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Cancer

Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with cancer, 2016.

Cancer is a disease in which abnormal cells divide in an uncontrolled way and eventually invade other tissues. The abnormal cells can form growths, called tumours, and spread to other parts of the body causing secondary tumours called metastases.

Who’s at risk and why?

The risk of developing cancer depends on a combination of factors that cannot be changed, such as age, sex, ethnicity and socio-economic deprivation and ‘modifiable’ risks dictated by individual lifestyle choices or environmental influences.

Modifiable risks can be controlled (prevented) or treated, and addressing them is the most efficient way of reducing morbidity and mortality from a range of common conditions. It is estimated that at least 4 out of 10 cancers (42%) could be prevented by appropriate lifestyle changes. For Leicester, this is equivalent to around 500 new cancer cases every year.

These factors include lifestyle factors such as smoking, diet and alcohol consumption, along with workplace and environmental factors such as chemicals exposure, certain infections and air pollution.

The level of need in the population

Every year, over 1,100 people in Leicester are diagnosed with cancer (1,144 in 2013) and there were over 4,800 cancer patients on GP registers in March 2015 (which amounts to a prevalence of 1.3% of the total population).

Overall, the incidence of cancer in Leicester has been lower than the national average at 509 per 100,000 in 2013, compared to 601 per 100,000 national rate. This means there are around 200 cases less than would be predicted from national rates.

Cancer is the second most common cause of death, accounting for 25% of all deaths in Leicester and a third of deaths in under 75 year olds. These averages in Leicester are lower than the England-wide equivalents, where cancer accounts for 29% of deaths in all ages and 41% of deaths in under 75 year olds.

Lung cancer claims the highest number of lives per year in Leicester; 139 in 2014, of which 76 were in under 75s. The next highest number of cancer deaths are from colorectal, breast, prostate and oesophageal cancers.

The cancer in the East Midlands report (which you can find under the onward journeys heading below), provides the most up to date summary of region-wide and in some cases local authority and Clinical Commissioning Group level data in respect to the following:

  • incidence and mortality
  • lifestyle risk factors
  • screening coverage
  • proportions of cancers detected by the various diagnosis routes
  • stage of cancer development at diagnosis and survival by stage
  • survival rates and place of death.

Current services in relation to need

Tackling modifiable risks associated with cancers, such as smoking or obesity, underpins many public health initiatives including tobacco control, alcohol harm reduction, healthy living campaigns and other.

Developing awareness of non-modifiable risk factors, such as family history, also has a role in prevention, by increasing the perception of individual risk and improving acceptance rates of cancer screening.

For all unpreventable cases of cancer, the main objective is to detect the disease as early as possible, preferably before any symptoms or signs manifest themselves, and especially before the distant spread occurs. Both screening and early diagnosis are important in achieving this objective.

Although not appropriate for all types of cancer, screening is the most effective way of identifying cancer in its earliest stages. There are three NHS cancer population screening programmes for the early detection of cervical, breast and bowel cancers.

Despite the undoubted potential of screening programmes to pick up cancer in its pre-clinical stages, the national data for 2006-2010 indicate that only about 5% of all cancer cases are diagnosed through screening. For the remaining 95% of cancer cases, the objective is to encourage early referral, diagnosis and treatment to ensure best possible outcomes.

The urgent GP referral rate (two week wait, or TWW) for suspected cancers in Leicester is significantly lower than the national average. There are about 7,000-8,000 such referrals in Leicester each year, so up to 160 patients could have had a delayed diagnosis as a result. The proportion of urgent GP referrals, which result in a diagnosis of cancer (conversion rate), is also significantly lower than that for England.

Projected services use and outcomes in 3-5 years and 5-10 years

Based on the current general practice cancer registration rate (1.2%) and population projections, the projected number of people with cancer is likely to grow by over 200 over the next 10 years.

The National Cancer Intelligence Network estimated that in 2015, around 6,900 people in Leicester were living up to 20 years following a cancer diagnosis and this figure could rise to 7,800 by 2020 and 8,500 by 2025 (23% increase).

Unmet needs and service gaps

Unmet needs and service gaps in cancer services are primarily linked to the late presentation by patients and lower than expected screening uptake.

Patients in Leicester tend to present at later stages of the disease and the local survival rates are also lower than expected. Late diagnosis is of particular concern in lung cancer, with as many as 50% of Leicester patients presenting in stage IV of the disease and only 20% of those patients surviving more than one year.

Screening coverage is relatively low in Leicester, particularly for cervical screening in the younger age groups of women, rates of which have been falling in the recent years. Similarly, the level of bowel screening is the lowest in the East Midlands, with only 47% of eligible people taking up the offer in 2014/15.

Expenditure on care for cancer patients is lower than expected for Leicester.

Recommendations for consideration by commissioners

Recommendations for commissioners include focusing on cancer prevention; targeting action to improve coverage of cancer screening programmes, with particular focus on those groups and/or communities in the city where uptake has been low and/or where there are inequalities in the disease burden; promoting cancer symptom awareness to encourage early presentation; working with the health services to improve pathways of referral, particularly urgent elective referrals; and reducing late presentation of cancer through emergency admission routes.

Onward journeys