Specialists Give NHS Poor Rating On Bowel Cancer Treatment

NHS standards for people with bowel cancer in the UK are considerably behind the treatment patients receive elsewhere in Europe, according to a new MORI survey of specialists released by the Cancer Research Campaign today.¹

95% of cancer doctors surveyed cited lack of access to innovative drug therapies as the main factor contributing to poor management of the disease in the UK.¹ The data have been released in anticipation of the forthcoming National Institute for Clinical Excellence (NICE) ruling on NHS use of newer chemotherapy drugs for bowel cancer.

A separate MORI survey of the general public has also highlighted that while cancer in general, and specifically bowel cancer, were viewed as important issues, respondents felt that the UK lagged behind France and Germany* in providing cancer care.² Bowel cancer is the second most common cause of cancer death in the UK³ and is a disease that is believed to have a major negative impact upon a patient's quality of life,² however, prospects for long-term survival in the UK are poor. The estimated five-year survival rates for patients with colon or rectal cancer in the UK were 39 and 38% respectively between 1986 and 1990,⁴ compared with survival rates of 47 and 43% in the rest of Europe⁵ and 64% in the USA.⁶

The public felt strongly that factors such as the area in which they live (78%), the specialist they first seek advice from (78%) and whether they have private medical insurance (77%) may potentially affect standards of cancer care.² The survey of oncologists also highlighted that specialists' choice of chemotherapy treatments for NHS patients is restricted by the climate of post-code prescribing.¹ The most readily available chemotherapy treatment for bowel cancer is 5-FU/FA, with almost all specialists (96%) stating that this treatment is available.¹ Conversely, the availability of other newer drugs is limited, often primarily for clinical trial use only.¹

Professor Gordon McVie, Director General of The Cancer Research Campaign says, "It is extremely disturbing that specialists feel the main reason for us lagging so far behind other countries in managing this disease is because newer chemotherapy treatments are not readily available on the NHS."

"We welcome the fact that NICE is reviewing current treatment patterns, particularly since some of these new treatments - by allowing the removal of liver secondaries - could for some patients increase their probability of long-term survival. The forthcoming NICE guidelines will play an important role in the choice of bowel cancer therapy available to patients in the future."

Professor McVie concludes, "The use of the newer chemotherapy agents for bowel cancer in combination with traditional chemotherapy (5-FU/Folinic Acid), could contribute significantly towards meeting the Government's target of reducing cancer death rates by 20% by 2010." ⁷

The survey also confirms the taboos surrounding bowel cancer, which prevent sufferers from seeking medical help early enough. Over three-quarters (77%) of cancer doctors stated that late presentation is a main factor contributing to poor management of the disease in the UK.¹ Once the cancer has spread to other areas of the body, most commonly the liver, curative surgery may not be a valid treatment option. Newer treatments however can reduce the size of the tumour in the liver making effective removal of that tumour by surgery a realistic option again. Research into screening and referral guidelines for GPs would also help fight the disease says the Cancer Research Campaign.

Technical details

1. MORI Survey. A random sample of 51 telephone interviews was conducted with colorectal oncologists between 11 December 2000 and 9 January 2001. Interviews were conducted using CATI (Computer Assisted Telephone Interviewing). The sample is geographically representative of colorectal oncologists practising in England, Wales and Northern Ireland (of which there are 126). Oncologists practising in Scotland were excluded as NICE guidelines are not valid in Scotland. Data have not been weighted. Generation of the data has been supported by an educational grant from Sanofi-Synthelabo.
2. MORI Survey. A random sample of 503 telephone interviews was conducted among the British general public in Great Britain (aged 18+) between 6-13 February 2001. Interviews were conducted using CATI (Computer Assisted Telephone Interviewing). Quotas were set during fieldwork, and weighting applied at the data processing stage to ensure representativeness in terms of gender, age, social class and region. Respondents felt the UK lagged behind France and Germany: 31% felt that UK care was worse than in France while only 8% felt that UK care was better. 29% felt UK care was worse than in Germany while only 9% felt that UK care was better.
3. Coleman, et al. Cancer Survival Trends in England and Wales 1971-1995: Deprivation and NHS Region. London, TSO 2000.
4. Berrino F, et al. Survival of Cancer Patients in Europe. The EUROCARE-2 Study. IARC Scientific Publication 1999; 151.
5. NCI. SEER Programme 1998.
6. White Paper, 'Saving Lives: Our Healthier Nation', Presented to Parliament by the Secretary of State for Health by Command of Her Majesty, July 1999.