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Let's beat cancer sooner

This is a guest post from Mike Birtwistle, Founding Partner at Incisive Health, who have just produced a new report for Cancer Research UK on the economic impact of early diagnosis.

There is now a consensus that diagnosing patients earlier saves lives. There is also recognition that late diagnosis – when a person’s cancer has already spread to other parts of the body – is one of the explanations for the UK’s poorer cancer survival, when compared to countries such as Sweden.

Yet the NHS has proved to be curiously reticent to make diagnosing cancers earlier a priority. Why?

The suspicion is that cost is a major factor. At a time when the NHS has been struggling to stay out of the red and services have been having a hard time coping with demand, the prospect of more patients needing earlier treatment has seemed daunting.

This may not seem in the interests of the public, but it may be the reality of cancer services today. A report commissioned by Cancer Research UK found recently that people working in cancer feel services are teetering on the brink.

The truth, however, is no-one has ever properly analysed the financial consequences of earlier diagnosis in planning cancer services.

So Cancer Research UK commissioned Incisive Health to do just that. Our findings, published today, show that there is a clear financial dividend from earlier diagnosis, as well as a compelling case for improving cancer survival.

Earlier stage treatment costs less

Our research looked at bowel, ovarian and lung cancers (and further divided bowel cancers into cancers of the colon and rectum). We modelled the costs of treating each cancer and assessed how these costs varied when cancers were diagnosed at different stages – either early (stage 1 or 2) or late (stage 3 or 4).

The results were clear. As well as delivering better results for patients, earlier stage treatment costs considerably less, as this graphics shows:

Early Diagnosis-09

Overall, treatment for stage 3 and 4 colon, rectal, lung and ovarian cancer costs the NHS nearly two and a half times the amount spent on stage 1 and 2 services.

Across England there are significant variations in the proportion of patients who are diagnosed with cancer at an early stage.

For colorectal cancer, there is a nearly a threefold variation between the highest and lowest performing areas. For lung cancer the variation is nearly fourfold. And for ovarian cancer it is nearly fivefold.

Financial dividend

This creates a significant opportunity for the NHS. If every area could do as well as the best in terms of early diagnosis, then the financial and health benefits would be significant:

  • For colon cancer, savings of over £24 million could be realised (benefitting over 4,500 patients)
  • For rectal cancer, savings of nearly £10 million could be realised (benefitting over 1,700 patients)
  • For ovarian cancer, savings of over £16 million could be realised (benefiting over 1,400 patients)

For lung cancer, the story is slightly different. Over 3,400 patients would benefit from earlier diagnosis but, due to higher levels of recurrence in lung cancer, there would be a modest cost of £6.4 million:

Early Diagnosis-07

But when you look at this lung cancer cost in terms of cost per year of life gained (something frequently used when talking about cancer drugs) it works out as £1,515 per year.

In health terms this is a bargain.

Survival

If these findings (which cover cancers where treatment costs are both higher AND lower for earlier stage diagnosis) were applied to all cancers, then savings in treatment costs of just under £210 million would be realised, resulting in more than 52,000 people being diagnosed with earlier stage cancer.

This shows that health services should be able to plan early diagnosis programmes in the expectation that they will be able to unlock significant savings in treatment. And they should do so in the expectation that they can achieve significant health gains for cancer patients.

We estimate that, if everywhere could do as well as the best in England, then more than 5,000 extra people each year would be alive five years after their cancer diagnosis.

The affordability opportunity

There has of course been a good deal of debate in recent weeks about access to expensive radiotherapyand cancer drug treatments.

But this report is not an argument for ignoring efforts to improve treatment to instead focus on early diagnosis.

In fact it is the opposite, setting out a way in which improvements to treatment can be afforded. Earlier diagnosis will save lives and avert treatment costs. These averted costs should instead be used to fund early diagnosis programmes and better treatments for those who need them.

As the population ages, the challenge of cancer will grow. Groundbreaking research is creating opportunities to rise to this challenge.

Earlier diagnosis offers the prospect of a step change in survival and the financial headroom to make available the fruits of research.

Now we must get on and deliver it.

Image via Wikimedia Commons

Comments

IJSS McLellan October 20, 2014

It’s a terrible waste of life. The Deceased’s family rarely forgives the NHS.

wendy September 23, 2014

I had blood tests done 24/12/2013 – fast tracked 30/12/2013 – test carried out Jan 2014 diagnosed with Smouldering Mulitiple Myeloma (incurable cancer but can be managed!) on Feb 12 2014. At diagnosis I was told it was a little known cancer, which was incurable but treatable with varying options unfortunately the treatment at the smouldering stage is worse than the illness – all said as if they were doing me a favour – and so I am classed as a watch and wait candidate – living with the knowledge that at any one of my 2 monthly appointments I could be told I need the treatment – living with the anxiety and stress of being on watch and wait is unbelievable! the further you go down the line and the more ill you begin to feel the angrier you become – with this condition you feel its more a case of “oh well it is incurable – why spend the money”!!!! what about people with the cancer suffering the treatment side effects early after diagnosis in the hope of up to 7 years remission, before having to start treatment again and at least not being left feeling like they are already on the scrap heap – I used to say if you had to have cancer mine is the best sort to have – now I say why could’nt I have had a cancer that could be cut out/ shrunk and treated from the off – why wont they pay to treat these cancers in the earliest stages – Myeloma is cancer of the bone marrow – it damages from the inside out, apart from all the other symtoms!!

Mike Birtwistle September 23, 2014

Hi – thanks for the comments on the blog. The comments by Susan Cowley, Marion Leslie SRN RSCN NDN, Alexandra Rose and Maryam all demonstrate how important earlier diagnosis is for patients. Put simply, diagnosing patients earlier gives them a greater range of treatment options, including ones that are less invasive or intensive. What is more, it gives a much greater chance of long-term survival. That we have shown that earlier diagnosis can also avert treatment costs makes the case even stronger. I firmly believe this is something that the NHS cannot afford not to do.

Sandra Benson made an important point about oesophageal cancer. We focused on bowel, lung and ovarian cancer in our study. We chose these cancers because they have affect large numbers of people (and so there’s good data), there is clear national guidance on treatment pathways and they have all been subject to activity to encourage earlier diagnosis. However, a similar approach could be taken to oesophageal cancer. Diagnosing oesophageal cancer earlier can play an important role in improving survival. If any reader is concerned about the symptoms, Cancer Research UK has more information here.

VeniceLaura mentioned the issue of ‘lead time bias’ with survival. This is when someone would have died at the same time, but being diagnosed earlier means that they appear to have ‘survived’ for longer with their cancer, when in fact they just survived for longer after being diagnosed. Lead time bias shouldn’t be a factor in our report, because we looked at the stage of cancer at the point of diagnosis (not the point in time when the diagnosis occurred). As I mentioned earlier in this comment, earlier diagnosis means that patients have a greater range of treatment options and a better chance of survival, so the impact on outcomes is a real one.

Thanks for all your comments and interest. If anyone else wants to leave a comment, I’ll check back in a couple of days and try to address them.

Mike
Incisive Health

Maryam September 23, 2014

It is even more obvious if you think about early diagnosis skin cancers and super inexpensive treatments (mole removal) compared to treating advanced melanomas that will cost more than $150k

VeniceLaura September 22, 2014

Survival is not the same as mortality. Has any of this research taken into account lead time bias? And if so, where is the explanation?
http://t.co/peGmDLZW5C

Alexandra Rose September 22, 2014

Totally agree with the early diagnosis. But how do we get doctors to listen to us? I was treated with sympathy and politeness, displaying all the symptoms of Ovarian cancer for years, but no one seemed to take it seriously. Now I have OC and have had to have much more serious surgery and chemotherapy which must be costing the NHS far more in the long run, and live with the horrible knowledge that the cancer may not have gone, or may come back and require more expensive and quality of life destroying chemo. It’s madness.

Marion Leslie SRN RSCN NDN September 22, 2014

I’ve have said this all along, since my daughter’s diagnosis was delayed, even though she was showing obvious signs. She was fobbed off by GPS, who told her she had gastritis and IBS, and only examined once when she was in so much pain and could hardly walk! It makes me extremely angry. Surely earlier diagnosis has to be cost effective, although gps seem very reluctant to refer or scan. I think the government should be making provisions for earlier diagnosis, but is unlikely at the moment with their austerity measures in place.

Sandra Benson September 22, 2014

Agree with all of the above but what about esophageal cancer you must start talking about this cancer as it is very prominent in the north of England

Susan Cowley September 22, 2014

Having lost my parents to bowel cancer and non-Hodgkin’s lymphoma, both of which I believe should have been detected much earlier, the human costs are incalculable. Perhaps the financial argument will have more influence on politicians to take action.