Cancer Care – A UK View

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Every year, over 250,000 people in England are diagnosed with cancer, and around 130,000 die as a result of the disease.

Annual NHS costs for cancer services are £5 billion, but the cost to society as a whole – including costs for loss of productivity – is £18.3 billion.

More people are surviving cancer. But our survival rates are still worse than those for other countries that are as wealthy as us.

There are 437 NHS hospitals and 168 NHS Trusts in the UK (England, Wales, Scotland, Northern Ireland) and these Trusts are made up of 1 or more hospitals in a particular region.

There are more than 300 individual NHS hospitals which offer Oncology and Chemotherapy services

Alongside these state funded healthcare establishments are 230 Private Hospitals in the UK and 140 or so of these offer Oncology/ Chemotherapy services

Cancer diagnosis and treatment will rise from £9.4billion in 2010 to £15.3billion by 2021 – an increase of £5.9billion in 2010, the average cost of treating and individual, diagnosed with cancer, was approximately £30,000; by 2021 – this will rise to almost £40,000

There will be a 20% growth increase in UK cancer rates by 2021

Cost of cancer technologies and treatments will continue to rise significantly over the 10 year period

The UK private health sector estimates a £531million increase over the same period

UK Cancer Incidence Rates

As of 2010 (the last comprehensive National figures), there were 324, 579 cases of Cancer in the UK

The incidence statistics available are compiled from data produced by the regional cancer registries in England, and the three national registries in Wales, Scotland and Northern Ireland

Breast Cancer, with an AS rate of 126 per 100,000 women (= 49,564 new female cases as of 2010) and is by far the most commonly diagnosed cancer in females, accounting for almost a third (31%) of all female cases

2005-2009, 85.1% of adult female breast cancer patients in England survived their cancer for five years or more.

Recurrence rates of Breast Cancer in UK are 26% of all surviving patients.

The next most common cancers in women are lung and bowel, accounting for similar proportions of cases (12% and 11%, respectively). Two of the top ten female cancer sites are sex-specific (uterus and ovary), compared with just one site (prostate) in males

Prostate cancer is the fifth fastest increasing cancer in males, with AS rates rising by around a fifth (22%) in the last decade. The use of prostate specific antigen (PSA) test for prostate cancer will have contributed to the marked increase in new diagnoses of this disease. This increase will occur with more awareness, less inhibition to be tested and scientific leaps in genetic marker diagnosis technology.

Across the UK, the highest AS rates for all cancers combined are seen in Wales for males (454 per 100,000) and Scotland for females (408 per 100,000)

Prevalence

In 2008, it was estimated that there are just over two million people living with or beyond cancer in the UK who had previously been diagnosed, and this is predicted to rise by more than 3% a year 1 Prevalence figures are influenced by both incidence and survival. Thus, the most prevalent types of cancer are those with a relatively high incidence rate and a good prognosis. In the UK the most prevalent cancer in males is prostate cancer and in females it is breast cancer.

The latest analysis shows that at the end of 2006, there were over 200,000 prevalent cancer patients in the UK who were alive one year after their diagnosis. In total, there were 1.13 million cancer survivors in the UK who were alive up to 10 years from diagnosis at the end of 2006.
Recurrence occurs in all cancers and rates vary by disease.

These latest estimates are much higher than previous forecasts of cancer prevalence. This is mainly because incidence has been rising whilst the death rates have continued to fall, leading to better survival. This trend is expected to continue over the coming years as a result of a number of factors, including an ageing population, earlier detection of cancer and continued improvements in treatment. However, recurrence rates may continue to rise.

Prognosis

By 2020, 47% of the population will be diagnosed with cancer at some point before they die, according to projections drawn up by Macmillan Cancer Support.

The incidence of cancer has risen by more than a third over the past 20 years. In 1992 about one in three people (32%) who died that year in Britain had had a diagnosis of the disease. By 2010 that had increased to 44%, a jump of 38%.

Macmillan’s latest estimates, based on official data on cancer incidence, all-cause mortality and projections of future cancer prevalence, predict that it will rise again, to 47%, by 2020.

The ageing population is the main driver of the trend, although lifestyle factors such as poor diet, alcohol consumption and physical inactivity are also causes, the charity said.

“In only seven years’ time nearly half the population will get cancer in their lifetime. This poses a herculean challenge for the NHS and for society,” said Ciarán Devane, Macmillan’s chief executive.

Macmillan Cancer’s analysis anticipates that the proportion of people who survive a diagnosis of one of the 200 or so forms of cancer will reach 38%. It has already risen from just 21% in 1992 to 35% in 2010.

The UK data clearly shows that the most common cancers (for both women and men where hairloss inducing chemotherapy is a significant risk) are increasing steadily annually and have been over many years.

This increase can be attributed in the main to better diagnosis techniques, an ever increasing elderly population and more awareness of symptoms and treatments.

Therefore, it is anticipated by the leading academics and clinicians in the UK that awareness, diagnosis, incidence rates of diseases such as Breast Cancer, Gynaecological and Prostate cancer will continue to rise over the next few decades.

This is coupled with the fact that the chemotherapy treatments offered will not change significantly during this period.
Therefore, for any NHS or Private Hospital Group, it can be expected that the level of patients requiring oncology and chemotherapy services will rise also accordingly.

Worldwide

As the world’s population continues to grow and age, the burden of cancer will inevitably increase, even if current incidence rates remain the same.

More than half of all cancers worldwide are already diagnosed in the developing countries, and without intervention this proportion is predicted to rise in the coming decades.

It is estimated there will be almost 22.2 million new cases diagnosed annually worldwide by 2030. These projections are based on demographic changes in populations using UN figures along with crude assumptions about the likely trends in incidence rates for six cancers. Further details are available in the World Cancer factsheet.

Based solely on current estimated mortality rates for 2008 and population projections, it is estimated there will be over 13.2 million deaths from cancer.

In 2008, the World Health Organisation (WHO) identified cancer as one of the four leading threats to human health and development (along with cardiovascular diseases, chronic respiratory diseases and diabetes).The WHO states that the global burden of cancer can be reduced and controlled by implementing three evidence-based strategies: preventing cancer from occurring in the first place, detecting cancer earlier and managing patients with cancer.

In September 2011, the United Nations General Assembly held a high-level meeting on non-communicable diseases to address the threat posed to low- and middle-income countries.

While it is clear that tackling cancer worldwide will remain one of the major challenges in the 21st century, this high-level meeting finally put cancer on the global agenda, providing the biggest and best opportunity to drive forward major change in this area.

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