How does cancer treatment in the UK measure up to other countries?

For more than a decade, a multidisciplinary group of experts, including academics, clinicians and data experts, from the International Cancer Benchmarking Partnership (ICBP) have been reporting on the variation in cancer survival between countries.

The partnership, which is hosted by Cancer Research UK, is a unique collaboration that explores what factors are driving differences in cancer survival so that it can identify changes to policy and practice that could make an impact for patients.

We already know that, for some cancer sites, the UK lags behind other, comparable countries when it comes to survival, and research from the ICBP has given us insight into some of the reasons why.

These range from how quickly GPs refer patients for tests, to each of the UK nations lacking consistent cancer policies, and a variation in the rate of early detection for many cancers.

Survival by stage at diagnosis is also a crucial indicator for assessing the quality of cancer treatment and care between countries, which the ICBP uniquely investigates.

Some previous ICBP studies show that stage for stage, patients in the UK have poorer survival than patients in other countries, this is especially true for the most advanced cancers and our older patients.

But those reasons alone leave the puzzle incomplete. The full picture is complex, multifactorial and likely to span the whole cancer pathway, and to complete it, we need to explore some other possible causes.

Now, new research from the ICBP, published today in Lancet Oncology, is giving us new pieces to slot into our puzzle.

A striking picture

The research looked at differences in how countries use chemotherapy and radiotherapy, two of the most widely used cancer treatments, to see if that could be a factor in why survival differs.

It’s the most comprehensive study of how chemotherapy and radiotherapy use varies to date, exploring the treatment of over 780,000 people diagnosed across countries in 3 continents between 2012 and 2017.

And the results were striking: people in the UK were treated with chemotherapy and radiotherapy less often, and faced longer waits to start treatment.

“For many aggressive cancers – such as ovarian, lung and pancreatic cancer, it’s vital that people are diagnosed and start treatment as soon as possible,” said Dr John Butler, clinical lead for the ICBP.

“Lower use of chemotherapy and radiotherapy in the UK could impact people’s chances of survival, especially for older patients.

“Although we have made progress, the last benchmark showed that cancer survival in the UK is still around 10 to 15 years behind leading countries. This study captures missed opportunities for patients in the UK to receive life-prolonging treatment.”

The findings

Along with the 4 nations of the UK, the research examined treatment data from three comparable countries, Norway, and some jurisdictions of both Australia and Canada. It included 8 cancer types: oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian.

Overall, people in the UK were treated with chemotherapy and radiotherapy less often than in comparable countries, and patients 85 and over were the least likely group to receive these treatments.

Countries with better cancer outcomes typically had higher use of chemotherapy and radiotherapy and shorter waits to start treatment.