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Current services in relation to need

Adults :: Cancer :: Current services in relation to need

Prevention

Prevention remains the best method of tackling cancer, reducing the burden caused by the disease and improving outcomes. Over half of all cancers can be prevented. Smoking is the single largest preventable risk factor for cancer. See chapter on smoking in 'Lifestyle and Wider determinants' section.

Poor diet and obesity are linked to cancer. The prevention work done in Medway is closely aligned to local and national strategies.

Excessive alcohol consumption is strongly linked to an increased risk of several cancers. A Medway alcohol strategy aims to promote sensible drinking and to reduce the impact of alcohol misuse.

The human papillomavirus (HPV) national childhood vaccination programme was introduced in 2008 for secondary school year 8 girls (12 to 13 years of age) as a three-dose schedule given within a six-month period. In 2014/15 the schedule changed to two doses; one in the Autumn term and the second in the Summer.

For 2014/15, HPV vaccination uptake for Medway of two doses was 80.7%, lower than the coverage for England (84.9%)[1]. This data excludes HPV vaccination given in general practice but will be included from 2015/16 onwards.

Increasing awareness and earlier presentation

Improving cancer outcomes in line with the best cancer outcomes in Europe requires better awareness of cancer signs and symptoms to ensure earlier diagnosis and treatment.

A range of surveys conducted between 2010-2012 by the Kent and Medway Cancer Network in partnership with Cancer Research UK, highlighted low levels of awareness of cancer risk factors and cancer signs and symptoms in Medway. A cancer delivery plan to improve cancer symptom awareness and cancer screening uptake was developed jointly with Public health, Medway Clinical Commissioning Group and the Communications Team from both Medway Council and the CCG was approved by the Health and Wellbeing Board in 2014. The plan focused on lung, breast and colorectal cancers and was implemented in 2015.

Public Health England leads and runs various national cancer symptoms awareness campaigns aimed at both the public and health professionals

Earlier diagnosis - cancer screening

Cancer screening is a vital tool for the early detection of cancers and pre-cancerous changes. There are three national screening programmes in the UK: breast, cervical and bowel.

Breast cancer screening

Women aged between 50 and 70 are routinely invited to breast screening once every three years. The programme was extended to include women aged 47 to 73 years in 2011.

Although, there has been a slight decline in screening coverage over the last few years in Medway, coverage is above the minimum standard (>70%) and above the average for England[2]. However, there are variations across general practices in Medway and Medway is yet to achieve the national target (80%).

An action plan was developed and implemented jointly with Medway CCG in 2014 through to 2015, to improve cancer screening uptake as part of a wider cancer mortality reduction plan in Medway.

Cervical cancer screening

All women between the ages of 25 and 64 years are eligible for cervical screening every three to five years depending on their age.

At the end of March 2016, the coverage for eligible women in Medway was 75.4%, above the average for England. However, there are variations across general practices in Medway. Coverage remains lower (74.0%) for eligible women aged 25-49 years in Medway, as in the rest of the country[3].

Bowel cancer screening

The NHS Bowel Cancer Screening Programme offers screening to all men and women aged 60 to 69 every two years. The programme started in West Kent and Medway in 2009 and was extended to include those aged 70 to 74 years in West Kent and Medway in January 2012.

In 2015, the percentage of eligible people aged 60-74 years in Medway screened for bowel cancer was 56%[4], above the minimum standard of 52% target.

In 2013, West Kent and Medway was one of six national pilot sites chosen to launch the Bowel Scope Programme (BSP) - a one off test for 55 year olds, which uses a camera on a flexible scope to look for and remove surgically, pre-cancerous growths in the lower part of the bowel. The roll out of the BSP has been phased across three years, with the final lists rolled out in early 2016. The uptake in Medway is 47%.

Improved access to diagnostic

The review of access to diagnostic in line with the four national priority areas across Kent and Medway has commenced. These areas include: chest x-ray to support diagnosis of lung cancer; non-obstetric ultrasound for the diagnosis of ovarian cancer; flexible sigmoidoscopy/colonoscopy for the diagnosis of colorectal cancer and Magnetic resonance imaging (MRI) brain for diagnosis of brain cancer. GPs now have direct access to chest x-ray to support diagnosis of lung cancer and non-obstetric ultrasound to support diagnosis of ovarian cancer.

Completeness of cancer staging

The completeness of cancer staging in Medway in 2013, has improved from the previous year with three-quarters (75.7%) of newly diagnosed cancers having a valid stage recorded at time of diagnosis[5]. The proportion presenting at an early stage (stage 1 or 2 as opposed to 3, 4 or unknown) was 44% in 2014 compared to 50% England average[4].

Ensuring better treatment

Table 2 shows the national targets for cancer waiting times with comparable figures for Medway and England. Please note, all figures are percentages.

  Operational standard Medway England
Two week wait from GP urgent referral to first consultant appointment 93 84.9 94.2
One month wait from a decision to treat to a first treatment for cancer 96 95.4 97.5
Two month wait from GP urgent referral to a first treatment for cancer 85 75.0 82.2
Table 2: Cancer waiting times (Q2 2016-17)[4]

The monitoring of cancer waiting time targets remains a priority. During Q2 2016-17, Medway was below the operational standard for two week waits, 31 day wait (diagnosis to treatment) and 62 day wait (referral to first treatment).

Medway CCG is supporting Medway NHS Foundation Trust in driving improvements in cancer waits and referrals. An action plan has been developed and the implementation of this plan is overseen by the Cancer Board.

Living with and beyond cancer

A Macmillan Information Centre and the Macmillan Chemotherapy unit is available at Medway Maritime Hospital to support people living with and beyond cancer.

Medway CCG, Macmillan Cancer support and Medway Council are working jointly to improve and provide access to advice and support on welfare benefits to people with cancer. Medway CCG is implementing the top tips guide to improve one-year survival for cancer produced by Macmillan Cancer Support.


References

[1]   Public Health England. Annual HPV vaccine coverage in England : 2014-15 2015;
[2]   Screening and Immunisations Team. Breast Screening Programme, England, Statistics for 2015-16 2017; https://digital.nhs.uk/catalogue/PUB23376
[3]   NHS Digital. Cervical Screening Programme, England - 2015-2016 2016;
[4]   Public Health England. Public Health Outcomes Framework data tool
[5]   National Cancer Registration and Analysis Service. Cancer Data