Cancer treatment inquiry launched: Move follows concern that quality of care is linked to deaths

THE Government's chief medical officer is leading a new initiative to improve cancer treatment in Britain because of mounting concern that patients in some parts of the country are getting poorer quality care and thus dying sooner.

Dr Kenneth Calman heads an expert group charged with developing a national strategy for cancer services. The aim is to reduce regional variations in survival rates by optimising treatment at all centres where cancer patients are seen. An estimated 5,000 cancer patients die unnecessarily each year because they do not get the best treatment.

In a letter to members of the group, Dr Calman accepts there are regional variations in the outcome of cancer treatment, and differences in mortality rates between the UK and other countries. These facts '. . . point to possibilities to improving outcomes . . . and there is some evidence . . . that treatment at specialist centres may improve survival as well as the quality of care . . .' he says. 'In policy terms this is a major issue to be considered with urgency.' He says there may be a case for more specialist centres, which some leading consultants have been campaigning for.

A previous attempt to improve cancer care with a series of 'consensus' statements on the best practice for a range of common cancers was blocked by senior consultants who believed it would threaten their freedom to treat patients as they saw fit.

There were also fears about the legal implications of consensus statements for doctors who departed from them. Only one statement on ovarian cancer was produced after a delay of two years. The committee behind the scheme, the Standing Sub-committee on Cancer, has been replaced by the new group.

The Department of Health said yesterday that the move was regarded as a 'general improvement' in how clinical advice on cancer was given to the Government. 'The Expert Advisory Group in Cancer is smaller and more compact and has direct access to the Chief Medical Officer, which wasn't the case before.' The 11 members, drawn from a range of cancer services and public health backgrounds, including radiology, nursing, research and education, have been appointed in a personal capacity.

Although detailed cancer statistics for the UK are not available, the chances of a patient surviving one of the most common cancers such as breast, bowel, lung or stomach are significantly less in Britain than in France, Norway or the United States. Despite powerful evidence that treatment for most cancers is better in research-oriented teaching centres than peripheral hospitals, many patients are never referred to one of the 54 specialist centres in England and Wales.

A Scottish study showed that the survival rate for women with early stage ovarian cancer who were treated at a teaching hospital was 60 per cent compared with 42 per cent for women treated at non-teaching centres. After 10 years the figures were 48 per cent and 29 per cent.

In addition, up to a third of patients never see an oncologist - a cancer specialist - but remain under the care of a gynaecologist or chest physician depending on their particular cancer. The number of oncologists per head of population in the UK lags behind every other country in Europe except Portugal.