Sajid Javid intends to declare ‘war on cancer’ and launch a call for evidence to underpin an ambitious 10-Year Cancer Plan for England. The government aims to seek ‘views from far and wide’ to help shape the work that will ‘take a far-reaching look at how we want cancer care to be in 2032 – 10 years from now. Looking at all stages, from prevention to diagnosis, to treatment and vaccines.’

Cancer care has improved dramatically in recent years. However, COVID’s impacts are undeniable:

‘While dedicated NHS staff ensured cancer treatment was maintained at 94% of pre-pandemic levels and 95% of people starting treatment did so within a month, there were nearly 50,000 fewer cancer diagnoses across the UK during the pandemic.’

The ‘war on cancer’ aims to build on the existing NHS Long-Term Plan with new and strengthened priorities.

Early identification

The last cancer strategy that came in 2019 promised three-quarters of cancers would be spotted at an early stage by 2028. Cancers at stage one or two are classified as ‘early’ and, prior to the pandemic, just over half of cancers were identified at these stages. There is concern that improvement in this statistic will grind to a halt – or worse, that the number of early identifications will even decrease – because of the drop in diagnoses during the pandemic.

It is important to note that it is not all doom and gloom. Cally Palmer, National Cancer Director for the NHS, noted that cancer pathways have continued to operate well despite the pandemic with ‘over 2 million checks in the last year alone and tens of thousands of people starting lifesaving treatment every month’.

In breast cancer diagnosis, AI has been shown to be as effective as human radiologists in spotting tumours from x-ray images. Given the success of this study and others like it, there is great potential for AI to be integrated into future iterations of national cancer screening programmes.

With the intention of making tests accessible closer to home, the government has also invested £2.3 billion to roll out Community Diagnostic Centres which will hopefully alleviate some strain on hospital staff. In their first full year of operation, these centres are planned to deliver up to 2.8 million scans.

Another positive is the ongoing NHS Galleri Trial which looks for distinct markers in the blood to detect cancer early. This could have wide applications to detect cancer across society. The trial includes people of all different backgrounds and ethnicities to ensure the results of the trial benefit all members of society equally. It’s vital that any progress is used to combat the health inequalities present in the UK, not reinforce them.

Tackling disparities and inequalities

None of the pandemic’s impacts have affected the entire population equally, and cancer care is no exception. COVID restrictions have meant that people have had to attend appointments and receive difficult news alone. This has been even more challenging for patients who may require interpreters.

In the absence of a BSL (British Sign Language) interpreter, Coleen, a deaf woman interviewed by the BBC, received a diagnosis she struggled to understand. Because of PPE rules, staff could not remove their masks to allow her to lip read and although she was supplied with a large quantity of written information this was unhelpful as she, like many people who are deaf from birth, struggles to read. All these factors left her feeling isolated at a time when support is so incredibly valuable. Coleen’s story is not unique and echoes the experiences of many other deaf patients and those who do not have English as their first language. As a result of barriers like this, many people across the UK will have had an already tough time made even more difficult by the disruption of COVID.

The call for evidence to underpin upcoming plans for Javid’s ‘war on cancer’ seeks views and experiences from a wide cross-section of society. Hopefully, experiences like Coleen’s will be included so that they are not repeated.

Boosting the cancer workforce

A familiar problem for the NHS is finding – and retaining – enough staff to combat the huge backlogs the service currently faces. Staff are tired, burning out, likely traumatised by the experiences of the past year, and vast numbers have had to isolate due to potential COVID exposure. Once again, cancer care is not safe from this challenge.

Lynda Thomas of Macmillan Cancer Support commented that improving diagnosis and treatment is like ‘building sandcastles while the tide comes’ without extra staff to support demand. Indeed, these improvements are but a small part of the puzzle. To combat staffing challenges, the government is ‘aiming to build a world class cancer workforce to help the NHS’s recovery by developing new roles along with training and upskilling the current workforce.’

Upskilling the current workforce is certainly a good idea, but a challenge that frequently arises is finding the time to train staff. NHS staff are already rushed off their feet, making it hard to fit training into their already packed schedules. The time investment would likely be worth it in the long term, but spare time is not something the NHS currently possesses.

Anna Jewell, chair of the Less Survivable Cancers Taskforce emphasised the urgency of the situation, stating that ‘if we are to truly be successful we need to go much further on cancer and improve the persistently poor outcomes that patients in this country have long experienced.’

Javid’s battle plans appear to be comprehensive, but whether the plan will be enough to counter the impact of those 50,000 fewer diagnoses remains to be seen.