Cancer (health and wellbeing needs in South Tyneside)

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs (NHS Choices).

Cancer sometimes begins in one part of the body before spreading to other areas. This process is known as metastasis.

More than one in three people will develop some form of cancer during their lifetime. In the UK, the four most common types of cancer are:

• breast cancer
• lung cancer  
• prostate cancer 
• bowel cancer

There are more than 200 different types of cancer, and each is diagnosed and treated in a particular way.

1.1 Spotting signs of cancer

Changes to your body's normal processes or unusual, unexplained symptoms can sometimes be an early sign of cancer.

Symptoms that need to be checked by a doctor include:

• a lump that suddenly appears on your body
• unexplained bleeding
• changes to your bowel habits
• a persistent cough

But in many cases your symptoms won't be related to cancer and will be caused by other, non-cancerous health conditions.

1.2 Reducing your risk of cancer

Making some simple changes to your lifestyle can significantly reduce your risk of developing cancer.

For example:

• healthy eating
• taking regular exercise
• not smoking. Smoking is the single biggest preventable risk factor for cancer.
• Ensuring if you drink alcohol you drink sensibly.

Early diagnosis through screening programmes is important in improving a person's quality of life as it can lead to early diagnosis.

1.3 Cancer in South Tyneside.

Cancer is a specific priority for South Tyneside and is identified as such in South Tyneside Clinical Commissioning Group's (CCG) Commissioning Intentions, and as part of broader work on smoking-related diseases in the Joint Health and Wellbeing Strategy.

The South Tyneside NHS RightCare Commissioning for Value (CfV) 'Where to Look' packs helped us identify the areas of greatest opportunity for improvement, with Cancer being recognised as one of our key priorities. Key areas that the pack highlighted where more work needs to be done to demonstrate improvements included:

• Cancer offers our biggest opportunity from a spend and outcomes perspective.
• Significant reduction in life years saved if Cancer was at the level of other CCGs.
• There is significant reduction in variation needed to bring South Tyneside to the level of its peer group in:
  • Spend on elective admissions
  • Mortality from all cancers under 75 years
  • Mortality from lung cancer under 75 years
  • Mortality from all cancers all ages.

South Tyneside has a cancer locality group. This is a multi-agency group chaired by the CCG to work with key stakeholders including patient representatives to ensure South Tyneside identifies and works on its cancer priorities.

The locality group works closely with the Northern Cancer Alliance. This is the organisation a NE approach to cancer. It is a collaborative through which health, social care and third sector stakeholders can work together to develop and deliver new models of care to achieve our collective ambition to deliver the ambitions identified by the Cancer Taskforce.

National data on cancer is collated by Public Health England. Specific South Tyneside cancer data is available to support the CfV information. These highlight:

• High prevalence of smoking,
• a legacy of heavy industry.
• For cancers, such as lung and bowel that are associated with deprivation, South Tyneside has much higher incidence than the national average.
• Breast cancer that is not associated with deprivation has an incidence close to the England average.
• Alcohol treatment figures for South Tyneside
• South Tyneside has a good record of identifying these three cancers at an early stage -all above the national average.
• South Tyneside also has a higher than England average for emergency presentation for these three cancers as well. This demonstrates the variation between different groups living in South Tyneside and the impact cancer has on them and their families. .
• The average number of days a person spends in hospital in their last year of life is higher than the England average.
• In general people living in South Tyneside have a greater risk of cancer where:
  • Rates of smoking are high
  • rates of obesity are high
  • levels of exercise are low
  • consumption of alcohol is high

South Tyneside's high-level priorities have been identified by the South Tyneside Cancer Locality Group and endorsed by South Tyneside Clinical Commissioning Group:

• Support a comprehensive Tobacco Control Strategy for South Tyneside. Particularly supporting Stop B4 Your Op pathways and a Smoke Free Hospitals Model in South Tyneside, which includes maintaining quite attempts when patients are discharged into the community,
• Improved access to lung cancer diagnostics targeted annual reviews for people with existing chronic obstructive pulmonary disease (COPD) and 30+ pack year smoking history. Low dose spiral CT screening for this cohort could be effective. This pilot was started in January 2017 and is the first of its type in the North East.
• Cancer and lung disease public awareness
• Ensure that alcohol intake is measured in primary care interactions and brief advice is provided. This service is currently commissioned from GPs and Pharmacies by Public Health but uptake is low. Alcohol questions are also part of the commissioned NHS Health Check.
• Bowel Cancer Screening -increasing the uptake of bowel screening in primary care.

In addition to specific priorities South Tyneside is developing a number of agreed clinical pathways across primary care (GP practices) and secondary care (hospital services). This linking together of services is part of the Healthpathways project. These pathways will ensure patients get the most appropriate treatment for their conditions.

Working with the Northern Cancer Alliance the South Tyneside Cancer Locality Group will deliver the following key objectives:

• Objective 1: Preventing more cancers especially in more deprived areas: campaigning and awareness-raising
• Objective 2: Increasing uptake of screening: especially within more vulnerable groups
• Objective 3: Increasing use of 2ww referral route, and direct access to tests: reducing unwarranted variation across NCA
• Objective 4: Reducing time to and stage at diagnosis: achieving stage shift of at least 10%
• Objective 5: Ensuring delivery of cancer waiting time standards in all CCG areas
• Objective 6: Offering all patients and their families 'living with and beyond' cancer support to live well
• Objective 7: Caring for all cancer patients with high quality evidence-based treatment.

By 2020 we will have:

• Reduced adult smoking prevalence to 13% overall and 21% for routine and manual groups (with a plan to further reduce overall smoking prevalence further to 5% by 2025)
• Increased the proportion of patients with a recorded cancer stage to 90%
• Increased the proportion of cancers diagnosed at stage 1&2 to 62%
• Ensured 95% of patients referred for testing are definitively diagnosed, or cancer is excluded, within four weeks
• Ensured every person with cancer has access to all four elements of the Recovery Package
• Ensured that all patients are on Stratified Follow up Pathways starting with those diagnosed with breast and urological cancers
• Increased one-year survival for all cancers to 75%
• Increased the numbers of patients surviving ten years or more to 57%
• GPs have direct access to diagnostic tests outlined in the NICE NG12 with 2 weeks and reports within 48 hours
• Mandated cancer waiting time standards are consistently met (85% meeting 62 day; 96% meeting 31 day target)
• Ensured all cancer patients have access to a CNS or key worker.

Improved on CPES 2015 overall satisfaction results: 84 - 87% at Trust level and 87 - 90% at CCG level

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs (NHS Choices). Cancer is not just one disease, but a wide-range of diseases across a wide range of components of the body. Suspected cancer has a number of pathways available to support the diagnosis. The most important cancers with regard to the number of people affected and the number of early deaths relate to cancer of the breast, colon, lung and prostate.

Achieving World-Class Cancer Outcomes a Strategy For England 2015-2020, is the national strategy for England and has highlighted areas of population risk.

• Every two minutes someone in England will be told they have cancer.
• Half of people born since 1960 will be diagnosed with cancer in their lifetime, with that proportion continuing to rise.
• The good news is that cancer survival is at its highest ever, with significant improvements made over the last 15 years.
• More than half of people receiving a cancer diagnosis will now live ten years or more.
• 280,000 individuals are now diagnosed with cancer in a year, a number which has been growing by around 2% per annum.
• Around half of these diagnoses will be of the most common cancers - breast, lung, prostate, and colorectal.
• Incidence is expected to reach over 300,000 diagnoses in 2020, and more than 360,000 in 2030. The rise is due partly to the ageing and growth of the population, a result of the overall success of the healthcare system, such that people are less likely to die early from other conditions, such as cardiovascular disease.
• Cancer is the biggest cause of death from illness or disease in every age group, from the very youngest children through to old age, with mortality significantly higher in men than in women. Death rates in England have fallen by more than a fifth over the last 30 years and by 10 per cent over the last decade5. They are expected to continue to fall, with a drop of around 17% by 2030. But 130,000 people still die from cancer each year - a number that has remained relatively constant as incidence has increased.
• There also remain groups of patients for whom outcomes and quality of life are particularly poor. Survival has improved significantly in some types of cancer, notably malignant melanoma, breast, testicular and prostate cancers. However, in lung, pancreas and oesophageal cancers and most brain tumours, survival has remained stubbornly low to date.
• We see significant variation in survival outcomes for patients across England. This variability cannot be explained solely by correlation with deprivation levels. It can be quantified across a number of indicators. For example, there is around a two-fold difference in the proportion of cancers diagnosed at an early stage.
• Health inequalities across England mean there is potentially avoidable variation in survival outcomes. There would be around 15,300 fewer cases and 19,200 fewer deaths per year across all cancers combined if socio-economically deprived groups had the same incidence rates as the least deprived .
• More than half of the inequity in overall life expectancy between social classes is linked to higher smoking rates among poorer people. The combination of improvements in survival and detection, and a growing and ageing population has resulted in an estimated 2 million people living in England who have had a cancer diagnosis.

• Historically, there has been less focus on the care received by patients after their initial treatment.
• We know that patients who have been diagnosed with cancer have a greater risk of being diagnosed with cancer again in the future.
• Many of the treatments we use can have long-term physical and mental health consequences, which result in a high proportion of individuals requiring subsequent health and social care support, and there are also practical impacts for patients such as loss of income.

• Key risk groups for cancer depend upon the cancer type e.g. some types of breast cancer have a strong familial link whereas lung cancer is strongly associated with smoking.
• There are other key drivers of these risk factors including:
  • Socio-economic deprivation.
  • Gender - cancer prevalence in females is higher than males in the NE.
  • Age increases the prevalence of cancer.

South Tyneside Cancer Profile on Fingertips

• Prevalence rates of cancer in South Tyneside are 2.8% (3.1% females and 2.5% males).
• Average prevalence 2.7% is higher than the England average (2.4).
• New cancer rates per year are higher than the England average 643/100,000 (England 515/100,000).
• Screening rates are for bowel screening (56.5%) are lower than the England average (59.7%).
• Screening rates are for breast (76.3%) and cervical screening (75%) are higher than the England average (72.5% and 73.5% respectively).

• Delivering a clear model for a Smoke Free South Tyneside Hospital,
• Delivering a clear pathway to help people stop smoking prior to elective surgery in South Tyneside,
• South Tyneside is only now starting a pilot to look at identifying lung cancer early (no other NE CCG has funded such an approach,
• More activity is needed to help people to live with and live beyond their diagnosis and subsequent treatment of cancer (survivorship)
• Support to help people (and carers) self-care and manage their conditions,
• Cancer has a bigger impact on socio-economic deprived communities than on more affluent ones.

Cancer has and will continue to have a significant impact on families in South Tyneside. The ageing population alongside of the number of people living with and beyond cancer will increase the demand for cancer services. It is estimated that there is a 3% year on year increase in resources needed to meet this demand. The burden of disease is felt more in lower socio economic groups from the combination of lifestyle issues, lower uptake of screening and late presentation. 50% of the variation in cancer can be explained by smoking rates in these groups (Achieving World-Class Cancer Outcomes a Strategy For England 2015-2020).

• Cancer Connections,
• a better u ,
• Better U Selfcare programme,
• Increasing Access to Psychological Therapies,
• Think Pharmacy First - provided by Pharmacists across South Tyneside,
• Integrated community teams / Social Navigators (housebound patients)
• 3rd sector services and advice are available - visit Wellbeing info
• Primary Care support including 2 week wait referrals so that suspected cancer can be identified as early as possible. GPs make these referrals following an appointment where they suspect the symptoms of a patient may be caused by cancer.
• Cancer site specific treatment services, some of these may be based outside of South Tyneside and are generally delivered at NHS Hospitals.

Key guidance from NICE identifies best practice regarding treatment.

Key guidance from the Northern Cancer Alliance identifies local NE local activity.

Tobacco smoking remains the biggest preventable cause of death and disease in the UK with over 8 million (20% of adults) Britons still smoking. Of the 80,000 deaths per year attributed to smoking, approximately 50% are caused by respiratory disease. 5% of hospital admissions are attributable to smoking, and smoking is estimated to cost society ~£13.4billion/ year. There is clear evidence from NICE and the British Thoracic Society that smoke-free hospitals and helping people to stop smoking prior to their elective surgery are key priorities to health "treat" smoking in patients.

Alcohol brief interventions have been reviewed and recommended.

Work needs to be undertaken regarding the public's views of the development of services and the development of new projects such as the lung cancer screening pilot.

The National Patient survey demonstrates that most patients are happy with the service they receive in regard to their cancer care.

• Focused work on Holistic Needs Assessment for patients at the end of their treatment.
• Understanding the impact the variation of socio-economic status has on the experience of cancer from prevalence through to emergency presentation / late stage diagnosis.

Last Updated: September 2017