Late cancer diagnosis 'costing lives and money'

"Almost half of cancer patients diagnosed too late," says The Guardian, citing a new report that explored both the financial and health impact of late cancer diagnosis.

The late diagnosis of almost all types of cancer usually means the disease has already spread within the body, making it less treatable, reducing a patient's chances of survival, and potentially increasing the cost of effective treatments.

This means an enduring aim of cancer treatment is to pick up the disease as soon as possible, so treatment is more likely to be effective.

The report predicted around 52,000 cases of four common cancers (colon, rectal, lung and ovarian) may be spotted too late every year, costing the NHS around an extra £150 million to treat.

Various theories have been put forward to explain why this is the case, including "patients put[ting] their heads in the sand when they feared cancer", and how "doctors are struggling to get patients seen quickly".

Who produced this report on late cancer diagnoses?

The report was produced by Incisive Health, a specialist health policy and communications consultancy, in collaboration with experts at Cancer Research UK, a leading cancer charity. It was funded by Cancer Research UK.

The report – titled "Saving lives, averting costs: an analysis of the financial implications of achieving earlier diagnosis of colorectal, lung and ovarian cancer" – presumed that early diagnosis is crucial, and aimed to uncover the financial implications of achieving earlier diagnosis for colon, rectal, non-small cell lung (the most common type of lung cancer) and ovarian cancers.

The report estimated the number of people currently diagnosed with cancer using national guidance and data sources. This included data on the stage of the cancer when it was diagnosed (where available), and the authors calculated the cost of treatment. They then modelled what would happen if the cancers had been diagnosed earlier.

What did the late cancer diagnosis report find?

The report found that in England there are marked variations in the proportion of patients who are diagnosed with cancer at an early stage.

For colorectal cancer, there is nearly a threefold variation between the highest and lowest performing local clinical commissioning groups (CCGs).

For lung cancer, the variation is nearly fourfold, and almost fivefold for ovarian cancer.

The report also found early-stage cancer treatment is significantly less expensive than treatment for advanced disease.

However, the costs of recurrence can be significant and should be taken into account when modelling overall cancer treatment costs.

Overall, late diagnosis is a major driver of NHS cancer treatment costs, the report found.

It also found that:

• Delivering earlier diagnosis for lung cancer would not be cost-saving, but would save lives.
• Taking the colon, rectal, lung and ovarian cancers together, savings of more than £44 million and health benefits for nearly 11,100 patients could be made if all areas achieved the best levels of early diagnosis.
• Colon, rectal, lung and ovarian cancers account for approximately 21% of overall cancer diagnoses in England. If the findings for these cancers were replicated for all cancers, savings in treatment costs of just under £210 million would be realised, resulting in more than 52,000 people being diagnosed with earlier-stage cancer. This suggests that commissioners should develop plans with the expectation of being able to realise significant savings if they can deliver earlier diagnosis.
• Even before new and potentially more expensive therapies are taken into account, the costs associated with treating cancer will increase as a result of rising numbers of cancer cases in the next 10 years.

The report concluded that, "The analysis presented in this report demonstrates that earlier diagnosis of cancer will deliver both an outcomes premium for patients and a financial dividend for the NHS through averted treatment costs.

"These findings create a compelling case for commissioners of NHS and public health services to act now to encourage earlier-stage diagnosis."

What does Cancer Research UK recommend?

Cancer Research UK recommends that the earlier diagnosis of cancer should be viewed as an efficiency as well as a quality priority for the NHS, and that all CCGs and local health and wellbeing boards should set out plans to encourage the earlier diagnosis of cancer.

It says too many patients in England do not have the stage of their cancer recorded and that this requires urgent attention.

The charity wants research into local information on the stage of cancer at the point of diagnosis to identify examples of "high performance" and explore the good practices that contribute to this.

Cancer Research UK has called for more government investment and top-notch research into earlier diagnosis and improved treatments for cancer.

The charity also wants NHS England to consider the case for using cancer as a pilot for a "multi-disease early diagnosis strategy".

Can we believe this report?

The Cancer Research UK report is clear in highlighting the limitations of its findings. These include:

• The way treatment plans are carried out depending on individual circumstances (treatment pathways) varies locally, so the examples presented in this report may not reflect local circumstances in every area of England.
• Cancer is a fast-moving area of medicine, and clinical practice can therefore change rapidly.
• Every patient's treatment will differ, so the pathways described in this report may not match those experienced by individual patients.
• The costing information used in this report is the best available to the NHS, but may not fully reflect the local variations in cost that can occur.
• Recurrences of cancer can be complex and rarely follow a clear pathway. The approach used in the model represents a simplification of what happens in clinical practice.
• Staging data in England is incomplete and requires further improvement.
• Information on the use of some clinical interventions, such as chemotherapy, is still maturing and requires interpretation.
• Future cost estimates were based on the clinical practices and costs of today. It is likely the cost of some existing interventions will reduce and that newer, potentially more expensive – but also more effective – treatments will become available.

The report states the clinical pathways, costs and assumptions were tested with clinical experts and amended on the basis of their feedback. They consider their results "sufficiently accurate to inform discussions and planning about the treatment cost implications of earlier diagnosis".

The report also only used data on England and its recommendations are therefore directed at NHS England. However, the authors state their conclusions and actions are likely to apply to the other nations that make up the United Kingdom of Great Britain and Northern Ireland.

How does this affect cancer care?

This report is mainly aimed at NHS planners, giving them more information about the impact of earlier cancer diagnosis. However, to the person on the street it is a good reminder of the need to be aware of the signs of cancer and not to ignore them.

Delays in diagnosis can cost lives. Speak to your GP if you experience changes to your body's normal processes, or symptoms that are out of the ordinary and persist for more than a few weeks. 

Conclusion

Arguably, a lot of the media coverage involved subtle distortions of Cancer Research UK's press release. The press release said that, "Half of cancers diagnosed at late stage, as report shows early diagnosis saves lives and could save the NHS money".

Much of the media skewed this as saying – to paraphrase slightly – that "half of all cancers are diagnosed too late".

Statements that indicate that cancers are currently diagnosed too late are somewhat loaded and subjective. They suggest that doctors might be missing the cancers, or that something has gone wrong and somebody is to blame.

The reality is that there are a number of reasons why some cancers are diagnosed at a late stage, all of which can be sought to be improved in a bid to aid earlier diagnosis.

One example is that by the time people have symptoms of some cancers, the cancer is already well advanced.

A second is that people may not be aware of, or ignore, symptoms of cancer before they seek medical advice, so when they do eventually go to the doctor the cancer is already at a late stage.

The underlying assumption of this report – that early diagnosis will benefit patients – is not disputed. What this report adds is information suggesting it might also be cost effective for cancer to be diagnosed earlier, and calls for more efforts being made to achieve this.

If you are unsure of the signs and symptoms of cancer, use Cancer Research UK's online self-check tool. If you have any questions or are worried about whether you might have cancer, visit your GP without delay.