Deadly disparities in cancer treatment

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Wide disparities in cancer care across the country are resulting in thousands of patients dying sooner than they should, a committee of MPs will say today.

Death rates from the commonest cancers are up to twice as high in some parts of the country compared with others, exposing a regional inequality in care. The report by the Commons Public Accounts Committee says there are "stark inequalities" in the incidence, treatment and experience of cancer in different parts of the country and the availability of the most effective drugs.

Cancer affects one in three people at some point during their lives, and one in four will die from it, but the committee found 30 per cent of cancer networks still had no plan for providing cancer services in their locality, three years after they were set up.

The Office for National Statistics calculated last year that if every area of the UK had the same incidence and mortality from cancer as the healthiest areas more than 25,000 cases of the disease and almost 17,500 deaths could be avoided. In a progress report on the NHS Cancer Plan, launched in 2000, the MPs' committee praises the "significant improvement" in cancer care in the past five years.

Despite a 31 per cent rise in cancer incidence between 1971 and 2000, largely driven by the ageing of the population, the death rate had fallen by 18 per cent in men and 7 per cent in women by 2002, it says. But the gap in survival rates between the best and worst off is increasing. Breast cancer death rates were 20 per cent higher in some regions in the North than in others, mainly in the South.

Deaths from lung cancer were twice as high in the worst region compared with the best, reflecting differences in the rate of smoking which is higher in deprived areas. Other patients suffered due to shortcomings in cancer treatment. For bowel cancer, some health authorities with a comparable incidence of the disease had sharply different death rates, mostly favouring more affluent areas.

Patients with prostate cancer have a 10 per cent better chance of surviving for five years if they live in London and the South-east than in Trent and the Northern and Yorkshire regions. London and the South-east consistently had the best survival rates for all cancers but patients consistently rated the capital's cancer services the worst. A total of 34 cancer networks were set up in 2002 to co-ordinate GP, hospital and social care and spread good practice around the country.

Edward Leigh, the chairman of the committee, said the picture halfway through the 10-year cancer plan was "mixed". The NHS had met a number of important targets, such as getting patients with suspected cancers seen promptly, more cancer drugs were available and more money was getting through to frontline services.

But he criticised persistent inequalities in access to care and the Government's failure to launch a promised programme to educate the public about the signs of cancer.

"Many cancer networks, particularly in more deprived areas, are failing to address these problems. It is hard to believe that nearly a third of the networks visited by the National Audit Office had no comprehensive plans for providing cancer services in their locality. But that was what they were set up to do."

The report condemns "unacceptably wide variations" in the take-up of cancer drugs recommended for NHS use. It highlights a nine-fold difference in the use of the breast cancer drug Herceptin a year after it was recommended by the National Institute for Clinical Excellence (Nice), ranging from 90 per cent of eligible women in some areas to 10 per cent in others.

The Tory health spokesman John Baron said: "There are still unacceptable shortfalls in the provision of cancer care. The Government has failed to address health inequalities and that continues to determine standards and services."

Jeremy Hughes, the chief executive of Breakthrough Breast Cancer, said: "Breakthrough welcomes the progress made in cancer services but the report...makes it clear the UK needs to be much better at diagnosing breast cancer early, offering better information about cancer signs and symptoms and enabling better access to screening services.

"The earlier breast cancer is detected the better your chances of survival.

"Although Nice has approved the use of Herceptin for women with advanced breast cancer, this report highlights having guidance in place is simply not enough. Unless efforts are made to ensure that such guidance is fully implemented, it will remain ineffective. Who you are and where you live should never define the kind of care, drugs and services that you will receive."

'It's a joke. This worry has been hanging over me for so long'

Natalie Ohnona, 26, discovered a pea-sized lump in her throat two years ago. She had been visiting doctors - who thought it was a harmless nodule - regularly for monitoring.

Then the lump grew, and although a biopsy tested negative for cancer, doctors agreed to remove it because it was making her feel sick.

She was operated on in July. Ms Ohnona said that three follow-up appointments were cancelled, and it was not until October when she was told the lump was cancerous. Ms Ohnona then had the whole of her thyroid removed, meaning she needed medication to replace its functions.

The cancelled appointments meant she waited until January to find out if she could start treatment.

Ms Ohnona, of Hunts Cross, Liverpool, said: "It's a joke. I have had this worry hanging over me far longer than anyone should expect to."

The Royal Liverpool Hospital apologised but said there were only two cancelled appointments. They said patients are usually informed of results within six weeks. Brian Goodinson, a hospital spokesman, said: "The delay was partly due to the fact that her consultant retired at the end of September. The thing we did know is that it wasn't harmful. When the lump was removed in July the danger had gone."

Geneviève Roberts