National plan for cancer treatment

Cancer services in England and Wales are to be radically reorganised in the first national cancer care plan, designed to overcome wide discrepancies in treatment, which can mean the difference between life and death.

The plan is the result of six months' work by a committee led by Dr Kenneth Calman, the Government's chief medical officer. It proposes a nationwide system of expert cancer units in local hospitals integrally linked to highly specialised cancer centres serving bigger populations of between 600,000 and 1 million people.

In Britain it is estimated that only half of cancer patients see a cancer specialist and that thousands die unnecessarily. When five-year survival rates for common cancers are measured against those of many comparable European neighbours, the NHS does worse. Breast cancer is the biggest single cancer cause of death in women in the UK. In France 73 per cent of women are alive after five years compared with 58 per cent in Britain.

A comparison with America shows that nearly 50 per cent of bowel cancer patients are alive after five years compared with 35 per cent here.

But there are wide differences in Britain as well. One Scottish survey showed that ovarian cancer patients treated at a major teaching hospital had 60 per cent survival rates compared with 42 per for women treated at local hospitals.

The cancer programme, disclosed to the Independent, will be published on Wednesday. In essence it provides for all people with cancer to benefit directly from the expertise of a specialist doctor experienced in treating their type of cancer.

Primary care is an important element of the structure. Through the units and centres family doctors will be involved in all aspects of the care of patients and their families.

The centres will be expected to give the GPs information, advice and guidelines to follow for individual patients and for running the cancer service.

Hospital doctors will be expected to take part in continuing education and any unit which offers an unusual treatment will be expected to justify its benefits. It appears that those without special expertise will not be allowed to treat patients.

For very rare cancers expertise will be concentrated in a small number of the major centres so that patients may still expect to be treated by doctors who have as much experience as possible in their condition.

The scheme will not be universally popular. The new structure will threaten some isolated radiotherapy centres which are too small to justify the specialist expertise being called for. There are also consultants who, it is claimed, see NHS cancer patients only occasionally and are not therefore expert in their treatment. But an NHS cancer practice means that they can provide lucrative cancer treatment in the private sector.

Dr Calman's committee, the Expert Advisory Group in Cancer, agrees that the best treatment is given by doctors and nurses who work in specialised groups.

About 250,000 new cancers are diagnosed every year but it is also estimated that 5,000 cancer patients a year die prematurely because they do not receive optimum treatment.

The report proposes an increase in the number of NHS oncologists. Each local cancer unit would be run by a designated consultant; doctors and nurses will be required to be expert in treating the common cancers, and an oncologist will be appointed to each unit directly or to work in close collaboration with the unit and the larger cancer centre.

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