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Chemotherapy delivery: challenges for the future
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Chemotherapy delivery: challenges for the future
Gill Donovan, Director of Patient Services, Cancer Care Cymru and Velindre Cancer Centre, Cardiff
Introduction
As a result of the rising incidence of cancer and the expanding range of treatments available, UK cancer services are working under growing pressure.1,2 In this article I will discuss national and local strategies for coping with the demand for cancer care, looking specifically at the issues of patient capacity and the drive to deliver cancer treatments nearer to patients’ homes. I will also reflect on examples of practices that have had a positive impact on service delivery.
The size of the challenge
It is estimated that 1 million people alive now in the UK have been diagnosed with cancer, and that a further 250,000 people a year will develop a malignant condition.1 The incidence of cancer is rising—the overall rate has increased by 31% since the 1970s, but mortality has fallen by 12% during the same time period.2 Moreover, as the population ages, the numbers diagnosed with cancer will increase.1 Knowledge about cancer is also on the increase, bringing greater ability to provide effective treatments—curative interventions and those that slow disease progression or mitigate its effects. Patients with cancer are now offered multiple interventions that were not possible just a few years ago. However, these new treatments are often in addition to, rather than a replacement for, existing options, and they are given over a prolonged period of time, again increasing the pressure on cancer services. The Commission for Health Improvement has estimated that more than 50% of people diagnosed with cancer will be given chemotherapy,3 a number that is expected to increase in the near future.2 All of these factors place additional demands on already overstretched services.
A survey of 42 hospitals, published in 2003, found a huge increase in the use of intravenous chemotherapy over the previous 3 years. The average increase was 200%, with some hospitals reporting a 500% rise. Unsurprisingly, this increase has had a significant impact on the pressures faced by the cancer care workforce.2
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Discussion.