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JSNA Chapter : Cancer

Section: Specific Condition
Next Review Date: 30/09/2014
Date Published: 06/10/2011

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Contents

  1. Introduction
  2. Who's at risk and why?
  3. The level of need in the population
  4. Current services in relation to need.
  5. Projected service use and outcomes in 3-5 years and 5-10 years.
  6. Evidence based (what works and what does not work)
  7. Unmet needs and service gaps
  8. Equality Impact Assessment
  9. Recommendations for Commissioning
  10. Recommendations for needs assessment work
  11. Key contacts
  12. Chapter References
  13. Signed off by


Introduction

Cancer is one of the commonest causes of death in Surrey. However the standardised mortality ratio (SMR) from cancer in Surrey is significantly lower than the national SMR, at 87.00 for Surrey compared to 100.00 for England. An SMR is a comparison of the number of observed deaths with the number of expected deaths in a population; it is expressed as a ratio of observed to expected deaths, multiplied by 100. If the SMR is equal to 100 it is likely to imply that the mortality rate is the same as the standard mortality rate, if it is higher than 100 it implies an excess mortality rate whereas a number below 100 implies below average mortality.

Some types of cancer are more common causes of death in Surrey compared with other parts of the country, for example Bowel Cancer and malignant melanoma. It is vital there are high quality commissioned cancer services in Surrey which support early diagnosis of cancer. This includes screening services and NHS Surrey must ensure that there is delivery of National Screening Programmes for breast, colorectal and cervical cancer to ensure early identification of cancer when treatment is most likely to be effective.

Of all cancers, 51.2% are not diagnosed by an urgent cancer referral pathway therefore NHS Surrey need to increase the numbers of patients who recognise the signs and symptoms of cancer and bring them into primary care. Survival rates are significantly influenced by diagnosing cancers at an earlier stage. NHS Surrey need to look at opportunities to diagnose them earlier, working with clinicians in primary and secondary care as well as promote awareness and prevention of lifestyle risk factors through wider public health initiatives.


Key issues and gaps

The evidence presented here suggests that the following unmet needs/service gaps exist in Surrey:

  • A requirement for a full and comprehensive cancer health needs assessment for Surrey
  • Major challenges geographically related to cancer mortality and incidence which requires further investigation
  • Limited understanding around projected service use and outcomes for Cancer Services in Surrey which requires further analysis
  • A need for a named clinical nurse specialist to be available to every patient in the Surrey Trusts, as outlined in the National Patient Experience Survey 2010
  • Access to financial support information for patients requires improvement. As we diagnose patients earlier and as we improve services and survival rates we need to look to how patients can best be supported to live with and beyond cancer.

 

Recommendations for Commissioning

The recommendations for commissioning identified here can be categorised under the following headings (see further down for more detail):

  • Prevention and early diagnosis
  • Quality of life and patient experience
  • Better treatment
  • Reducing inequalities 

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Who's at risk and why?

It is estimated that half of all cancers could be prevented by positive lifestyle choices. These measures include (1):

  • Not smoking (this reduces the risk of lung cancer, mouth cancer, bladder cancer and cervical cancer in particular)
  • Reducing alcohol intake (this reduces the risk of liver cancer, oesophageal cancer and bowel cancer)
  • Maintaining a healthy body weight (this reduces the risk of breast cancer in women after the menopause and bowel cancer)
  • Eating a healthy and balanced diet high in fruit and vegetables (this reduces the risk of colorectal cancer, stomach cancer and breast cancer)
  • Keeping active (this reduces the risk of breast cancer and bowel cancer)
  • Safe sun exposure (this reduces the risk of skin cancer such as malignant melanoma)

Table 1: Incidence of cancers (numbers) in 2008 for Surrey and England

 Cancer Type  Surrey Incidence  England Incidence
 All tumors  6,410  314,863
 Breast  893  9,664
 Colorectal  692  32,117
 Lung  515  33,256
 Prostate  686  31,227
 Female genital organs  302  15,407

Source : National Cancer Intellegence Network (NCIN), 2011

Breast Cancer

Breast cancer is now the most common cancer in the UK and almost 46,000 new cases are diagnosed every year (2) , this is true for Surrey, with 893 new cases diagnosed in 2008.

Colorectal/Bowel Cancer

Bowel cancer affects more than 36,500 people in the UK every year, and 692 in Surrey. It is the second most common cancer in women and the third in men. Eating a diet low in red or processed meat and high fibre, fruit and vegetables can reduce the risk of bowel cancer. Being physically active helps to cut the risk, but being overweight or regularly drinking too much alcohol increases it (3). Colorectal cancer is the 2nd most common cancer in men in Surrey.

Lung Cancer

Lung cancer is the 2nd most common cancer in the UK and each year more than 38,000 people are diagnosed with the disease (4). In Surrey lung cancer is the 4th most common cancer, with 515 diagnosed in 2008.
Smoking causes around nine out of ten cases of lung cancer. The longer a person smokes, the greater their risk of getting the disease. Quitting smoking dramatically reduces the risk of lung cancer.


Prostate Cancer

Prostate cancer is the most common cancer in men. It is responsible for 25% of newly diagnosed cases of cancer in England and Wales. This cancer accounts for 11% of all diagnosed cancers in Surrey, 23% of cancers in men. The chances of developing prostate cancer increase as men get older. Most cases develop in men aged 65 or older. For reasons that are not understood, prostate cancer is more common in men who are Afro-Caribbean or African descent and less common in men of Asian descent. The causes of prostate cancer are largely unknown (5) .

Skin Cancer

Skin cancer is one of the most common cancers in the UK and the number of people who develop it is increasing. There are two main types of skin cancer, malignant melanoma which is less common but more serious and non-malignant melanoma skin cancer which is very common but not so serious. Like most cancers, skin cancer is more common in increasing age (6) .

Malignant Melanoma

In Surrey malignant melanoma of skin is ranked the 8th most common cancer. The majority of cases are caused by ultraviolet radiation from the sun or use of sunbeds (7) . Malignant melanoma is relatively rare, accounting for 10% of all skin cancer cases. However, malignant melanoma is responsible for most deaths from skin cancer. In England and Wales, approximately 1,500 people die every year due to malignant melanoma (8) .

Bladder cancer

Bladder cancer is the 7th most common cancer in the UK and there are more than twice as many cases of bladder cancer in men than in women (9). Bladder cancer was one of the first cancers to be linked to industry and has an important place in the history of occupational diseases (10) .

Oesophageal cancer

Oesophageal cancer is the 9th most common cancer in the UK and around 8 in 10 oesophageal cancers occur in people aged 60 or over. There are two main types of cancer of the oesophagus, squamous cell carcinoma and adenocarcinoma. The latter is increasing rapidly in the Western populations but the underlying reasons for this are unclear (11) .

Stomach cancer

Stomach cancer is the 8th most common cancer in men in the UK and the 13th most common cancer in women and 95% of new cases of stomach cancer in the UK are in people aged 50 and over. Helicobacter pylori, a bacterial infection in the lining of the stomach, are the biggest cause of stomach cancers (12) .

Cervical and other gynaecological Cancers

Cervical cancer affects around 2,800 women each year in the UK, and is the 2nd most common cancer in women under 35 (13) . Cancer of the uterus is the 4th most common cancer in women in the UK, in 2007 7,536 cases were diagnosed (14). In the UK ovarian cancer is the 4th most common cancer in women, with nearly 7,000 cases diagnosed every year (15). In Surrey, gynaecological cancers (including cervical, uterus and ovary), rank the 5th most common cancer and the age standardised incidence rate per 100,000 population of female genital organs in Surrey in 2007 was 43.7 which is significant when compared to England at the same time which was 48.4. Unfortunately there is no information available with regards to survival and mortality for these cancers, there is therefore no further mention of these cancers in this JSNA Chapter. 

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The level of need in the population

Incidence

The incidence is the number or rate of new cancers in a given time period. The directly age standardised incidence rate of all types of cancers in 2008 for men in Surrey is lower than that for the South East (361 per 100,000 and 384 per 100,000 respectively). The incidence rate in women is also lower in Surrey than the South East rate (311 per 100,000 and 346 per 100,000 respectively).

Prevalence

Prevalence is the proportion of a population that has a disease in a specified time period. In 2009/10 in Surrey there was a prevalence of 1.6% of the registered population recorded as diagnosed with Cancer. This compares with an England prevalence of 1.4%. This higher prevalence could be due to people living longer with cancer in Surrey.

Table 2: Prevalence of all cancers, GP registered populations on Cancer register

 Year  Surrey PCT  SEC SHA  England
 2009/10  1.6%  1.6%  1.4%
 2008/09  1.4%  1.4%  1.3%
 2007/08  1.2%  1.2%  1.1%
 2006/07  1.0%  1.0%  0.9%

Source: Quality and Outcomes Framework (QOF), 2011 

Mortality

Cancer is one of the commonest causes of death in Surrey. The mortality rate from all cancers in Surrey is significantly lower than the national rate. Some types of cancer are more common causes of death in Surrey compared with other parts of the country. In Surrey mortality from Colorectal cancer and malignant melanoma are higher than both the England and South East rates. Insert chart – Mortality from all cancers all ages – SMR

Survival  

For most cancers Surrey, West Sussex and Hampshire (SWSH) Cancer Network has a higher 1 and 5 year survival rate with the exception of prostate one year survival which is lower than England for SWSH Cancer Network.

Table 3: 1 and 5 year relative survival rate (% of patients)

     SWSH CN      England    
     Persons : Rate Persons :LCL Persons: UCL  Persons: Rate Persons:LCL Persons: UCL
 1 Year relative survival  All  72.32 71.69 72.95 69.78 69.69 69.87
   Breast (Female)  96.64 95.9 97.37 95.86 95.74 95.98
   Colorectal 74.93 73.14 76.72 74.15 73.89 74.41
   Prostrate  94.53 93.41 95.64 95.11 94.85 95.27
   Trachea, Bronchus and Lung  32.69 30.66 34.73 29.43 29.17 29.68
 5 Year relative survival  All  55.08  54.24  55.91  52.01  51.89  52.13
   Breast (Female)  86.91  85.4  88.41  83.65  83.4  83.89
   Colorectal  54.14  51.61  56.66  52.97  52.62  53.33
   Prostrate  83.74  81.26  86.21  82.73  82.38  83.09
   Trachea, Bronchus and Lung  8.74  7.4  10.08  7.97  7.8  8.14

Source: Thames Cancer Registry via the national cancer information service

Note:
A confidence interval is the range of values within which we are 95% confident that the true population value lies. Confidence intervals have upper and lower values.
LCI = Lower Confidence Interval
UCI = Upper Confidence Interval
  

Breast Cancer

Incidence

The incidence of breast cancer in Surrey has been higher than South East and England rates, however since 2004, the rate has been falling lower than the rate for England. In Surrey, Elmbridge has the highest incidence rate and Mole Valley the lowest.

Figure 1
Incidence of breast cancer all ages: females SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre 

Mortality

The mortality from breast cancer in Surrey is below both the England and South East mortality rates, with Spelthorne recording the highest mortality rates and Woking the lowest.

Figure 2 
Mortality from breast cancer all ages: DSR: 2007-2009

Dataset: Mortality specific conditions, Source: NHS Information Centre 

Colorectal/Bowel Cancer

Incidence

The incidence of colorectal cancer in Surrey is below both the South East and England, and the rate has been falling in Surrey from 1993 to 2008. In 2008 Spelthorne was recorded as having the highest incidence rate and Surrey Heath the lowest. There is also higher incidence in men than women.


Figure 3
Incidence of colorectal cancer: persons all ages SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre
 
Mortality

The mortality from colorectal cancer in Surrey is higher than both the England and South East rates, with Woking recording the highest mortality rate and Waverley the lowest. Mortality from colorectal cancer is higher in men than women.

Figure 4
Mortality from colorectal cancer all ages: DSR (2007-2009)

Dataset: Mortality specific conditions, Source: NHS Information Centre 

Cervical Cancer

Incidence

The incidence of cervical cancer in Surrey is below the rates for both the South East and England and this rate has fallen in Surrey from 1993 to 2008.

Figure 5
Incidence of cervical cancer all ages: SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre  

Mortality

The mortality rate from cervical cancer in Surrey is below the England and south east rates. Runnymede has a significantly higher mortality rate than Surrey and any other of the boroughs.

Figure 6
Morrtality from cervical cancer all ages: DSR (2007-2009)

Dataset: Mortality specific conditions, Source: NHS Information Centre

Lung Cancer

Incidence

The incidence of lung cancer in Surrey is below both the South East and England and has been falling from 1993 to 2008 in Surrey. Runnymede currently has the highest incidence of lung cancer with Guildford reporting the lowest incidence. The incidence rate in Surrey is higher among men than women.

Figure 7
Incidence of lung cancer persons all ages: SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre 

Mortality

In Surrey the mortality rate for lung cancer is below both the England and South East rates. Runnymede has the highest mortality rate and Guildford the lowest. Mortality from lung cancer in Surrey is higher in men than in women.

Figure 8 
Mortality from lung cancer persons all ages: DSR (2007-2009)

Dataset: Mortality specific conditions, Source: NHS Information Centre 

Prostate Cancer 

Incidence

The incidence rate in Surrey is higher than the South East but lower than England and the rate has increased from 1993 to 2008. Elmbridge has the highest reported incidence in Surrey and Tandridge the lowest.

Figure 9
Incidence of prostate cancer all ages: SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre 

Mortality

In Surrey the mortality rate for prostate cancer is barely below both the England and South East rates. Woking has the highest mortality rate and Epsom and Ewell the lowest.

Figure 10
Mortality from prostate cancer all ages: SMR (2007-2009)

Dataset: Mortality specific conditions, Source: NHS Information Centre

Skin Cancer

Incidence

The incidence of skin cancers (excluding malignant melanoma) in Surrey is below England but higher than the South East Coast SHA and the incidence has increased since 1993. The incidence is higher in men than women.

Figure 11
Incidence of skin cancer excluding malignant melanoma all ages: SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre

Mortality

In Surrey the mortality rate for skin cancers other than malignant melanoma is below both the England and South East rates. Runnymede has the highest mortality rate and Mole Valley the lowest. Mortality from skin cancers other than malignant melanoma in Surrey is higher in men than in women.

Figure 12
Mortality from skin cancer other than malignant melanoma all ages: SMR (2007-2009)

Dataset: Mortality specific conditions, Source: NHS Information Centre

Malignant Melanoma

Incidence

The incidence of malignant melanoma in Surrey is higher than the England rate but lower than the South East rate. Malignant Melanoma incidence has been increasing from 1993 through to 2008. In Surrey the rate is higher in women than in men.

Figure 13
Incidence of malignant melanoma persons all ages: SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre

Mortality

The mortality rate from malignant melanoma in Surrey is higher than the England and South East rates. Reigate and Banstead have the highest mortality rate and Spelthorne has the lowest. Mortality in Surrey from malignant melanoma is higher in men than in women.

Figure 14
Mortality from malignant malanoma persons all ages: DSR (2007-2009)

Dataset: Mortality specific conditions, Source: NHS Information Centre

Bladder Cancer

Incidence

The incidence of bladder cancer in Surrey is below the rates of both England and the South East and the rate in Surrey has been falling from 1993 to 2008. The incidence in Surrey is higher in men than women.

Figure 15
Incidence of bladder cancer persons all ages: SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre

Oesophageal Cancer

Incidence

The incidence of oesophageal cancer in Surrey is below the South East and England rates and has fallen from 1993 to 2008. The incidence is higher in men than in women in Surrey.

Figure 16
Incidence of oesophageal cancer persons all ages: SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre

Mortality

The mortality rate from oesophageal cancer in Surrey is below both the England and South East rates. Runnymede has the highest mortality rate and Epsom and Ewell have the lowest rates. Mortality in Surrey from oesophageal cancer is higher in men than women.

Figure 17
Mortality from oesophageal cancer persons all ages: DSR (2007-2009)

Dataset: Mortality specific conditions, Source: NHS Information Centre 

Stomach Cancer

Incidence

The incidence of stomach cancer in Surrey is below both the South East and England rates and has fallen from 1993 to 2008. The incidence is higher in men than women.

Figure 18
Incidence of stomach cancer persons all ages: SRR

Dataset: Cancer incidence yearly trend, Source: NHS Information Centre

Mortality

The mortality rate from stomach cancer in Surrey is below the England and South East rates. Guildford has the highest mortality rate and Mole Valley have the lowest rates. Mortality from stomach cancer in Surrey is higher in men than in women.

Figure 19
Mortality from stomach cancer persons all ages: DSR (2007-2009)

Dataset: Mortality specific conditions, Source: NHS Information Centre 

Childhood cancers

Around 1,500 children in the UK are diagnosed with cancer each year. Around 300 children in the UK die from cancer each year . Childhood cancers can be grouped into twelve types :

  • Leukaemias
  • Soft tissue sarcomas
  • Kidney tumours
  • Brain and central nervous system tumours
  • Bone tumours
  • Carcinomas and melanomas
  • Retinoblastomas
  • Lymphomas
  • Gonadal and germ cell tumours
  • Liver tumours
  • Sympathetic nervous system tumours
  • Other and unspecified tumours

The incidence of childhood cancers in Surrey is very low.

Summary

In summary the data above shows the following key issues:

  • The prevalence of all cancers in Surrey is higher than that for England and the same as the South East Coast SHA. The higher prevalence could be due to people living longer with cancer in Surrey
  • For most cancers Surrey, West Sussex and Hampshire (SWSH) Cancer Network has a higher 1 and 5 year survival rate with the exception of prostate one year survival which is lower than England for SWSH Cancer Network
  • Mortality from colorectal/bowel cancer is higher in Surrey than in England and the South East, with Woking experiencing the highest mortality rate which is significantly higher than Surrey and the other boroughs
  • Mortality from cervical cancer in Surrey is lower than the England and South East mortality rates, with Runnymede experiencing a significantly higher mortality rate than Surrey and any of the other boroughs
  • Incidence of prostate cancer is higher in Surrey than the South East, but lower than England, with Elmbridge reporting the highest incidence rate which is significantly higher than the Surrey rate and the rates of the other boroughs
  • Incidence of malignant melanoma in Surrey is higher than England, but lower than the South East, however, mortality is higher in Surrey than both England and the South East. Reigate and Banstead were reported to have the highest mortality rate
  • Mortality from stomach cancer in Surrey is lower than England and the South East, with Guildford experiencing the highest mortality rate
  • A lack of information of the impact of childhood cancers in Surrey

Further investigation of these key issues is required and therefore it is recommended that a health needs assessment of cancers in Surrey be carried out.


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Current services in relation to need.

Preventing cancer

Over half of all cancers could be prevented through lifestyle changes. Smoking is one of the biggest preventable risk factors for many cancers. Please see the smoking chapter for more information on smoking prevalence and cessation. (See JSNA Smoking Chapter)

Routes to diagnosis

Table 4: Referral routes for patients newly diagnosed with cancer – April to September 2009

   Referral Type          
 Organisation Urgent (TWR)  Breast Symp  Screening  Other  Total treated  TWR per 1,000 population
 Surrey PCT  39.4%  1.6%  7.8%  5.2%  2,423  8.43
 England  43%          

Source: National Cancer Waiting Times database report
Note: TWR = the two week rule cancer wait target where people must be seen within the two weeks.
Breast Symp = Breast symptomatic service, which is where women are referred into the service via a GP

Table 5: Referral routes for patients newly diagnosed with cancer by tumour site – April to September 2009

 Tumor Site Referral type      
   Urgent (TWR) Brest Symp Screening  Other
 Brain/CNS  2.9%  0.0%  0.0%  97.1%
 Breast  46.1%  8.7%  32.7%  12.5%
 Children  6.3%  0.0%  0.0%  93.8%
 Gynae  51.8%  0.0%  5.0%  43.3%
 Haem  32.0%  0.0%  0.0%  68.0%
 H&N  37.3%  0.0%  0.0%  62.7%
 Lower GI  34.3%  0.0%  10.8%  54.9%
 Lung  32.0%  0.0%  0.0%  68.0%
 Other  23.8%  0.0%  0.0%  76.2%
 Sarcoma  15.8%  0.0%  0.0%  84.2%
 Skin  52.7%  0.0%  0.0%  47.3%
 Upper GI  29.5%  0.0%  0.0%  70.5%
 Urology  38.1%  0.0%  0.0%  61.9%
 Total  39.4%  1.6%  7.8%  51.2%

Source : National Cancer Waiting Times Database Reports, 2011

Stage at diagnosis

Table 6: Stage at diagnosis for SWSH cancer network patients

 Measure  Date  Tumour site  Stage at diagnosis (% of patients)        
       Stage1(Local) Stage 2 (Direct ext) Stage 3(Nodal inv) Stage 4 (Mets) Stage unknown or N/A
 Stage at diagnosis for SWSH CN patients  2005-2007  All patient diagnosed  38% 5% 9% 17% 29%

Source: Thames Cancer Registry
Note: More information on cancer staging can be found at the following link: http://cancerhelp.cancerresearchuk.org/about-cancer/what-is-cancer/grow/the-stages-of-a-cancer


The Thames Cancer Registry has employed its own simple 4-level staging system since 1965 and successfully stages around 80% of all solid tumours. The classification system uses information in the patients’ notes to determine if the disease is local (stage 1), has extension beyond the organ of origin (stage 2), has regional lymph node involvement (stage 3) or has metastasised (stage 4). However, there are some concerns regarding this data about whether it is truly reflective of staging for all individual tumour sites. It is therefore advisable to analyse individual tumour site staging information, this is being collected in acute trusts as part of a minimum dataset.

Screening

It is vital that we provide quality screening for cancers such as breast cancer, cervical cancer and colorectal cancer, and that there are quality commissioned cancer services in Surrey. NHS Surrey must ensure that there is delivery of National Screening Programmes to ensure early identification of cancer when treatment is most likely to be effective. Please see the screening chapter for more information on the cancer screening programmes in Surrey. (Seee JSNA Screening Chapter).

Patient experience survey

The National Cancer Patient Experience Survey 2010 provides insights into the care experienced by cancer patients who were treated as day cases or inpatients during the first three months of 2010. 158 acute hospital NHS trusts took part in the survey.

The survey found that responses from cancer inpatients reflected a more positive experience of their care and treatment compared to hospital inpatients generally. Nationally, the survey concluded that there were insufficient nurses on duty, however, locally all acute trusts but one exceeded the national average.

The report has highlighted some variation in satisfaction across tumour sites and between Trusts in Surrey. The key outcomes for the Surrey, West Sussex & Hampshire (SWSH) cancer network are as follows:

  • The survey and reports demonstrate that there are some cross cutting themes emerging
  • Information on availability of financial support is an area where all SWSH Cancer Network trusts could improve
  • 2 of the 4 Trusts were in the lowest-scoring 20% of Trusts nationally for a named Clinical Nurse Specialists for every patient

Example pathways for Breast, Lung and Prostate Cancer have been included on Surreyi for further information:
Sources:

SWSH Cancer Network Breast Site Specific Group (NSSG): Constitution (2010)
SWSH Cancer Network Lung Site Specific Group (NSSG): Constitution (2010)
SWSH Cancer Network Urology Site Specific Group (NSSG): Constitution (2010)
All available from SWSH Cancer Network Offices, Guildford. Please follow the links.

Each pathway has been approved by the relevant Network groups. They have also been approved for publication in the JSNA by the NSSG Chair (Breast – Dr Julie Cooke, Lung – Dr Michael Wood, Prostate – Mr Neil Barber)

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Projected service use and outcomes in 3-5 years and 5-10 years.

As screening programmes become more established incidence may increase as well as demand for treatment. There are also an increasing number of people now surviving cancer or living with it for many years. As the Surrey population ages and risk factors for specific cancers increase, this will inevitably lead to an increase in incidence of cancers. More work around projections for service use and outcomes for cancer services over the next 3-5 years and 5-10 years is required for Surrey, along with a full cancer health needs assessment.


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Evidence based (what works and what does not work)

The following help to decrease the impact of cancer: 

  •  Increasing importance of genetics 
  •  Prevention – early diagnosis 
  •  Prevention – reduction in lifestyle factors e.g.: smoking, obesity, alcohol consumption, sun exposure 
  •  Increasing uptake to NHS cancer screening programmes

For more information please review the following:      

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Unmet needs and service gaps

The evidence presented here suggests that the following unmet needs/service gaps exist in Surrey:

  • A requirement for a full and comprehensive cancer health needs assessment for Surrey
  • Major challenges geographically related to cancer mortality and incidence which requires further investigation, which will become part of the needs assessment
  • Limited understanding around projected service use and outcomes for Cancer Services in Surrey which requires further analysis through the work carried out on the needs assessment
  • A need for a named clinical nurse specialist to be available to every patient in the Surrey Trusts
  • Access to financial support information for patients requires improvement. As we diagnose patients earlier and as we improve services for patients we need to look to how patients can be supported.

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Equality Impact Assessment

Health equity audits for cervical and bowel cancer screening are currently being undertaken in Surrey.
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Recommendations for Commissioning

Prevention and early diagnosis

To improve cancer mortality and survival rates by improving symptom awareness, ensuring access to screening programmes and ensuring prompt and appropriate referral. This will be achieved by working with SWSH cancer network and local providers to review national commissioning guidance on family history provision, an assessment of population growth, identifying opportunities to increase patient uptake of screening, provision of information to primary care on current referral practices, implementing and sustaining 14 day results for cervical cytology, continuing the age extension of breast and bowel screening, and ensuring effective use of GP direct access to diagnostic tests.

Quality of life and patient experience

Improving outcomes for people living with and beyond cancer. This will be achieved by ensuring clinicians have the necessary skills to communicate effectively with patients, ensure access to national information prescriptions for patients, review findings of national patient experience survey, and consider the opportunities for increased access to clinical nurse specialists.

Better Treatment

Ensure timely access to high quality, clinically effective and cost effective treatments and care for all cancers, at every stage of the cancer journey, including delivery of waiting time standards, expansion in capacity and the effectiveness of radiotherapy services through to end of life. Ensure that Surrey-wide issues for patients at the end of life (from any diagnosis), which prevent full implementation of the End of Life Care Strategy and quality markers, are addressed through collective initiatives.

Reducing inequalities

Provide patients with the best possible experience and outcomes by delivering equitable, high quality, clinically safe and cost effective cancer services 

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Recommendations for needs assessment work

  • Conduct a health equity audit of existing cancer services
  • Conduct an assessment of population growth by PCT, Tumour type, type of treatment needed and analysis of incidence, mortality, survival for Surrey to identify target groups, cancers and inform strategic planning in order to improve ability to target service developments to areas of greatest need.

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Key contacts

Chloe Todd, Interim Public Health Screening Coordinator - chloe.todd@surreycc.gov.uk

Surrey, West Sussex & Hampshire (SWSH) Cancer Network

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Chapter References

  1. http://www.cancerhelp.org.uk/about-cancer/causes-symptoms/preventing-cancer  
  2. http://www.cancerresearchuk.org/breastcancer/breast_cancer/  
  3. http://info.cancerresearchuk.org/cancerandresearch/cancers/bowel/  
  4. http://info.cancerresearchuk.org/cancerandresearch/cancers/lung/  
  5. http://www.nhs.uk/conditions/cancer-of-the-prostate/Pages/Introduction.aspx  
  6. http://info.cancerresearchuk.org/cancerstats/keyfacts/skin-cancer/  
  7. http://info.cancerresearchuk.org/healthyliving/sunsmart/skin-cancer-facts/  
  8. http://www.nhs.uk/conditions/malignant-melanoma/Pages/Introduction.aspx  
  9. http://info.cancerresearchuk.org/cancerstats/keyfacts/bladder-cancer/  
  10. http://info.cancerresearchuk.org/cancerstats/types/bladder/riskfactors/  
  11. http://info.cancerresearchuk.org/cancerstats/keyfacts/oesophageal-cancer/  
  12. http://info.cancerresearchuk.org/cancerstats/keyfacts/stomach-cancer/  
  13. http://info.cancerresearchuk.org/utilities/atozindex/atoz-cervical-cancer  
  14. http://info.cancerresearchuk.org/cancerstats/types/uterus/incidence/uk-uterus-cancer-incidence-statistics  
  15. http://info.cancerresearchuk.org/utilities/atozindex/atoz-ovarian-cancer  
  16. http://info.cancerresearchuk.org/cancerstats/childhoodcancer/  
  17. http://info.cancerresearchuk.org/cancerstats/keyfacts/Childhoodcancers/  

 


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Surrey, West Sussex & Hampshire (SWSH) Cancer Network

If you have any feedback/comments please send it to jsnafeedback@surreycc.gov.uk  

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Please read this chapter in conjunction with the following.



Updated: 08 July 2014 | Owner: Adwoa Owusu
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