cancer

https://www.gp-update.co.uk/webinars

RCGP 

Early Diagnosis of Cancer https://elearning.rcgp.org.uk/course/info.php?id=109

Early Diagnosis of Cancer Significant Event Analysis Toolkit

https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/early-diagnosis-of-cancer-significant-event-analysis-toolkit.aspx

Primary Care Cancer Toolkit

https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/primary-care-cancer-toolkit.aspx

Cancer Action Learning Sets- Please see the Surrey Training Hub training calendar for dates in your area

Click here to see our Webinars on demand page (Clinical)

Outreach Library Service can identify, collate, and summarise evidence for you, to inform your clinical practice, patient pathways and professional development. https://future.nhs.uk/surreyheartlands/view?objectID=26431600 

Fingertips

Public Health England (PHE) tool containing data on cancer services at GP, primary care network (PCN) and CCG level collated by the National Cancer Registration and Analysis Service (NCRAS).

https://fingertips.phe.org.uk/profile/cancerservices

PCN Directed Enhanced Service and QoF Quality Improvement (QI) 2021-22

NHS England – QOF Quality Improvement Domain 2020/21 – Early diagnosis of cancer

https://www.england.nhs.uk/wp-content/uploads/2020/02/20-21-qof-qi-cancer.pdf

Surrey and Sussex Cancer Alliance Resource Pack

https://www.england.nhs.uk/south-east/cancer-alliances/surrey-and-sussex-cancer-alliance/resources/

NHS Confederation: Delivering the early diagnosis of cancer PCN specification - Webinar (2020) https://www.nhsconfed.org/events/delivering-early-diagnosis-cancer-pcn-specification

CRUK Early Diagnosis of cancer: Guide to the GP Contract 2021/22 for Primary Care Networks (PCNs) and Practices

https://www.cancerresearchuk.org/health-professional/learning-and-support/resources/gp-contract-guide

Macmillan Cancer Support

Supporting Early Cancer Diagnosis: a quality improvement toolkit for cancer care in primary care

https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/early-cancer-diagnosis-quality-improvement-toolkit

Macmillan Primary Care Resources supporting the PCN DES

Public Health England 

Early Cancer Diagnosis (2019; Updated 2021) https://www.ethnicity-facts-figures.service.gov.uk/health/physical-health/cancer-diagnosis-at-an-early-stage/latest

Cancer in the South East (2018) https://www.gov.uk/government/publications/cancer-in-the-south-east

The Strategy Unit (Midlands and Lancashire Commissioning Support Unit)

Evidence Review: Early diagnosis of cancer (2020) https://www.strategyunitwm.nhs.uk/publications/evidence-review-early-diagnosis-cancer

Cancer Research UK

Cancer incidence statistics 2020

 https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence

Capacity to Diagnose? An analysis of Cancer Diagnostic Activity in England (2018) https://www.cancerresearchuk.org/sites/default/files/mar18_capacity_to_diagnose.pdf

Early Detection and Diagnosis of Cancer. A roadmap to the future (2020) https://www.cancerresearchuk.org/sites/default/files/early_detection_diagnosis_of_cancer_roadmap.pdf

Cardiff University 

UK-wide research to look at impact of Covid-19 on early cancer diagnosis (2020) https://www.cardiff.ac.uk/news/view/2413601-uk-wide-research-to-look-at-impact-of-covid-19-on-early-cancer-diagnosis

Fingertips

https://fingertips.phe.org.uk/profile/cancerservices

Local Cancer Intelligence England

Local Cancer Intelligence helps you understand the changing cancer population within your Clinical Commissioning Group (CCG) in England. It also shows how this compares within Cancer Alliances for some of the data sets available on the tool.

https://lci.macmillan.org.uk/england/

Office for National Statistics (ONS)

Cancer survival in England: national estimates for patients followed up to 2017 (2019)  https://www.ons.gov.uk/releases/cancersurvivalinenglandadultstageatdiagnosisandchildhoodpatientsfollowedupto2017

Published Research

Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

Author(s) Chima S, et al. 

Source: British Journal of General Practice 2019 28 69 (689) pe809-e818

Full-text: https://bjgp.org/content/69/689/e809.long

Improving early cancer diagnosis in primary care

Author(s): Merriel, WD. et al.  

Source: Prescriber 2020 31 (9) p10-14

Full-text  https://wchh.onlinelibrary.wiley.com/doi/10.1002/psb.1862