Fighting cancer together, why we need a strategy
The Department of Health has announced that it is to commission a new cancer strategy for Northern Ireland.
Why does this matter, what would it look like and what difference will it make?
Currently Northern Ireland has the dubious distinction of being the only part of the UK without an up-to-date cancer strategy. Its last one was published in 2008 and since then we know a lot more about both the prevention and treatment of the disease.
Furthermore statistics issued by the Northern Ireland Cancer Registry this week show that the number of cancer cases has increased by 15% over the past ten years.
It is important to remember that the primary reason for this is our ageing population.
Around nine in ten of cancer cases are in people aged 50 and over. This is because over time our cells get damaged, this builds up over age and therefore the older we are the greater the risk of cancer. And as the general population ages, cancer increases.
The latest figures show that there were 9,521 cases of cancer in 2017. It is projected that, on current trends this figure will rise to 14,148 by 2035.
Cancer is, and will remain the greatest cause of premature deaths. It is not, however, inevitable. Around 40% of cancers are caused by behavioural, lifestyle or environmental factors.
Therefore the first task of any cancer strategy will be to prevent as many as possible from getting the disease in the first place.
Three examples are risks associated with smoking, alcohol use and obesity. All three disproportionality affect people in areas of deprivation.
A strategy would be expected to examine what more can be done to treat those addicted to nicotine; what might be done to help people make better choices about drinking, and how to reduce obesity.
This is not something that a Health Department can achieve on its own. It will involve public health campaigns and in many instances legislation, for example introducing minimum alcohol unit pricing and restrictions on drink promotions. The Third Sector will have a huge part to play in this work.
Early detection is critical too. In cases of bowel cancer, for example, there is a 94% survival rate if it is identified early.
There are two important factors. First of all people need to understand and recognise the early signs and symptoms of cancer and be encouraged to come forward if they develop them. This will require a major public health campaign.
Second healthcare services need to act fast to diagnose and treat them. Northern Ireland is not starting in a good place. Cancer survival rates lag behind the rest of the UK, and are on a par with some eastern European countries. Targets for waiting lists for cancer treatment are not being met, indeed have never been met, and more diagnoses as a result of greater public awareness will exacerbate this without appropriate investment.
In terms of treatment, a new strategy would need to explore how we can ensure that cancer drugs which are available in England are also available to patients in Northern Ireland. The requisite funding needs to be found.
At the centre of it all is the patient who has to deal with the worry and stress of diagnosis, the symptoms of the condition and of any treatments.
The days when doctors were seen as demi gods are long gone. Every patient needs to be at the centre of their own care, an equal partner in the cancer journey, wherever it may lead. A strategy needs to address this as well, and that will mean consulting with service users and carers to ensure that the service is designed around them.
Another important area will be to support people to have as healthy and happy lives as possible. Survival rates have improved and will continue to do so. Already we are seeing some conditions – prostrate cancer is a good example – where it is increasingly common for people to die with cancer rather than from it. As some forms of cancer become more manageable we need to ensure that they are managed well.
The same applies to those whose lives will be claimed by cancer. Palliative and end of life care needs to be the best it can be. All of us will die, but the journey needs to be as pain-free as possible, and when death comes we should be in a place of our choosing, surrounded by those we want to be there, with the same attention paid to the end of our life as it was to our births, weddings and other waypoints on the journey.
There will be many other considerations to work through as well: ensuring the health service has the right staff with all the right training, and that we have access to the best treatments are two of the most obvious ones.
The Department has pledged to work with patients, staff and cancer charities to develop the strategy. This commitment to co-production is admirable and is how all health services should be designed.
It is also looking with obvious admiration to England which now has an Independent Cancer Taskforce which first designed and is now implementing England’s Cancer Strategy.
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