British expatriate and breast cancer survivor Amanda Thomson considers herself lucky. "When I was diagnosed in 1993, I lived in Brussels, Belgium," she said. "There I had immediate access to a cancer specialist and also received high quality care. In the United Kingdom, I fear there would have been much longer time-lags, and I may not have even seen one."
It is this type of scenario, presumably, that encouraged British Prime Minister Tony Blair to take action to improve cancer treatment and care in the U.K. In a letter published May 20, 1999, in the London newspaper, the Daily Mail, he announced the beginning of a national crusade against cancer aimed at saving 60,000 lives over the next 10 years.
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The same day his letter appeared, Blair invited some of the U.K.'s top cancer experts to his residence at 10 Downing St. to pinpoint what is needed in the fight against cancer, a group of diseases which kill 156,000 Britains every year.
According to a report issued at that meeting by the British Department of Health, all the news on cancer is not gloomy. Death rates from stomach cancer have fallen by half during the past 20 years; from cancer of the testicles by almost three-quarters. Lung cancer rates in men under 65 years of age have decreased by more than 60% from their peak in the 1960s, the report stated.
"Britain also undertakes first class cancer research, has excellent cancer centers, and its hospice movement is among the leading in the world," said Gordon McVie, M.D., director-general of the Cancer Research Campaign in London and European editor of the Journal of the National Cancer Institute.
Lower Rates
One reason British survival rates for major cancers such as lung, breast, prostate, and colorectal cancer are below both the European average and the United States, said McVie "is the lack of access to the best and latest treatments in our country."
According to McVie, who was one of the specialists invited by Blair (see list of those invited in sidebar), there are only about 150 medical oncologists in the U.K, a number that he considers "far too few for a population of almost 56 million." In comparison, he said, the Netherlands, with its 14 million people has about 400 medical oncologists.
Cancer patients compare the current situation to a lottery, and a study carried out by the Association of Cancer Physicians in 1994 confirms their assessment. The study showed that 40% of cancer patients in the U.K. never see an oncologist.
There is also evidence that Britain is a significantly lower user of chemotherapy than its European neighbors.
"Drug rationing is commonplace; our use of cytotoxic treatment is only a quarter of what Americans administer per patient and about half the use of countries such as France, Italy, and Germany. In addition, availibility of radiotherapy also varies from region to region," said Karol Sikora, Ph.D., chief of the World Health Organization's Cancer Programme and professor of international cancer medicine at the Hammersmith Hospital in London. "We could achieve the best results in the world, but the system is too patchy."
Although a report issued in 1995 by Britain's previous government announced an intent to reform cancer services, little has been accomplished in the meantime. The so-called Calman/Hine report named after then chief medical officers of England and Wales respectively, Kenneth Calman, M.D., and Deidre Hine, M.D. led to the concept of a series of interlinked cancer centers and units covering the entire country.
Pitifully Small
"It was heralded as the way forward by both the previous government and our current administration, but central resources to implement the plan have been pitifully small," said Sikora. "There still is no formal dialogue between cancer centers in the U.K. and no central control. The National Cancer Forum a derivative group of the Calman/Hine team meets every 6 months, but has no executive role or resources."
The country's National Health Service has produced evidence-based treatment guidelines for the major cancers, but Sikora criticizes them as "lacking specificity, which make them poor tools for a busy clinician."
Hope for Future
Experts hope that the meeting about the Prime Minister's new crusade will improve cancer management in the U.K.
"I would assess the meeting as being the government's way of demonstrating the priority it gives to improving cancer services," said Nicholas Day, Ph.D., professor of epidemiology and director of the Institute of Public Health at the University of Cambridge.
"It was more than public relations or good intentions. For far too long no one has been willing to upset clinicians who are not at the forefront of medical oncology," he said. "Health service managers are now in the position to change this."
A White Paper, "Our Healthier Nation," issued by Blair's Department of Health calls for action on prevention, screening, and treatment and aims to reduce cancer deaths in people under 75 by at least another fifth by the year 2010.
To achieve this, the government announced it will provide about 63 million British pounds (U.S. $90 million) over the next few years to create a smoking cessation service within the NHS to especially help people in deprived areas quit the habit.
An additional 56 million British pounds (U.S. $84 million) will be earmarked for smoking prevention programs, which will target particular groups such as children under 16 and pregnant women. Over the next 2 years, new screening programs for colorectal and prostate cancer will be tested in pilot studies and the biggest "shake-up" ever of existing cervical and breast cancer screening programs is under way.
Further, the NHS announced a plan to increase the number of medical oncologists by 400 over the next 5 years, as well as to provide an extra 150 million British pounds (U.S. $220 million) for better clinical services.
"This money is an excellent start," said Rosalind Eeles, M.D., head of the cancer genetics clinic at the Institute of Cancer Research, and the Royal Marsden Hospital in London. "However, more money needs to match this for basic and translational research."
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Sikora said that since the 150 million British pounds are coming from an already exisiting lottery, he does not think it constitutes a firm commitment to further funding.
"Improving our position will require investment especially in the crucial area of molecular biology which is likely to revolutionize chemotherapy," he said. "The public fear cancer more than any other illness. Our policy-makers need to provide the resources to bring cancer treatment up to the same standards as in the rest of Europe."
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