'The NHS is letting down our cancer survivors'

People are surviving cancers, but there is a cost

Millions of people now survive cancer, thanks to better detection and treatment.

But this is placing an ever-growing demand on the NHS system that deals with these patients' aftercare and checks.

In this week's Scrubbing Up, cancer expert Professor Jane Maher says the current system is wasteful, ineffective and not the best way to spot many recurrent cancers.

The cancer story is changing - no longer is a cancer diagnosis an automatic death sentence.

Due to advances in treatment, more people are living longer and having to cope with the consequences of cancer.

In the UK there are two million people alive who have survived cancer at any given time.

This figure will grow to four million by 2030 - these millions need comprehensive post-treatment support.

Follow-up

At the moment, cancer patients who survive initial treatment enter what is called the "follow-up" system - regular appointments to check that the cancer has not returned.

Traditionally, follow-up involves out-patient department visits with a consultant, backed up with diagnostic tests.

But there is surprisingly little evidence that this method is the best way to spot recurrences of cancer or the other possible long-term health consequences of being treated for cancer.

Recent work suggests that around 70% of recurrence of breast cancer could be detected by either patients noticing symptoms themselves or by surveillance testing alone, with a face-to-face appointment if needed.

But this is only possible if patients are helped to understand their illness, can access regular tests and know how and when to contact specialists if problems arise.

The current system is also not meeting cancer survivors' needs.

One in five people living after treatment for cancer will develop long-term emotional, psychological and physical problems that seriously affect their quality of life.

Yet there are few, if any, NHS services specifically for cancer survivors.

Treatment problems

This not only affects their quality of life, but also leads to unnecessary illness that costs the NHS - and the UK - dearly. It means people can't get back to work and may need treatment for other conditions caused by cancer or its treatment, coming on months or even years later. This cannot continue.

The NHS needs to radically transform the way it provides support for patients following hospital treatment.

Doctors need to be able to assess the level of risk, to identify which patients need regular face-to-face appointments and specialist support and which patients could, given the right tools and skills, manage their own condition.

Fundamental changes in the way that aftercare is provided would be cost effective, both to the NHS and to the wider economy.

Macmillan's own research shows 90% of survivors have both physical and emotional needs after treatment, with many unable to return to work as a result.

If patients are equipped with the information to know when they need to see a health professional or when they may need a diagnostic test, this will reduce the need for unnecessary follow-up appointments.

This, in turn, will free up resources which can be reinvested in the new aftercare services for people with cancer. It costs much less to provide a person with the skills and knowledge to self-manage their condition, and provide support if needed from a nurse in the community, than it does to make them travel to hospital for a follow-up appointment that doesn't take into account all of their needs.

Effective rehabilitation services that supported people to get back to work would mean fewer people claiming benefits, more people paying taxes and employers retaining experienced staff. It's a win, win, win situation.