Area of Research: Cancer Awareness, Screening and Early Diagnosis
Section 1: Summary of main strands/themes for research
The overall purpose of the unit research programme will be to undertake research and evaluations to inform future policy on raising awareness of cancer symptoms, cancer screening programmes, and early diagnosis of cancer. The specific objectives are to:
- evaluate the effectiveness of ongoing, rolling campaigns focused on increasing the awareness of the signs and symptoms of suspected cancer in line with the Department of Health and Social Care (DHSC) 10-Year Cancer Plan;
- produce evidence to support the optimisation and transformation of screening programmes for cancers in line with the DHSC 10-Year Cancer Plan;
- produce evidence to support primary care in achieving timely recognition and referral of suspected cancer in line with the DHSC 10-Year Cancer Plan;
- evaluate improvements on the patient/individual experience as set out in the DHSC 10-Year Cancer Plan;
- produce evidence to help tackle health disparities, particularly variations in the uptake of screening programmes, awareness and patient experience and the effectiveness of interventions to reduce such variations with considerations of informed choice;
- monitor worldwide research into awareness, screening, and early diagnosis of cancer and patient experience and to undertake systematic reviews where appropriate;
- produce evidence to support the provision of balanced information on cancer screening and early diagnosis to the public;
- produce evidence on the impact of innovations and improvements that the pandemic has helped to accelerate, especially in life sciences, such that they can be incorporated appropriately into standard care; and
- monitor additional interventions and innovations that could support the delivery of our existing ambitions.
Section 2: Details of policy context and background
The NHS Long Term Plan was published in January 2019. For patients diagnosed in 2018, cancer survival was over 10 percentage points higher than in 2003. However, there is worrying evidence that diagnosis rates have dropped significantly during the pandemic. More than 166,000 people die of cancer in the UK every year, and 1 in 2 people in the UK will develop cancer in their lifetimes.
Improving cancer survival remains a high priority, and diagnosing cancer earlier is one of the biggest actions the health and care system can take to improve cancer survival. Patients diagnosed early, at stages 1 and 2, have the best chance of curative treatment and long-term survival. The NHS Long Term Plan for the first time set a challenging ambition to increase the number of cancers diagnosed at Stage 1 and 2 from around 55% now to 75% by 2028.
Reflecting this, in February the Government launched its Call for Evidence for a new 10-Year Cancer Plan. The Plan will be a new vision for how the UK will lead the world in cancer care. It will take a long-term look at how we harness innovation, place more emphasis on prevention, and how to improve the patient experience by 2032, with ambitious plans for action in several different areas.
It is important however to note that achieving improved levels of early diagnosis should not come at the expense of overdiagnosis, specifically within a screening context. We must continue to be led by the evidence and recommendations of the UK National Screening Committee (UK NSC) which weigh up both the harms and benefits of potential screening programmes.
The Government’s Life Sciences Vision includes focus on specific ‘Missions’, that are technology or disease specific where there is an opportunity to take a Vaccines Task Force-type approach, with a single empowered decision maker to mobilise private and public sector science and investment. The missions will also help the NHS to solve some of the biggest healthcare problems of our generation. One of these missions is cancer. The mission includes enabling early cancer diagnosis.
A number of groups are in place to oversee these important work areas, including NHS England Programme Boards for each screening programme, the ‘Be Clear on Cancer’ Steering Group and the UK NSC. NHS England also has a Cancer Patient Experience Advisory Group.
Section 3: Justification for research topics
The independent Cancer Taskforce noted in 2015 that 280,000 individuals were diagnosed with cancer annually, a number which had been growing by around 2% per annum. Around half of diagnoses were of the most common cancers – lung, prostate, breast and colorectal – and the other half were rare or less common types, and this was predicted to continue. Continually rising incidence means the Taskforce anticipated that we would see over 300,000 diagnoses in 2020 and more than 360,000 in 2030.
The rise is in part due to the ageing and growth of the population, a result of the overall success of the healthcare system, such that people are less likely to die early from other conditions, such as cardiovascular disease. But it is also in part driven by shifts in our lifestyles, which are increasing our age-standardised risk. These changes place increasing demands on the health system, alongside demands resulting from the changing nature of other conditions.
Cancer is a leading cause of death in every age group, from the very youngest children through to old age, with mortality significantly higher in men than in women. Death rates in England have fallen by more than a fifth over the last 30 years and by 10 per cent over the last decade. They are expected to continue to fall, with a drop of around 17% by 2030. But 130,000 people still die from cancer each year – a number that has remained relatively constant as incidence has increased - and there remain groups of patients for whom outcomes and quality of life are particularly poor.
Section 4: Other related research activity of which the Unit will need to be aware
The NHS England Cancer Programme is piloting/trialling interventions to aid early cancer diagnosis such as Cytosponge® for oesophageal cancer, colon capsule endoscopy, and the GRAIL multi-cancer blood detection test.
The wider NIHR has significant resources allocated to Cancer research. Applicants should be familiar with other on-going work in the NIHR related to topics pertinent to this unit, to maximise synergies and avoid duplication.
Section 5: Other issues relevant to this programme of research
It is likely that cancer screening, early diagnosis and patient experience will remain a government priority long into the future.
New research should endeavour to exploit existing cancer data sets around processes as well as health outcomes. These could provide further insight on patient experience as well as the effectiveness of existing screening programmes and early diagnosis.
The PRU also has a role in providing advice to the UK NSC on robust methodology and design of research to ensure decisions are based on high-quality evidence.