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In February, the government launched the National Cancer Plan (NCP) for England to “fight cancer on all fronts so that more people become cancer-free… and fewer people get cancer in the first place”.
Writing in the plan’s introduction, Wes Streeting, Secretary of State for Health and Social Care, says it will also “transform how cancer care feels for patients and their families”.
Professor Peter Johnson, NHS national clinical director for Cancer, went on to say that the plan “sets a clear roadmap for the NHS to diagnose more cancers earlier, ensure more patients are treated on time and improve survival”.
The UK lags
Certainly, something needs to be done. According to Cancer Research UK (CRUK), there are more than 386,000 new cancer cases in the UK annually – that’s about 44 every hour. Each year, 170,000 people die from cancer in the UK, a higher average than in many other countries. For instance, CRUK noted in 2024 that 70.7 per cent of people with stage three colon cancer in Norway and 70.1 per cent in Australia survived for five years. In the UK, five-year survival was just 63.3 per cent. For some cancers, UK survival rates are below those in Romania and Poland.
The government estimates that the NCP will mean that three-quarters of people diagnosed with a malignancy in 2035 will be cancer-free or living well with cancer five years later. This compares with a projected 60 per cent of those diagnosed with cancer in 2022 and 50 per cent in 2008. The government estimates that the NCP will save 320,000 lives by 2035.
Dr Clare McNaught, president of the Royal College of Surgeons of Edinburgh, says: “NHS cancer performance targets in England have not been met since 2015 and our patient outcomes from cancer care lag significantly behind our European counterparts.
“We therefore welcome the publication of this 10-year cancer plan, which pledges to address the deficiencies in our cancer diagnosis and treatment pathway and to address the impact of social deprivation on cancer survival.”
“NHS cancer performance targets in England have not been met since 2015”
A comprehensive approach
The NCP envisages more rapid diagnosis, personalised care and faster treatment. By March 2029, for example, 80 per cent of patients will be diagnosed or receive the all-clear within 28 days of an urgent referral for suspected cancer, the NCP says. The plan also aims for 85 per cent of patients to start treatment within 62 days of referral and 96 per cent to start treatment within 31 days of a decision to treat.
To help meet these ambitions, the NHS will provide another 9.5 million diagnostic tests (a 12.8 per cent increase) annually by March 2029. For example, where possible, England’s 170 Community Diagnostic Centres will be open for at least 12 hours a day, seven days a week.
According to a national standard, 98 per cent of histopathology (microscopic examination of tissue) tests should be reported within 10 days. Currently, only 68 per cent meet this deadline. Digital automation and AI could enhance histopathology productivity, the plan envisions.
Furthermore, evaluating DNA released from dying tumour cells circulating in the blood (ctDNA) can hasten treatment decisions. Lung cancer ctDNA results are available seven to 14 days earlier than tissue genotyping (determining the cancer’s genetic make-up), so patients can start targeted therapies sooner. Measuring ctDNA can detect relapses of colorectal and breast cancer months earlier than tissue genotyping.
The changing game
According to the NCP, innovative treatments will transform the prospects of cancer patients, even if the malignancy is uncommon.
“Whilst we support the adoption of new innovative technologies, such as robotics and AI in cancer treatment, we urge the government to first address the basic issues that are delaying cancer care now, such as antiquated IT and diagnostic facilities, which are widespread in our current system,” says
Dr McNaught.
In an article commenting on the NCP published in the British Medical Journal (BMJ), researchers from the London School of Hygiene and Tropical Medicine echoed this sentiment, noting: “Clinicians have long been frustrated by slow, poorly designed IT systems and will likely be sceptical after observing recurrent procurement failures that have hindered rapid digital transformation.”
The NCP also aims to deliver “enhanced care” during and after treatment to help “patients with more extensive needs… to live well”. This approach, called ‘supportive oncology’, includes rehabilitation, psychological support, preventative interventions – such as physical activity and smoking cessation – as well as rapid management of severe and sudden symptoms.
Among many other changes, the NCP advocates “timely and proactive identification of palliative care and end-of-life care needs”. As part of this, it aims to “correct the inequality that despite most people wanting to die at home or in a hospice, most still die in hospital”.
Prevention is first prize
Cancer Research UK believes that 10 risk factors contributed to 34 per cent of all cancers in England during 2023. For instance, obesity and overweight accounted for eight per cent of malignancies. The NCP envisages working “with the pharmaceutical industry to enable more people to access new weight loss services and treatments”, such as glucagon-like peptide-1 receptor agonists.
UV radiation contributed to four per cent of cancer cases. A 2012 BMJ paper reported that people who have used sunbeds are 25 per cent more likely to develop melanomas than non-users. The paper found that using sunbeds before 35 years of age increased melanoma risk by 87 per cent. The government will consult on strengthening restrictions, including ensuring that only people aged 18 years and older use commercial sunbeds, and will call for evidence to understand whether further action to tackle melanoma is needed. In the meantime, community pharmacy teams should continue promoting sun safety.
Infections contributed to four per cent of cancer cases. From this year, community pharmacists will begin administering the human papillomavirus (HPV) vaccine to young people who missed the jab at school. This and other changes to enhance vaccine uptake will contribute to delivering the government’s commitment to eliminate cervical cancer by 2040. HPV vaccinations also protect against some malignancies of the head and neck, mouth, vagina, vulva, penis and anus.
Alcohol contributed to two per cent of cancer cases. The NCP plans new mandatory health warnings and nutritional information on alcohol labels.
Tobacco was the top risk factor, however, accounting for 14 per cent or 47,300 of cancer cases in England during 2023.
“The plan’s steps on tobacco, HPV and harmful UV exposure are important,” says Dr Giota Mitrou, executive director of research and policy at the World Cancer Research Fund International. “They complement existing commitments on healthier food environments and clearer alcohol labelling. We now need bolder action on addressing overweight and obesity, reducing alcohol consumption and improving environments that shape health from early on in life. We welcome the ambition of the cancer plan on cancer care and survival. Now we need to match that with more ambition in prevention, which needs to be strengthened and delivered at pace.”
An industrial strategy?
No one doubts either the need to improve cancer care or the plan’s ambition. However, writing in the BMJ, the London School of Hygiene and Tropical Medicine (LSHTM) researchers say that the NCP is less “a health reform strategy” and more “an industrial strategy” that “frames cancer services as a national platform for research, innovation and commercial growth, with improvements to health outcomes almost secondary in its purpose”.
They say the plan includes “little information on how we can deliver a personalised service to manage some 200 types of cancer, and an increasing pipeline of treatments with a stagnant workforce and patients living precariously with more comorbidities”. Moreover, the NCP lacks, they argue, “sufficient detail” about dealing with issues such as improving specialist commissioning, improving poor performance and enabling equitable access to high-quality specialist care.
The NCP regards cancer as “a touchstone for the wider NHS: a tide on which all ships rise, and a litmus test for our mission to modernise the health service. If we get cancer care right, we get healthcare right”.
However, the LSHTM researchers point out that it is just the latest in a “long series” of plans that set out to improve cancer care. “None have successfully shifted England’s position as a laggard in achieving the survival rates seen in comparable countries, nor reduced deep and persistent socioeconomic inequalities,” they write.
Time will tell if this time the NCP delivers on its ambition.
A community pharmacy pilot
The new plan reaffirms the importance of pharmacy teams, saying that community pharmacies “will have an expanded role in cancer diagnosis – for example, in offering first line tests to people who have symptoms which could indicate cancer”.
Later this year, pilot community pharmacies will test for early oesophageal cancer and a pre-cancerous form called Barrett’s oesophagus. Patients swallow a capsule attached to medical-grade string. The capsule dissolves in their stomach releasing a sponge. Pulling on the string moves the sponge through the food pipe, collecting cells that pathologists can then examine for malignancy or Barrett’s oesophagus. The pilot pharmacies will be able to refer certain patients directly to secondary care for further investigation.
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