The London Cancer New Drugs Group Meeting 2008

A clinician’s response

Provided by Dr Alison Jones, Director of Cancer Services, University College Hospital, NHS Foundation Trust

I am a Medical Oncologist specialising in breast cancer, working both in a cancer centre and also in a cancer unit, and I was Clinical Director for Cancer Services at University College Hospital’s NHS Foundation Trust for 5 years. I am also a member of the London Cancer New Drugs Group, representing the North London Cancer Network.

I congratulate the Cancer Tsar on producing the Cancer Reform Strategy. Much of this is excellent, particularly in terms of the aspirations for patients with cancer, but as always the devil is in the detail, and my main concerns are that there will be some practical difficulties in implementation within the NHS in the current structures for cancer services, and that the areas of responsibility for implementation of different aspects of the Cancer Reform Strategy are not clearly demarcated between primary care, acute trusts and cancer centres. This may be particularly difficult in London if the proposed reform of primary care and acute trusts within the development of polyclinics is implemented. I also have concerns that there has been insufficient focus on current and future technological developments, particularly in relation to imaging and pathology, which may redefine how we treat patients with a greater focus on individualised care, which in itself would be more patient-focused, but would come at the cost of initial heavy capital investment. It is also stated in the strategy that cancer is a disease of increasing age, and with the increasing ageing population in the UK, we will have both an increase in the incidence and the prevalence of cancer in older people. The needs of elderly patients with cancer and their tolerance of treatment may, however, be very different from younger patients and, to date, clinical trials have poorly informed practice for the elderly. There is insufficient integration of cancer services and care of the elderly, which may make some of the aspirations of some of the Cancer Reform Strategy difficult.

Based on my experience in working with people with cancer, there are a number of common wishes:

• The best chance of cure with good quality of life
• Honest, clear information on available options
• To have their diagnosis fast-tracked to 3 days or less
• To see the same specialist at every hospital visit
• To access the latest scientific development
• Convenient, streamlined, focused services as close to home as possible with dedicated car parking
• To be treated in a decent environment with dignity
• To get the best possible care without worrying about its cost

Sometimes these wishes have to be looked at in the light of practical implementation. For example, patients would like a service that is both consultant-led and consultant-delivered. However, with increasing site specialisation for cancer specialists, particularly in the field of oncology, the wish for specialist care may not always be compatible with delivery of care locally.

The number of cancer specialists in the UK is lower than in most European countries, and will need to be increased. Also, it is clear that we must take cognisance of the issues of training so that we are still able to develop and deliver a high-quality cancer service in the future. Some of the issues of patient focus may be addressed by the provision of a ‘key worker’ to help provide continuity of care for individual patients.

 

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