Cancer Reform Strategy - NHS Cancer Screening Programmes

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88 CANCER REFORM STRATEGY6.25 Patient experience surveys have shownthat BME groups, in general, report a worseexperience of treatment and care. The actionsset out in chapter 5 are intended to helpaddress this.6.26 As we move forward it will be importantto assess the impact of newer trends inmigration, ensuring that cancer services areequipped to meet the needs of differentpopulations. For example, many migrantcommunities from Eastern Europe have higherrates of smoking which may require specificlocal action. Good commissioners will considerthe needs of all the groups they serve anddevelop strategies to address these.Age and cancer6.27 Cancer predominantly affects older people.Fifty one percent of all cancer diagnosed is inpeople over 70 years old and more than threequarters of all cancer deaths occur in peopleaged over 65 years.6.28 The link between increasing age andincreasing risk of developing cancer appears tobe poorly understood by the public. For examplea recent study by the NHS Cancer ScreeningResearch Group found that over 50% of womenwrongly believe that the risk of breast cancerdoes not vary with age, with only one per centcorrectly believing that the oldest women are atgreatest risk. 37 Lack of awareness that they arestill at risk of developing breast cancer appearsto be one of the major reasons why olderwomen with breast cancer present later andwith more advanced disease than youngerwomen.6.29 The information we will collect onawareness, clinical outcomes and patientexperience will be a powerful tool for identifyingareas where further work is necessary if olderpeople are to benefit from the best possiblecancer services.6.30 There is some evidence that older peoplereceive less intensive treatment than youngerFigure 10: Proportion of patients in England and Wales in the various age bands whoreceived any active anti-cancer treatment7060Proportion (percent)50403020100-54 .55-5960-6465-6970-7475-7980-8485+Age bandsData from the second annual report of the national lung cancer audit programme
CHAPTER 6: REDUCING CANCER INEQUALITIES 89people even when they are fit enough to do so.Evidence recently published in the British Journalof Cancer suggests that, even after adjusting fortumour type, when compared to youngerwomen older women are less likely to receivestandard management for breast cancer, suchas radiotherapy treatment. 38 Similarly, datagathered from the national lung cancer auditsuggests that older people are less likely toreceive radical treatment (Figure 10) 39 . Experts inthe care of older people will be invited to jointhe National Cancer Equality Initiative to adviseon this.6.31 Most clinical trials focus on patients underthe age of 65, meaning that less data areavailable on the efficacy of treatment in olderpeople. We believe that later stage trials shouldbe conducted in groups who would be mostlikely to be treated with the medicines inquestion. We will work with the NCRN todevelop ways of encouraging more clinicaltrials to include older people. We will alsoencourage medicines’ regulators andindustry to work together so that the useof age as an exclusion criterion in cancerclinical trials is avoided wherever possible.6.32 In the meantime, we do not believethat age should be used as a barrier totreatment. The assumption should be thatolder patients should receive the same levelof treatment. The only acceptable criteriafor not giving a clinically appropriate andcost effective treatment should be poorpatient health or a patient themselvesmaking a choice not to receive furthertreatment. We will explore ways of makingthis more explicit when guidance is issuedon interventions where clinical trials mayhave excluded older people.6.33 The majority of children have theopportunity to participate in clinical trials andthis should continue. However, the situation isless impressive for teenagers and young adults.Over 70% of attendees at a recent TeenageCancer Trust conference reported that they wereBox 33: Age appropriate servicesThe Christie Teenage Cancer Unit is one of a number of units in the country, supported by theTeenage Cancer Trust, that cares specifically for teenagers & young adults with cancer, a distinctgroup with unique needs that differ from both children and adults. The unit is aimed at 16-24year olds and currently has 13 beds plus a day service. It provides a hospital environment that isappropriate to young people including internet access per bed, allowance of mobile phones andaccess to music equipment, Sky TV etc. There is also access to space for socialising and space tomeet the needs of families, siblings and carers.A diagnosis of cancer in this age group results in complex psychosocial issues for both thepatients and their families/carers. Young people at the Christie are therefore cared for by staffwith extensive knowledge and expertise in cancer in this age group – staff with knowledge of ayoung person’s cancer journey, typical reactions of young people facing cancer, young people’scoping mechanisms, excellent communication/interpersonal skills and the ability to recognizepsychological problems/dysfunction in young people to ensure early/timely intervention.Extensive support services are also offered led by a Support and Activity Coordinator. Supportgroups are available to young people throughout treatment; from diagnosis and for many yearsafter treatment. These groups ensure that young people remain socially motivated, continue tofunction as young people, have access to their peer group, support from other patients and aidthe transition process back to ‘normality’ once treatment is completed. There is also a teenage &young adult community liaison post to bridge the gap between children’s and adult existingcommunity services/teams and to offer expert advice regarding care for this group to existingcommunity staff and ensure that young people with cancer are offered support at home whilstundergoing cancer treatment. In addition the unit has a lead teenage & young adult nurse todrive and coordinate the services offered.
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Cancer Reform Strategy
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DH INFORMATION READER BOXPolicyHR/W
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3Forewordby the Prime MinisterAt on
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6 CANCER REFORM STRATEGY9. Your NHS
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8 CANCER REFORM STRATEGY9. Excessiv
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10 CANCER REFORM STRATEGYWe will al
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What the Cancer Reform Strategy mea
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17Chapter 1:The challenge of cancer
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CHAPTER 1: THE CHALLENGE OF CANCER
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33Chapter 2:Preventing cancerChapte
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CHAPTER 2: PREVENTING CANCER 352.15
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