8 December 2015
Macmillan Cancer Support warns that lack of post-diagnosis support is putting ‘unsustainable’ pressure on the NHS
The NHS in England spends more than £500 million a year on emergency care[i] for people diagnosed with the four most common cancers alone, a new report from Macmillan Cancer Support reveals[ii]. Of this, more than £130m is spent treating people more than six months after their diagnosis, when initial treatment has usually finished[iii].
A new report, Cancer Cash Crisis, warns that a lack of post-diagnosis support for people living with cancer is putting increased pressure on overstretched A&E departments as the health service faces another winter of high demand.
The report reveals the often life-long costs associated with supporting the growing number of people living with cancer. The charity calls for an end to the current ‘dysfunctional’ one-size-fits-all approach to cancer after-care which often fails to help people recover well and have a good quality of life.
The charity urges the government to fully fund and implement the cancer strategy for England, warning that ‘choosing to do nothing will only increase costs’ in years to come.
New figures in the report estimate that total care and support for people living with cancer beyond their initial treatment will reach an estimated £1.4bn a year by 2020, £1bn of which will be spent on treating the consequences of cancer and its treatment, such as damage to internal organs and severe limb swelling.[iv]
The number of people living with cancer in England is expected to soar to at least 3.4 million by 2030[v], with more people than ever before surviving a cancer diagnosis in the long term. The charity says the needs of people living with cancer must be addressed through a full programme that helps people live well beyond their initial treatment.
While early diagnosis is important, care costs can be high even when cancer is caught at an early stage, according to the report. For example, new figures reveal that for the 40,000 women diagnosed with early-stage breast cancer each year[vi], the cost of inpatient care during diagnosis and initial treatment (£155 million) is dwarfed by the almost £100 million more (£250 million in total) spent on inpatient hospital care after their initial cancer treatment ends[vii].
Findings published earlier this year showed that fewer than one in three people (31%) diagnosed early with a common cancer (breast, prostate or lung cancer) will survive both long-term and in good health.[viii] This is despite their early diagnosis and the cancer not spreading.
Deborah Grigg, 46, from Buckinghamshire was diagnosed in March this year with triple negative breast cancer. She says:
“Following radiotherapy I’d been told my skin may still continue to burn for a few weeks after treatment. What I wasn’t told was that my skin was so thin it was prone to infection and that in fact I had cellulitis. After my treatment, I was given a leaflet and a number to call but I could never get through. I couldn’t even get hold of my GP for two days so I was admitted to A&E with a giant abscess. If I’d had better support after my treatment, five very expensive days in hospital could have been avoided."
Juliet Bouverie, Executive Director of Services & Influencing at Macmillan Cancer Support, says:
“Emergency care should be a last resort for people living with cancer, and the fact that such vast amounts are spent on it each year is symptomatic of a system that is not geared towards helping people take control of their health. This has to change, and the government and NHS must take the difficult but vital decision to fully fund this shift.
“The story does not end when someone’s treatment finishes, and many people live with the effects of cancer for the rest of their life. This means the NHS needs the money to care for people far beyond initial treatment. There will be significant cost implications in the future if the government and NHS do not invest now. Quite simply, money has to be spent now, and spent wisely, to save later.
“The government and the NHS must fully fund and implement the cancer strategy for England, investing this money at the earliest stage. The strategy provides a range of important solutions that will put cancer care on course for improvement, and help stem the rising tide of costs. One such recommendation is the rolling out of a recovery package including a holistic needs assessment and other key interventions which have been proven to help people get their lives back after treatment.”
The recent Spending Review announced an extra £3.8bn investment in the NHS next year, but detail is yet to be confirmed as to how the NHS plans to spend this cash injection.
For further information, please contact:
Patrick Pringle, Media & PR Officer, Macmillan Cancer Support
0207 840 4891 (out of hours 07801 307068)
Notes to Editors:
1. We must not forget the cost of co-morbidities for people living with cancer; 1.8m people living with cancer in the UK also have another long term condition such as heart disease. Macmillan acknowledges that all figures are possible underestimations. All figures in the release for England only.
[i] This includes any inpatient hospital admission that is unpredictable and at short notice because of clinical need
[ii] Macmillan Cancer Support/ Laudicella et al. (City University), in partnership with Imperial College London and the National Cancer Intelligence Network (NCIN) at Public Health England. Cost of cancer in England. Unpublished data – paper in preparation. Other results Laudicella M, Walsh B, Burns E, Smith P, Irvine L Abstract O-31. The economic burden of cancer in England: evidence from patient-level data analysis. European Journal of Cancer Care. Special Issue: National Cancer Intelligence Network Cancer Outcomes Conference 2015, 8-10 June 2015, Europa Hotel, Belfast. Volume 24, Issue Supplement S1, pages 1–23, June 2015. Presented in Macmillan Cancer Support. 2015. Cancer cash crisis.
[iii] This figure excludes costs in the last twelve months of life
[iv] Macmillan Cancer Support/Monitor Deloitte. The cost of English NHS cancer care. Costs based on the sum of monitoring and consequences of treatment so exclude end of life care, diagnosis and anti-cancer treatment. Costs based on 13 cancer types that comprise 77% of cancer prevalence in 2010. The approach primarily used population projections, incidence projections, staging and survival data and assumptions about recurrence rates to model cancer cohorts for up to 15 years post diagnosis and a bottom-up health economic model built upon a set of cancer-specific ‘archetypal’ clinical pathways. These pathways include the probability and cost of various activities. They were initially defined using NICE and NHS clinical guidelines and refined in conjunction with internal Deloitte and external clinical experts, this means they represent a semi-optimised set of pathways, rather than capturing the full variety of real-world clinical practice. The costs of activities are primarily based on NICE technology appraisals and the National Tariff. ̶The costs do not include the costs associated with the treatment of non-cancer long-term conditions of cancer patients, except when cancer treatment produces acute exacerbation.
[v] Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202. (Projections scenario 1). Macmillan analysis based on extrapolation of 2010 and 2020 projections that the number of people living with cancer in 2015 in the UK. The England share of the UK total is taken from Maddams J, Thames Cancer Registry, personal communication. See also Maddams J, et al. Cancer prevalence in the United Kingdom: estimates for 2008. Br J Cancer 2009; 101: 541-547
[vi] Estimated from the numbers of new breast cancer diagnosis in 2013 and the rate of diagnosis at an early stage (stage 1, 2 or 3). Office for National Statistics. Cancer Statistics Registrations, England (Series MB1), No. 44, 2013 www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-394268 and National Cancer Intelligence Network. 2014. Imputed stage survival workbook, 2012. http://www.ncin.org.uk/publications/survival_by_stage
[vii] Diagnosis and initial treatment is defined as all inpatient hospital care for any reason 13 weeks pre-diagnoses to six months post diagnosis. Care after their initial cancer treatment ends includes all inpatient hospital care for any reason between six months post diagnosis to death or up to seven years afterwards. Costs include all inpatient hospital provided during this period for any reason. Adjuvant endocrine, chemotherapy or biological therapy would go on for longer than six months, although these are non-inpatient treatments.
[viii] Macmillan Cancer Support. More than 2 in 3 people diagnosed early with common cancers experience poor health. June 2015. Macmillan analysis from the Routes from Diagnosis research programme, undertaken by Monitor Deloitte for Macmillan Cancer Support. www.macmillan.org.uk/Aboutus/News/Latest_News/Morethan2in3peoplediagnosedearlywithcommoncancersexperiencepoorhealth.aspx (accessed November 2015)
About Macmillan Cancer Support
When you have cancer, you don’t just worry about what will happen to your body, you worry about what will happen to your life. Whether it’s concerns about who you can talk to, planning for the extra costs or what to do about work, at Macmillan we understand how a cancer diagnosis can take over everything.
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