Variable cancer waiting times review underway

Tuesday 18th June 2019

The Scottish NHS is looking into bringing in shorter waiting times for less survivable cancers such as pancreatic, liver and brain cancer, the Health Secretary has confirmed.

Speaking at the latest meeting of the cancer cross party group (CPG) in the Scottish Parliament, Jeane Freeman said an expert group was examining the benefits of varying waiting times according to tumour biology and would report in late autumn.

Such variation has been called for by the less-survivable cancer taskforce – a union of six charities campaigning on behalf of people affected by a less-survivable cancer, including Action Against Heartburn, the British Liver Trust, Guts UK!, Pancreatic Cancer UK, the Roy Castle Lung Cancer Foundation, and the Brain Tumour Charity.

They say people with these cancers “can’t afford to wait six weeks for treatment.”

The Scottish Health Technologies Group has been tasked with undertaking an evidence review to examine the benefits and practicalities of varying cancer waiting times for treatment according to tumour biology.

In Scotland, current targets include ensuring 95% of patients starting treatment within 62 days of receipt of an urgent referral with suspicion of cancer, and 95% of patients starting treatment within 31 days from a decision to treat, regardless of the patient’s referral route.

Ms Freeman told the meeting: “We are sticking with the current 62- and 31- day targets pending all of this. In the interim the [clinical review of cancer waiting times] implementation group has commissioned the Scottish Health Technologies Group to undertake an evidence review so that we can aid the clinical discussion as to whether waiting times in the future should be variable according to different tumour biology.

“…They will start the review this month and then report back findings and recommendations in late autumn.”

The average five-year survival rate for someone diagnosed with a less-survivable cancer is only 17% - one of a number of statistics prompting the taskforce to call for the introduction of rapid diagnostic centres in Scotland – similar to those rolled out in England recently – and adapted waiting time targets.  

A taskforce representative explained: “Faster treatment is important, because we don’t have a solution for diagnosing these cancers earlier at the moment and so when people do get diagnosed there’s no time to wait.”

“We can’t wait for six weeks to get into treatment. A campaign that Pancreatic Cancer UK launched last year called for faster treatment and it was based on models of care where rather than using the 31 day or 62 day treatment time targets, people managed to get from the point of diagnosis into surgery or into chemotherapy within 20 days and you can see far more people actually receiving treatment and definite survival gains.”

The group says there is “compelling” evidence to vary targets by the type of cancer, based on current survival rates.

 “We know that, for example, [in England] there was a one year 75% survival target for all cancers and that’s just completely unachievable for the less-survivable cancers.

“The problem is if you set targets that health boards may think are unrealistic you may end up working for the low hanging fruit and not think its relevant to oesophageal cancer, brain cancer and other less-survivable ones.

“We need to see disaggregated targets for waiting times and also survival rates.

“[This work] on cancer waiting times in Scotland could really spearhead the way across all of the nations of the UK because a blueprint is being developed based on looking at the evidence – this could be really ground-breaking if we see the results we want.”