Cancer Research UK – Science blog

Over the past few years, pressure on NHS cancer services has been mounting.

Cancer waiting times, which show whether the health system is meeting its targets for quickly diagnosing and treating cancer help show us the extent of this pressure.

Testing for cancer, diagnosing it and starting treatment quickly saves stress and anxiety for people. Not only this, but cancer that’s diagnosed and treated at an early stage, when it isn’t too large and hasn’t spread, is more likely to be treated successfully. Prompt diagnosis and treatment underpin this.

There are four important targets that indicate how well cancer services are doing.

Here are the latest results in England for April 2023:

Urgent suspected cancer referrals standard: Target Missed

• 77.7% of people were seen by a specialist within 2 weeks of an urgent suspected cancer referral. The target is 93%. Performance in April 2023 was the 7th worst on record.

The Faster Diagnosis Standard: Target Missed

• 71.3% of people were diagnosed, or had cancer ruled out, within 28 days of an urgent referral in April 2023. The target is 75% and was introduced in 2021, but has only been met once since then, in February 2023.

The 62-day standard: Target Missed

• Only 61% of people in England received their diagnosis and started their first treatment within 2 months (or 62 days) of an urgent referral in April 2023. This is well below the target of 85% and this target has not been met since 2015, with a record low in January 2023.

The 31-day standard: Target Missed

• 90.5% of people started treatment within 31 days of doctors deciding a treatment plan in April 2023. The target is 96% and this performance was the 3rd worst on record.

The above data are specific to England. Scotland, Wales and Northern Ireland also have their own cancer waiting times targets.

What does this mean for people affected by cancer?

It can be easy to forget that behind these numbers are real people going through an incredibly anxious time.

In April 2023 alone, around 5200 people who started cancer treatment in that month had waited longer than two months since their urgent referral. If the 62-day target was met, around 3,200 additional patients would have begun treatment on time.

Quantifying the impact of missing targets and longer waits on patient outcomes is difficult as the research is limited.

The picture is different for different cancer types – some progress quicker than others – but we know the overall impact is likely to be negative. One study estimated that a 4-week delay to cancer surgery led to a 6-8% increased risk of dying.

People with more aggressive cancers are prioritised for early treatment where possible, but there can be good reasons why someone might experience a long wait for treatment.

For example, it can take longer to plan treatments intending to cure someone’s cancer, and sometimes patients need prehabilitation before starting treatment to give them the best chance of recovering well.

But increases in missed targets mean people who need potentially lifesaving cancer treatments are waiting, and worrying, for longer – and that is a big concern.

Despite delays, people shouldn’t put off coming forward if they are worried about symptoms. It’s always better to be on the waiting list than not at all, and if doctors are concerned, they will push things through as quickly as possible.

Getting back on track

We know that a major factor contributing to long waits for cancer diagnosis and treatment is chronic shortages of key NHS staff.

The Government has committed to developing a Long Term Workforce Plan, which could address these workforce shortages and help get cancer services back on track.

But that plan has now been delayed a number of times, and when it can take 15 years to train an oncologist, radiologist or surgeon, every day without a plan is a step further away from getting cancer services to where they need to be.

So we need to see that Long Term Workforce Plan published, clearly setting out how many staff we’ll need in the next 5, 10 and 15 years. Crucially, this needs to be matched with the funding to recruit, train and retain those staff.

The challenges facing cancer services are significant and complex, but they are not insurmountable. In the coming months the Government has the opportunity deliver on its promise to tackle NHS waiting lists and make cancer a priority. Without action, people with cancer will continue to experience unacceptable delays for diagnosis and treatment.

Though it’s promising to see some progress, all cancer waiting time targets in England have been missed yet again. Behind today’s numbers are patients who are anxious about their future and hard-working NHS staff who are stretched to capacity.

The solution to tackling these delays lies in the hands of the Government who must show leadership and publish the long-awaited workforce plan for England. Without a fully-funded strategy to recruit, train and retain the staff we need, it will be difficult to improve cancer survival for all.

Michelle Mitchell, chief executive of Cancer Research UK

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