Cancer

More than one in three people in England will develop cancer at some stage in their lives and one in four will die from it. Consequently the prevention, detection and treatment of cancer are key priorities for Stockton-on-Tees.

Over 250,000 people in England are diagnosed with cancer every year and around 130,000 die from the disease. Currently, about 1.8 million people are living with cancer. (Department of Health, 2011a).

The earlier a cancer can be diagnosed the greater the prospect of survival. Evidence suggests that later diagnosis of cancer has been a major factor in the poorer survival rates in the UK compared with some other countries in Europe.

Cancer is the leading cause of premature death (people under 75) nationally and the second highest cause of death across all age groups. Locally, cancer poses particular challenges to the health of the population of Hartlepool. Overall, incidence of cancer is higher than national levels and survival from some cancers is among the worst in the country.

Cancer services have changed considerably over the last decade. The NHS Cancer Plan (2000) and the Cancer Reform Strategy (2007) set out the objectives and vision to improve cancer services across the UK.

Lives can be saved from cancer, primarily through better awareness of the signs and symptoms and earlier diagnosis of cancer.

This is made even more important by the fact that the burden of cancer is increasing dramatically: it is expected that there will be 100,000 more cases per year over the next 15 years in the UK.

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Last updated: 2017-03-27 09:27:25
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1. What are the key issues?

1. Premature deaths from cancer
Early death from cancer in Stockton remains significantly higher than the England average.  Cancer mortality is the second largest contributor to premature death after cardiovascular disease.

2. Lifestyle risk factors
The high levels of excess mortality from cancer can be attributed in part, to the excessively high risk factors in both socioeconomic and lifestyle terms. Lifestyle factors that contribute to the burden of cancer include high smoking prevalence rates, high and increasing levels of obesity combined with a low uptake of physical activity and excessive levels of alcohol consumption.

3. Improving screening uptake
Participation in the national screening programmes for breast, cervical, and bowel cancer can significantly reduce a person’s risk of developing one of these cancers. Where screening is possible, it is an important method of detecting abnormalities at an early stage, enabling treatment when the cancer is most likely to be curable or, in some cases, even before it develops.

4. Improving awareness of cancer signs and symptoms
Several factors are associated with longer delay by patients in seeking help. These include failing to recognise that symptoms were serious or could be due to cancer. The public’s awareness of early cancer symptoms is poor and may be contributing to late presentation and poorer survival. NHS Hartlepool and the Department of Health have successfully run a range of campaigns to improve the public’s awareness of cancer symptoms and to encourage them to present promptly to the doctor. It will take time to bring about significant change in behaviour.
 

Last updated: 30/05/17

2. What commissioning priorities are recommended?

2012/01
Reduce premature deaths from cancer through improved cancer prevention, early detection and prompt, effective treatment and care.  This will help to reduce the death rate from cancer, improve prospects for survival and improve quality of life for those affected by cancer.

Reducing the delay before first going to see a GP among patients from disadvantaged groups can reduce inequalities in cancer outcomes. Ensuring patients are referred quickly to specialist services by GPs and improving access to diagnostics can reduce cancer mortality. Remains a commissioning priority.

2012/02
Tackle lifestyle risk factors by using interventions that reduce smoking and alcohol consumption, increase fruit and vegetable consumption, reduce obesity and encourage physical activity. Primary prevention (preventing people getting cancer in the first place) is seven times more effective than secondary prevention (detecting cancer before it is symptomatic leading to prompt treatment). Remains a commissioning priority.

2012/03
Improve screening uptake.  Achieving adequate levels of uptake in cancer screening requires a variety of approaches that need to be shaped by the characteristics of both the screening programme and the target population. Addressing inequalities in uptake is a priority for screening programmes. Cancer screening has the potential to make a major contribution to early diagnosis initiatives and will best be achieved through uptake strategies that emphasise wide coverage, informed choice and equitable distribution of cancer screening services. Remains a commissioning priority.

2012/04
Improve awareness of cancer signs and symptoms. The public’s awareness of early cancer symptoms is poor and may be contributing to late presentation and poorer survival. Early diagnosis and treatment of cancer is an important factor in improving outcomes for cancer services.

Early diagnosis requires that individuals are aware of the symptoms of early cancer, that they have access to primary care professionals and seek advice from them if symptoms occur, that these symptoms are then identified as potential symptoms of cancer, and finally that appropriate investigations and referrals are initiated. Remains a commissioning priority.

2014/01
Improve cancer staging data
. Rapid diagnosis and treatment improves not only survival but also the quality of life of survivors and reduces their longer term care needs. Important to improving early diagnosis is to have better information on the stage of cancer at diagnosis. It is therefore important that we have systems and processes in place that can help obtaining more accurate and complete information on cancer staging.

2014/02
Improve patient experience
. The needs of people with cancer needs to be identified and met so they feel well supported and informed, able to manage the effects of cancer treatment and the impact on everyday life.

It is important that people with cancer approaching the end of life feel well cared for and pain and symptom free. Each person with cancer has an individually tailored care plan which includes a holistic needs assessment, treatment summary and a cancer care review.
 

 

Last updated: 26/05/15

3. Who is at risk and why?

Age
Cancer can develop at any age, but is most common amongst older people. This is because the changes that make a cell become cancerous in the first place take a long time to develop.  More than three out of five new cancers are diagnosed in people aged 65 or over, and over one-third are diagnosed in those aged 75 or over.

Gender
Men are at significantly greater risk than women from nearly all of the common cancers that occur in both sexes with the exception of breast cancer.

Cancer Research UK (2010) considers the current overall burden of cancer among men in the UK and outlines the extent of the differences between the sexes. It also suggests possible reasons why men are at more risk of both getting and dying from so many cancers.

Socioeconomic status
Incidence and mortality rates from cancer are higher in disadvantaged areas. Therefore the greatest scope to make rapid improvements is by focusing activity on disadvantaged areas.

There is a range of inequalities in the outcomes and experience of cancer patients. These can occur at every stage of the patient pathway, including in awareness, incidence, access to treatment and care, patient experience and survival.

Ethnicity
Evidence from bowel screening pilot studies has shown that uptake of the screening test varies significantly between different groups. Typically, areas with high deprivation and high proportions of minority ethnic groups have the lowest uptake rates. Uptake is also lower among men than among women.

Lifestyle
Over half of all cancers could be prevented if people adopted healthy lifestyles such as:

  • Stopping smoking;
  • Avoiding obesity;
  • Eating a healthy diet;
  • Undertaking a moderate level of physical activity;
  • Avoiding an excessive alcohol intake; and
  • Avoiding excessive exposure to sunlight.

It is estimated that about one-third of all cancers are caused by smoking, unhealthy diets, alcohol and excess weight (Parkin et al, 2011).

Smoking causes more than four in five cases of lung cancer.

Cancer Research UK has developed a data visualisation 'infographic' that illustrates the number of cancers that could be prevented by changes to lifestyle and environment (Cancer Research UK, 2012).

Family history
Most cancers develop because of a combination of risk and the environment, and not because individuals have inherited a specific cancer gene, However, many people with cancer in the family worry that they are at greater risk of getting it themselves. Having a couple of relatives diagnosed with cancer when over the age of 60 doesn’t mean there is a cancer gene running in the family. Genetics specialists estimate that only about 2 or 3 in every 100 cancers diagnosed are linked to an inherited gene fault.

The more relatives who have had cancer, and the younger they were at diagnosis, the stronger the family history.

Occupational exposure
People who work in certain jobs, especially in the manufacturing industry, are most likely to be exposed to high levels of synthetic chemicals. This is known as ‘occupational exposure’.

Cancer Research UK estimates that occupational exposure to cancer-causing chemicals is responsible for about 2% of cancer deaths in the UK. This usually affects only a small number of people in very specific jobs. These exposures are less of a problem now in the UK because the most dangerous chemicals have been banned for several decades.

 

Last updated: 26/05/15

4. What is the level of need in the population?

This section focuses on all cancers, along with specific data for bowel, breast and lung cancer.  The conclusions from a regional assessment of need for children and young people are included.  The National Cancer Intelligence Network provides detailed cancer data, some of which is presented below.

Definitions
Incidence – the number of new cases in a particular time period (usually 1 year).
Prevalence – the number of cases in living people at a particular moment in time.
Mortality – the number of deaths.
Survival – Sometimes known as relative survival, this is the proportion of the diagnosed population who are still alive at a certain time after diagnosis, taking into account mortality from other causes.

Cancers are classified according to the International Classification of Diseases, tenth revision (ICD-10).  The following definitions are used here.
All cancers – ICD-10 C00-C97
Bowel cancer – ICD-10 C18-C20 (colorectal / lower gastrointestinal [GI])
Breast cancer – ICD-10 C50
Lung cancer – ICD-10 C33-C34
Prostate cancer – ICD-10 C61
Skin cancer (malignant melanoma) – ICD-10 C43

 

All cancers
About 980 people are diagnosed with cancer in Stockton-on-Tees annually.  The incidence of all cancers in Stockton-on-Tees is broadly similar to comparable areas and regional and national averages.  Including all ages, cancer incidence is higher for men than women but the cancer incidence rate for females aged under 75 is higher than for males.  The female under 75 rate is significantly higher than both England and Dudley (a similar area to Stockton).

Incidence of all cancers by gender, Stockton, 1993-2011

Stockton all cancer incidence age<75 benchmark, 2009-11

 

There are likely to be about 3,550 people living with cancer in Stockton-on-Tees.  The increase in prevalence shown is likely to be due to a combination of better data recording, improved survival and earlier diagnosis.  Recent changes in NHS structures mean that Stockton-specific data is no longer available for this indicator.

Cancer prevalence, Hartlepool and Stockton, 2005/06 to 2012/13

 

On average there were 520 deaths due to cancer annually, nearly one-third of all deaths in Stockton-on-Tees.  Mortality from all cancers has been falling in Stockton-on-Tees, similar to the pace of reduction seen nationally.  This results in a widening of the relative gap between Stockton-on-Tees and the England average for cancer mortality, although the absolute gap is maintained.

Stockton cancer mortality trend by gender, 2993-2012

Within Tees there is a strong association between cancer mortality and deprivation.  The mortality rate in the most deprived areas is about twice that seen in the least deprived areas.  Areas in Tees that are in the 30% most deprived in England (D1-D3 below) have mortality rates significantly worse than England, whereas those in the 30% least deprived (D8-D10 below) have mortality rates significantly better than England.

Cancer mortality and deprivation, Tees, 2010-12

 

Bowel Cancer
Bowel cancer incidence in Stockton-on-Tees varies somewhat, but is almost always higher than the national rate.  The incidence rate for men is about 69 per 100,000 population compared with about 37 per 100,000 for women.  The male rate is higher than England but the female rate is similar to England and both rates have remained at a broadly similar level for the past ten years.  About 77 men and 52 women are diagnosed annually in Stockton-on-Tees.  Bowel cancer screening has been introduced in recent years and this should help in identifying cases.

Stockton bowel cancer incidence trend 1993-2011

 

Bowel cancer mortality in Stockton has been reducing at a faster rate than in England as a whole, and is currently slightly less than the England for both men and women.  The male mortality rate is higher than the female mortality rate.  About 24 men and 20 women die from bowel cancer each year in Stockton.

Stockton bowel cancer mortality trend 1993-2012

Bowel cancer survival in Stockton-on-Tees has been increasing steadily and is similar to England at one and five years after diagnosis.  Taking into account population mortality from all causes, about 75% of people diagnosed with bowel cancer survive for 1 year and about 55% survive for five years.

Stockton bowel cancer survival, 1990-2010

 

Breast cancer
Although fluctuating from year-to-year, breast cancer incidence in Stockton-on-Tees had been rising but there has been little increase in recent years.  Broadly speaking the rate locally is in line with the England average, with about 140 women diagnosed annually in Stockton.

Stockton breast cancer incidence trend 1993-2011

 

The screening rate for breast cancer in Stockton is above the England average and the national standard of 70% screened within the past three years (Public Health England, 2012).  However, nearly 4,500 women, one-fifth of those eligible, do not attend breast screening in Stockton.  There is variation in the number of women screened between general practices (HSCIC, 2013).

Tees breast cancer screening benchmark 2013

Tees breast screening trend, 2008/09 to 2013/14

Breast screening rates by general practice, Stockton, 2012

The rate of women dying from breast cancer in Stockton-on-Tees has remained similar recent years.  This compares with a falling rate seen in England as a whole.  For a while, deaths from breast cancer in Stockton-on-Tees were below the England rate and latest data shows the local rate is above the national rate.  About 40 women in Stockton die from breast cancer each year.

Stockton breast cancer mortality trend, 1993-2012

Breast cancer survival has increased at both one and five years after diagnosis.  Survival rates in Stockton are similar to England.  Taking into account population mortality from all causes, about 96% of women diagnosed with breast cancer survive for 1 year and about 86% survive for five years.

Breast cancer survival, Stockton, 1990-2010

 

Lung Cancer
The incidence of lung cancer has been falling for men but rising for women in Stockton-on-Tees, as seen nationally.  Lung cancer incidence in Stockton-on-Tees is about 40% higher than England, with about 80 per 100,000 men and 55 per 100,000 women diagnosed.  About 89 men and 70 women are diagnosed annually.

Stockton lung cancer incidence trend by gender, 1993-2011

 

Deaths from lung cancer in Stockton-on-Tees are about one-quarter higher than the rate seen in England.  Locally male rates appear to be reducing at a similar rate to England, female rates are fluctuating but broadly stable in recent years.  About 73 men and 61 women in Stockton die each year from lung cancer.

Stockton lung cancer mortality trend by gender, 1993-2012

Survival following a diagnosis of lung cancer is much lower than for bowel and breast cancer.  Taking into account population mortality from all causes, about one-third of people diagnosed with lung cancer survive for 1 year and about 7% survive for five years.  Survival rates in Stockton are similar to England and the North East.

Lung cancer survival, Stockton, 1990-2010

 

Prostate cancer
The incidence of prostate cancer in Stockton-on-Tees is below England and has remained broadly similar in the past decade compared with an increase nationally.  About 80 men per 100,000 population are diagnosed with prostate cancer in Stockton, compared with about 105 per 100,000 in England.  About 90 new cases per year occur in men in Stockton.

Despite having fewer incident cases, mortality from prostate cancer in Stockton tends to be higher than England.  In recent years, Stockton’s mortality rate has increased but nationally the rate has decreased.  About 35 men die from prostate cancer annually in Stockton.

Prostate cancer survival has decreased in Stockton in recent years, compared with an increasing rate nationally.  Taking into account population mortality from all causes, about 90% of men diagnosed with prostate cancer survive for 1 year and about 82% survive for five years.

Stockton prostate cancer survival, 1990-20110

 

Cervical cancer
Screening for cervical cancer in Stockton-on-Tees is lower than the national standard and similar to the England average.  More than 10,000 eligible women in Stockton have not been screened within the past 5 years.  An additional 8 women per working day over 5 years need to be screened to achieve full coverage.

Tees cervical cancer screening benchamrk, 2013

Tees cervical screening coverage, 2008/9 to 2013/14

 

Skin cancer
The incidence of skin cancer has been increasing steadily for 20 years.  The rate in Stockton-on-Tees is now higher than the England average, having been significantly lower for many years.  There have been about 35 new cases and six deaths annually in the past 5 years.

Stockton skin cancer incidence trend, 1993-2011

 

Children and Young People
Within Stockton-on-Tees fewer than 65 cancer cases were identified in people aged 0-24 in the five-year period 2006-2010.  A comprehensive needs assessment for this age-group has been carried out for the North of England Cancer Network (NEPHO, 2012).  It shows that the incidence and mortality in this age group is similar to England while survival is better than England.  Haematological cancers are most common in younger age groups whereas solid tumours are most common in teenagers, which has implications for service specification.

The following is an extract from Public Health England’s Health & Wellbeing Board Cancer profile, and provides an overview of cancer indicators in Stockton-on-Tees compared with England averages and the spread across all other localities in England.

Stockton HWB cancer profile

 

Additional sources of cancer intelligence can be found at:

Health & Wellbeing Board Cancer Profiles 2012 - Middlesbrough (NYCRIS, 2012)

Cancer e-Atlas: http://www.ncin.org.uk/cancer_information_tools/eatlas.aspx

National Cancer Intelligence Network: http://www.ncin.org.uk/home.aspx

Cancer Mortality Profiles (Public Health England)

Gynaecological cancer hub (National Cancer Intelligence Network)

Head and neck cancer hub (National Cancer Intelligence Network)

Skin cancer hub (Public Health England)

Urological cancer hub (National Cancer Intelligence Network)

 

 

Last updated: 26/05/15

5. What services are currently provided?

Tees cancer strategy 2014-2018
A Tees Cancer Strategy has been developed. It sets out a five year vision for improving cancer outcomes in Teesside. The strategic objective is to develop and promote services that reduce the risk of developing cancer in local communities and, when people develop cancer, they have an excellent chance of surviving, wherever they live. The strategy is being supported by prevention, diagnostic, treatment and support services that are comparable with the best in in similar areas in England.

The strategy also addresses information needs of professionals and patients. This concerns having systems and processes that support service improvements, and providing information on where and how people living with cancer can access financial, emotional and spiritual advice and support, to ensure a holistic person centred approach to care.

The Tees Cancer Locality Group, a multiagency group, oversees the implementation of the strategy. The group will ensure that partners have plans in place to deliver specified actions and monitor progress towards the achievement of outcomes.

Prevention

Tees Lung Cancer Awareness Programme
In 2010, the Tees National Awareness and Early Diagnosis Initiative (NAEDI) project was established in 2010 across Tees general practices. The aim was to raise awareness and promote early diagnosis of the signs and symptoms of cancer by identifying eligible people aged 40-74 at high risk of developing cardiovascular disease (CVD) and making them more aware of the signs and symptoms of cancer. In April 2014, the NAEDI project was replaced with a Lung Cancer Awareness Programme, integrated into the Tees Lung Health Check (LHC), as COPD and lung cancer share similar risk factors and symptoms. The LHC is aimed at detecting chronic obstructive pulmonary disease (COPD) in all smokers aged 35 or over who are greater risk of the disease.

The Lung Cancer Awareness Project involves patients attending the Lung Health Check being giving the opportunity to review the signs and symptoms of lung cancer, discuss any concerns with their GP and referred for further investigations if required. The project utilises the Cancer Research UK Lung Cancer: How to spot the symptoms and reduce your risk leaflet as a resource to focus on the signs and symptoms of lung cancer in the high risk COPD screened population. The rationale behind the project is that by developing a systematic approach to increasing awareness of the signs and symptoms of lung cancer. This will help reduce the delays that lead to patients being diagnosed with more advanced disease and thus experiencing poorer one and five year survival.

Be Clear on Cancer Campaigns
Be Clear on Cancer (BCOC) Campaigns were launched in 2010 and have been running since then.. The campaigns including breast cancer in women over 70, Blood in Pee, Oesophago-gastric, lung and ovarian, focus on the early signs and symptoms of cancers and encourage people to see their GP. They are helping to reach more people and drive earlier diagnosis of cancer. More campaigns are planned in 2014 and 2015

For each campaign there is a comprehensive evaluation process, with data collected on a number of metrics, reflecting key points along the patient pathway. These include: symptom awareness, attendances at primary care, urgent referrals and diagnostic investigation activity. Important measures of campaign outcomes include cancers diagnosed and stage distribution. The BCOC evaluation update show reported outcomes to include more people presenting with symptoms, increase in referral for diagnostic investigation, increase in the proportion of patients receiving surgical resection as a first definitive treatment and improved survival.

Tees Awareness and Early Diagnosis Roadshow
The Tees Awareness and Early Diagnosis Roadshow  aims to increase awareness of long term health conditions such as heart disease and strokes, chronic obstructive pulmonary disease (COPD) and cancer in Teesside communities. It builds on the Macmillan Cancer Awareness Roadshow to deliver an interactive awareness roadshow that invites the local population to find out more about LTCs including cancer.  It will deliver awareness activities from a variety of community settings and target all sections of the community to help increase awareness of signs and symptoms and the importance of early diagnosis.

Primary care

Rapid diagnosis and treatment improves not only survival but also the quality of life of survivors and reduces their longer term care needs. In Stockton, like the rest of England, people are unfortunately still being diagnosed with advanced cancer, where an earlier diagnosis might have led to a much better outcome. Primary care is central to improving early diagnosis and a number of tools are in place to support this.

Significant Event Audit
The results of the Significant Event Audit carried out in 2012 by the North of England Cancer Network (NECN) in 55 practices across the North of England on the issues contributing to delay in cancer diagnosis are being used to improve care. The audit builds on primary care audit work started in 2009. Practices are able to review practice systems and processes and decision processes and use findings to reflect on cancer diagnosis.

General practice profiles
General practice cancer profiles produced by the Cancer Intelligence Network (NCIN) provide comparative information for benchmarking and reviewing variations at Clinical Commissioning and Groups and general practice level. There are now three years of data with trends at CCG and practice level. The profiles are being used to help practitioners think about clinical practice and service delivery for cancer and, in particular, early detection and diagnosis.  GP locality cancer lead with support from Macmillan GPs use practice profiles to engage with GP practices in the cancer agenda. This includes focused work with practices highlighted as outliers as well as offering a practice visit to all practices in Stockton-on-Tees.

Willie Hamilton Risk Assessment Tool
The National Cancer Action Team supported the piloting of a Risk Assessment Tool for lung and colorectal cancer based on Professor Willie Hamilton’s CAPER studies (Cancer Prediction in Exeter) as part of its work to reduce delays in diagnosis of cancer and save an estimated 5,000 lives each year nationally. The Northern England Strategic Clinical Networks continue to work with GPs to implement evidence based Risk Assessment Tools (RATs) to help identify those at most risk of having cancer.

Educational activities
The Northern England Strategic Clinical Networks are disseminating various tools, guidance, training and best practice to GPs.  Other educational opportunities are being used to push the cancer agenda. A quarterly cancer bulletin goes out to all GPs and practice managers in the area. There is also work carried out with GPs and practice managers to support Be Clear on Cancer public awareness campaigns and regional and national audits.

Secondary care

Screening
Screening involves testing individuals in the apparently healthy population to identify those who have, or are at risk from, disease but do not yet have symptoms. The three national cancer screening programmes are for breast, cervical and bowel cancer. These programmes aim to detect pre-cancerous changes or early stage cancer and prevent the development of cancer or improve the likelihood of survival.

There are significant variations in coverage of programmes across general practices. NHS England and Public Health England are working with the Tees Valley Public Health Shared Service (who monitors performance on behalf of the Stockton-on-Tees Borough Council Director of Public Health), the local public health team and voluntary and community organisations and groups to address these.

Breast cancer screening
The NHS Breast Screening programme provides breast screening every three years for all women aged 47-73. Women over 73 can also request to be screened.

Breast screening can detect early changes in breast tissues which can be assessed and if they are cancerous are treated.

Cervical cancer screening
The NHS Cervical Screening programme invites women aged 25 to 50 for screening every three years and those aged 50 to 64 every five years.
Cervical screening can detect cancer in a woman’s cervix (the neck of the womb) when she has no symptoms. It also prevents cancer in a much greater number of women by detecting and treating early abnormalities which, if left untreated, could lead to cancer.

Bowel cancer screening
The NHS Bowel Cancer Screening programme offers screening every two years to men and women aged 60 to 74. People over 75 can request a screening kit.

Bowel cancer screening aims to detect bowel cancer at an early stage (in people with no symptoms), when treatment is more likely to be effective.  Diagnosing bowel cancer early through population screening is anticipated to greatly improve health outcomes and reduce mortality from bowel cancer by up to 16%. (Cochrane Database of Systematic Reviews, 2006). Bowel cancer screening can also detect polyps. These are not cancers, but may develop into cancers over time. They can easily be removed, reducing the risk of bowel cancer developing.

Hospital and community based services

Peer review
The National Cancer Peer Review (NCPR) Programme against service standards for all cancer sites and cross-cutting cancer services provide important information about the quality of clinical teams and a national benchmark of cancer services across the country.  The programme now includes end of life care and is going well in the North Tees & Hartlepool Hospitals Foundation Trust (NTHFT). The Trust also participates in all relevant National Clinical Audits. These clinical audits and outcome reviews are critical to continuous service improvement. The commissioners (CCGs and NHS England) provide support to the Trust to implement the findings.

Willie Hamilton Risk Assessment Tool
North Tees and Hartlepool Hospitals is working with NHS Hartlepool and Stockton-on-Tees CCG to support the implementation of this model. There are plans to provide the capacity with the Trust to support the implementation of the tool.

Macmillan Cancer Information Service
MacMillan Cancer Support on a number of initiatives to improve patients’ experience, with the need for bespoke personalised information and support delivered by Information and Support Specialists. The centre provides access to expert welfare benefits advice from the Macmillan Welfare Benefits adviser to deal with the costs associated with cancer.

There is currently no Macmillan Information and Support Centre within North Tees Hospital and continued provision is being explored. Holistic Needs assessment and Health and Wellbeing clinics are well established in Haematology and Breast Care at North Tees Hospital.

In Stockton, the Council is working in partnership with Macmillan Cancer Support to support people affected with cancer and West View Resource Centre offer welfare benefits advice.

Survivorship programme
North Tees and Hartlepool Hospitals are working with Macmillan Cancer Support and the CCG to ensure follow-up care for patients with cancer occurs in the most appropriate place for the patient. This should increasingly be in primary care and community, but only if appropriate for patient and should build on the Cancer Survivorship Recovery Package. A Survivorship Programme is being developed for people with specific cancers.

The Cancer Survivorship ‘Recovery Package’ is a combination of different interventions, which when delivered together, will greatly improve the outcomes and coordination of care for people living with and beyond cancer.  These are:

  • Holistic Needs Assessments and care planning at key points of the care pathway,
  • A Treatment Summary completed at the end of each acute treatment phase, sent to patient and GP
  • A Cancer Care Review completed by GP or practice nurse to discuss the person’s needs, and
  • A patient education and support event, such as a Health and Wellbeing Clinic, to prepare the person for the transition to supported self management, which will include advice on healthy lifestyle and physical activity.


 

Last updated: 13/11/15

6. What is the projected level of need?

Cancer incidence
In Stockton-on-Tees cancer incidence is rising.  For men the increase is at a slower rate than for women.  Nationally cancer incidence is rising for both men and women.  The total number of new cancer cases is forecast to increase from about 1,150 in 2015 to about 1,320 in 2021.

Stockton cancer incidence forecast

 

Cancer mortality
Cancer mortality rates in Stockton-on-Tees for men are falling at a faster rate than for women.  Cancer mortality is also falling nationally.  For men, mortality in Stockton-on-Tees is falling faster than in England as a whole but for women the mortality gap remains broadly similar.  The number of cancer deaths is expected to increase slightly from 530 in 2012 to 545 in 2021.

Stockton cancer mortality forecast to 2021

 

Last updated: 26/05/15

7. What needs might be unmet?

Low screening uptake
Participation in cancer screening programmes could be improved by:

  • Better meeting the needs of those with physical and learning disabilities
  • Ensuring people who are not registered with a GP have access to screening
  • Working with local communities to raise awareness, address screening myths and improving participation in screening.

Stage of diagnosis
Early diagnosis and treatment of cancer is an important factor in improving outcomes for cancer. In addition to programmes targeted at the population such as awareness campaigns and population-based screening for cancer, providing fast access to efficiently managed services remains key to ensuring a patient moves along the pathway towards diagnosis and treatment in the most timely and appropriate manner.

GP support
Although GPs typically only see around eight or nine new cancer patients each year, they see many more patients presenting with symptoms that could be cancer.  A range of support is available to help GPs assess when it is appropriate to refer patients for investigation for suspected cancer, such as NICE referral guidelines, but more could be done to support them.

Media campaigns to increase signs and symptoms awareness
The findings from the Tees NAEDI evaluation outlined that most primary care practitioners participants felt that a media campaign to support awareness and early diagnosis initiatives is beneficial.  More media campaign and community activities are needed to support local initiatives and regional and national campaigns. Campaigns need to include specific activities that reflect the communication needs of different sections of the community.

 

Last updated: 26/05/15

8. What evidence is there for effective intervention?

National Institute for Health and Clinical Excellence

Public Health Guidance
Skin cancer prevention: information, resources and environmental changes (PH32)

Clinical Guidance
Prostate cancer (CG58)
Breast cancer (early & locally advanced) (CG80)
Advanced breast cancer: Diagnosis and treatment (CG81)
Colorectal cancer (CG131)
Ovarian cancer (CG122)
Lung cancer (CG121)

Quality Standards
Breast cancer quality standard (QS12)
Quality standard for lung cancer (QS17)
Quality standard for colorectal cancer (QS20)
Quality standard for ovarian cancer (QS18)

NICE lists over 250 sets of guidance relating to specific cancer anatomical sites.  For the full list see:
http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7165

Cancer Awareness Measure (CAM)
One of the main factors associated with a delay in seeking help for cancer is a failure to recognise early cancer symptoms and later diagnosis is strongly associated with poorer survival rates.

In 2010, Public Knowledge carried out the CAM on behalf of NHS Tees. This established a baseline level of cancer awareness in the area served by NHS Tees. In 2011, this research was replicated, to evaluate any change that had taken place in awareness levels in the intervening period.

There were notable positive changes in prompted awareness. These changes included increases in agreement levels with regard to many of the healthy lifestyle related risk factors, which tend to be the risk factors that respondents are least likely to agree with overall.

NHS Tees National Awareness and Early Diagnosis Initiative (NAEDI)
The approach to case finding (for generic cancer symptoms)  adopted by NHS Tees via their NAEDI Cancer Awareness and Early Detection Programme provided an opportunity to target people at high risk of developing CVD who may also be more likely to develop cancer due to related lifestyle behaviours.


Tees Lung Cancer Awareness Project
The approach to raising the awareness of lung cancer signs and symptoms  current smokers eligible for Lung Health Checks provide an opportunity to target smokers who are also at high risk of developing lung cancer.

Within the primary care setting there are further opportunities to target patients who are at higher risk of cancer due to lifestyle. This could include looking for lung cancer and/or other cancers in people with chronic obstructive pulmonary disease (COPD) and other long-term conditions.

Be Clear on Cancer Evaluation Update
The Be Clear on Cancer campaigns evaluation update show increased public awareness of cancer, referrals for diagnostic assessments and early diagnosis and treatments. A more coordinated approach to campaigns is being adopted to ensure that the potential impact on primary and hospital services are minimised.

Improving participation in cancer screening
Research has shown that individuals interpret their health status according to their own social and cultural experiences and beliefs.  Working directly with these communities, and using evidence based methods of communication can help to change attitudes and encourage participation in screening (NHS Cancer Screening Programmes (2009) Communicating Risk Information about Breast and Cervical Cancer and Cancer Screening to Women from Minority Ethnic and Low Income Groups).

Increased awareness of less common cancers
It is important to make efforts to improve survival rates in the less common cancers.  The Be Clear on Cancer campaigns aim to raise public awareness of some of these cancers.

McPhail S, et al. (2013). Emergency presentation of cancer and short-term mortality Br J Cancer. 109(8):2027-34. Shows that emergency presentation for breast, cervical, colorectal, lung and prostate cancer is predictive of short-term mortality even when age, stage, and co-morbidity are accounted for.

Health and Social Care Information Centre (2013). National Lung Cancer Audit 2013: Report for the audit period 2012.

 

Last updated: 26/05/15

9. What do people say?

Tees Cancer Awareness Measure (CAM)
The 2010 Tees CAM was carried out to establish a baseline level of cancer awareness across Tees. The survey asked 585 participants to state reasons for delaying visiting the doctor if they suspected they had a sign or symptom of cancer.

Respondents were asked to identify reasons why people might put off going to see a doctor, even when they think the symptoms might be serious, and were asked if any of these reasons would personally cause them to delay contact.

The main reasons respondents gave for putting off visiting the doctor were: worries about what the doctor might find (39%); difficulties making an appointment (27%); feeling scared (24%); and worries about wasting the doctor’s time (23%).

Cancer symptoms survey
The Cancer Symptoms Survey Report - Delay Kills (Cancer Research UK, 2013) highlighted that thousands of people  are dying early because of ignorance and denial of cancer symptoms. It suggests that, based on latest figures, if Britain were to match the best cancer survival rates in Europe, 11,500 fewer people would die every year. Just matching the European average would save 6,000 to 7,000 lives every year.

The survey used the Cancer Awareness Measure (CAM) to explore awareness about warning signs and symptoms of cancer 2,090 British people. Some of the results are:

  • More than three quarters of respondents failed to mention pain, coughing, bladder and bowel problems..
  • People's attitudes to early possible signs of cancer when found was poor with about a third reporting that if they spot potential serious early signs of cancer they would delay getting them checked because they would be worried about what the result might be; another third that it would be difficult to make an appointment to see their GP and a quarter that might be a waste of the doctor's time.
  • Generally, low level of awareness of some of the risk factors, the things that affect a person's chances of developing the disease.

The report highlights that much more efforts are needed to do to raise awareness about the early signs of cancer and for people to know that catching the disease early gives them much better chance of survival.

Cancer patient experience surveys
South Tees Hospitals encourage and support patients to participate in national cancer patient experience surveys. They include Cancer Patient Experience Survey, Radiotherapy Patient Experience Survey, National VOICES of bereaved people of palliative care patients and their families. Reported satisfaction levels for local cancer services are generally in line with national targets.

However survey results show that:

  • black and minority ethnic (BME) patients were more likely to report not receiving understandable answers to their questions
  • patients from more disadvantaged areas were more likely to report delayed diagnosis
  • lesbian, gay and bisexual patients were less likely to report being treated with dignity and respect
  • patients with mental health conditions and/or a learning disability were more likely to feel treated as “a set of cancer symptoms”
  • women were less likely to feel they were treated with respect and dignity and given sufficient privacy.

Local partners use results to identify ways of to improve the experience of patients from all communities.

Macmillan’s Nine Outcomes
This is the first in a regular series of state of the nation reports from Macmillan Cancer Support, aimed at showing how the UK is performing on the issues that matter most to people with cancer. It involves a comprehensive review of the available evidence which are applied to Macmillan’s ‘Nine Outcomes’ – nine statements that people living with cancer say they want to see by 2030. They outcomes are:

  • I was diagnosed early’
  • I understand, so I make good decisions’
  • I get the treatment and care which are best for my cancer, and my life
  • Those around me are well supported’
  • I am treated with dignity and respect’
  • I know what I can do to help myself and who else can help me’
  • ‘I can enjoy life’
  • I feel part of a community and I’m inspired to give something back’
  • ‘I want to die well’

The Tees Cancer Strategic objectives are in line with the nine outcomes.

 

Last updated: 26/05/15

10. What additional needs assessment is required?

Early diagnosis and treatment of cancer is an important factor in improving outcomes for cancer services. In addition to programmes targeted at the population such as awareness campaigns and population-based screening for cancer, there is a need to provide fast access to efficiently managed services.

A regional assessment of children and young people’s cancer needs has been carried out.  The findings of this need to be considered within Teesside. 
Health Needs Assessment for Children and Young People Across the North of England Cancer Network (NEPHO, 2012).

 

Last updated: 26/05/15

Key contact

Name: Victoria Ononeze
Job title: Public Health Cancer Lead
e-mail: victoria.ononeze@nhs.net
Phone number: 01642 745174

References

National strategies and plans

Macmillan Cancer Support (2014). Cancer in the UK 2014: State of the Nation Report.
Department of Health (2014). Improving Outcomes: A Strategy for Cancer fourth annual report.
Department of Health (2013). Living Well for Longer: a Call to Action on Avoidable Premature Mortality.
Chief Medical Officer (2014). Annual Report of the Chief Medical Officer: Surveillance Volume, 2012: On the State of the Public’s Health. Chapter 6 – Cancer trends.
Department of Health (2011a). Improving Outcomes - A strategy for cancer.
Department of Health (2011b). Improving Outcomes: A strategy for cancer – First Annual Report
Department of Health (2007). Cancer Reform Strategy
Department of Health (2000). The NHS Cancer plan: a plan for investment, a plan for reform.

 

Local strategies and plans

 

Tees Cancer Strategy 2014-2018 (in press)

 

Other references

Abdel-Rahman M, Stockton D, Rachet B et al (2009). What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable? Br J Cancer. 2009 Dec 3;101 Suppl 2:S115-24.

Cancer Research UK (2010). The Excess Burden of Cancer in Men in the UK.

Cancer Research UK (2012). How many cancers can be prevented?

McPhail S, et al. (2013). Emergency presentation of cancer and short-term mortality

NHS Tees (2010) Tees Cancer Awareness Measure Survey

National Cancer Intelligence Network Cancer e-Atlas

National Cancer Intelligence Network

NEPHO (2012). Health Needs Assessment for Children and Young People Across the North of England Cancer Network

NYCRIS (2011). PCT cancer fact sheets

NYCRIS (2012). Health & Wellbeing Board Cancer Profiles

Parkin, DM; Boyd, L; Darby, SC et al (2011).  The Fraction of Cancer Attributable to

Lifestyle and Environmental Factors in the UK in 2010. British Journal of Cancer 105, Sup 2, S1-S82

Public Health England (2015). Longer lives