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Cancer strategy focuses on prevention and survivor care

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The Department of Health has launched a new strategy for cancer care, concentrating on prevention, inequalities, early diagnosis and services for survivors. Nerys Hairon reports.

The Department of Health published its new Cancer Reform Strategy last week outlining the direction for cancer services for the next five years (DH, 2007). This new strategy builds on the progress made since the publication of The NHS Cancer Plan (DH, 2000).
Considerable progress has been made on cancer over the past decade. Cancer mortality has fallen, survival rates are improving for many cancers and patients’ experience of their care has improved (DH, 2007).
However, significant challenges and opportunities remain, which the new strategy seeks to address. For example, the incidence of cancer is increasing as people live longer and more people are alive having survived cancer. And early diagnosis and improved treatment has brought about the new concept of ‘survivorship’ in cancer.
The reform strategy sets out a programme of action across 10 areas: preventing cancer; diagnosing cancer earlier; ensuring better treatment; living with and beyond cancer; reducing cancer inequalities; delivering care in the appropriate setting; using information to improve quality and choice; stronger commissioning; funding world-class cancer care; and building for the future.
For a full outline of actions in each area, see www.dh.gov.uk.

Preventing cancer
Half of all cancers could be prevented by changes to lifestyle, such as:
• Stopping smoking;
• Avoiding obesity;
• Eating a healthy diet;
• Undertaking a moderate level of physical activity;
• Avoiding an excessive alcohol intake;
• Avoiding excessive exposure to sunlight (Cancer Research UK, 2005).
Public awareness of the main preventable risk factors for cancer is poor. A recent survey by Cancer Research UK (CRUK) showed that only 5% of the population could, unprompted, name four of the six lifestyle factors linked to cancer listed above. Some 77% were only able to name two or fewer of these factors.
Given the importance of cancer prevention, the DH recommends that PCTs and cancer networks should give high priority to increasing awareness of risk factors. It suggests they may wish to use the risk factor module of CRUK’s forthcoming assessment tool to define a baseline and assess progress.
The evidence linking obesity to cancer has become much stronger since The NHS Cancer Plan (DH, 2000; World Cancer Research Fund and American Institute for Cancer Research, 2007). Being obese raises the risk of many cancers, especially cancers of the uterus, kidney, colon, gallbladder and oesophagus. It is also linked to breast cancer in post-menopausal women. For non-smokers, obesity is now the most important preventable risk factor for cancer. The government has committed to developing a cross-government strategy to tackle obesity and this will be published shortly.
Other areas with programmes of action outlined to prevent cancer are: tobacco and smoking; alcohol; excessive ultraviolet exposure; human papillomavirus vaccination; genetic predisposition and cancer; and research in cancer prevention.

Earlier diagnosis
The strategy emphasises that late diagnosis is the major factor contributing to poor cancer survival rates. Screening is vital to diagnosing some cancers early. In order to improve and expand cancer screening the DH plans to:
• Reduce the variation of coverage in cervical screening between PCTs and inform women of the result of their test within two weeks of it being taken. New technologies are to be used as and when the research evidence supports this, and the falling participation of women aged 25–35 will be tackled;
• Extend breast screening to nine screening rounds between 47 and 73 years by 2012, with a guarantee that women will have their first screening before the age of 50, facilitated by the roll-out of digital mammography;
• Expand the NHS Bowel Cancer Screening programme from 2010 to invite men and women aged 70–75 to take part. By the end of 2010, decisions will be taken about possible roll-out to people in their 50s;
• Commission research on the feasibility of a UK trial of CT screening for lung cancer.
In addition, a new National Awareness and Early Diagnosis Initiative will coordinate a programme of activity to support local interventions to raise public awareness of the signs and symptoms of early cancer and encourage people to seek help from healthcare services sooner.

Survivorship
The incidence of cancer is rising due mainly to the ageing population. Survival rates for cancer are also improving, with 10-year survival rates having doubled in the last 30 years and continuing to increase.
This means that the total number of people who are living longer with cancer is growing considerably. Many patients who are cured of their cancer may be left with physical or psychological effects from the diagnosis and treatment of their disease. Some will live for many years receiving active treatment as their disease relapses and remits.
Some points in the strategy related to living with and beyond cancer focus on implementing NICE guidance; information, communication, decision-making and choice; psychological support; the role of clinical nurse specialists (CNSs); training to improve the patient experience; and surviving cancer.
NICE published guidance on supportive and palliative care for adults with cancer (NICE, 2004), with a target date for full implementation for December 2007. In recognition of some of the difficulties faced by cancer networks the DH has extended the deadline for implementation to December 2008, while remaining committed to full implementation.

Improving patient experience
In the area of information and communication, all senior cancer professionals will, over time, be expected to demonstrate that they have the necessary competencies in face-to-face communication after a training course. This means showing the level of competencies to communicate complex information, involve patients in clinical decisions and offer choice. In addition, the DH says it needs to ensure that other healthcare staff who treat and support cancer patients have had access to good communication skills training. General skills that healthcare professionals should acquire to improve patient experience are outlined (see box).

TRAINING TO IMPROVE PATIENT EXPERIENCE

• High-quality training should equip healthcare professionals to:
• Deliver information to patients effectively;
• Work as part of an integrated multidisciplinary team;
• Engage in appropriate ‘what if’ conversations;
• Assess and manage/respond to the nursing care needs of survivors of cancer;
• In the case of clinical nurse specialists, provide effective psychological support to patients.Source: DH (2007)


Tumour-specific national information pathways will be launched in 2008, making nationally agreed information available to frontline cancer health professionals to offer to patients at key points in their cancer journey.
Cancer patients and their families and carers may need psychological care and support. Good psychological support services should be in place to support patients from the point of diagnosis and as they move along the patient pathway. Providing support to patients in distress is a key component of the CNS’ role, and the DH recommends that commissioners should work to make sure that appropriate training is available for them.
Further detailed consideration now needs to be given to services for survivors of cancer. The national cancer director will lead a new National Cancer Survivorship Initiative to take this forward, in partnership with Macmillan Cancer Support and other cancer charities. This will need collaboration between primary and acute care, social care services, service users and patients and the voluntary sector.

Conclusion
It is clear that nurses will be vital in delivering many aspects of the Cancer Reform Strategy. They will be particularly important in increasing awareness of risk factors, improving patient information and communication, providing psychological support and meeting the needs of survivors of cancer.


References
Cancer Research UK (2005) Reduce the Risk Campaign.
www.cancerresearchuk.org

Department of Health (2007) Cancer Reform Strategy. London: DH.
www.dh.gov.uk

Department of Health (2000) The NHS Cancer Plan: A Plan for Investment, A Plan for Reform. London: DH.

NICE (2004) Improving Supportive and Palliative Care for Adults with Cancer. London: NICE.

World Cancer Research Fund, American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. Washington DC: AICR.

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