Double Tree by Hilton Hotel Bellshill, ML4 3JQ 2 nd November 2017
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1 Double Tree by Hilton Hotel Bellshill, ML4 3JQ 2 nd November 2017 Dr Richard Roope RCGP and Cancer Research UK Cancer Clinical Champion Senior Clinical Advisor Cancer Research UK
2 Housekeeping
3 Housekeeping Fire Exits Toilets Mobile phones Questions Certificates Thanks to the team who have set up the day: RCGP and Cancer Research UK Team Double Tree by Hilton Hotel Staff
4 The Day: The expanding role of Primary Care and Cancer Control Tea and Coffee Primary Care and cancer prevention Lunch and networking Scottish referral guidelines and urgent referrals Symptomatic qfit National Cancer Diagnositic Audit for Scotland Evaluation
5 Primary Care and Cancer Control
6 Primary Care and Cancer Control Cancer: why all the interest? Why is early diagnosis important? Past where were we? Present where are we? Future where next? Survivorship End of life care
7 Cancer: why all the interest?
8 Cancer: why all the interest? Causes of death in Scotland 1 1. Circulatory Disease 2. Cancer 3. Other 4. Mental Health 5. Respiratory 2 1. Cancer 2. Other 3. Circulatory Disease 4. Mental Health 5. Respiratory 3 1. Cancer 2. Circulatory Disease 3. Other 4. Respiratory 5. Mental Health 4 1. Circulatory Disease 2. Cancer 3. Respiratory 4. Other 5. Mental Health
9 Cancer: why all the interest? Causes of death in Scotland 1 1. Circulatory Disease 2. Cancer 3. Other 4. Mental Health 5. Respiratory 2 1. Cancer 2. Other 3. Circulatory Disease 4. Mental Health 5. Respiratory 3 1. Cancer 2. Circulatory Disease 3. Other 4. Respiratory 5. Mental Health 4 1. Circulatory Disease 2. Cancer 3. Respiratory 4. Other 5. Mental Health Which do you think is the correct column? (high to low)
10 Cancer: why all the interest? Causes of death in Scotland 1 1. Circulatory Disease 2. Cancer 3. Other 4. Mental Health 5. Respiratory 2 1. Cancer 2. Other 3. Circulatory Disease 4. Mental Health 5. Respiratory 3 1. Cancer 2. Circulatory Disease 3. Other 4. Respiratory 5. Mental Health 4 1. Circulatory Disease 2. Cancer 3. Respiratory 4. Other 5. Mental Health
11 Cancer: why all the interest?
12 realising-realistic /pages/9/ - last accessed
13 Why cancer? Premature (<65) Death rate per 100,000
14
15 Cancer why all the interest? The Future:
16 The perfect storm:
17 The perfect storm:
18 The Scale of the Challenge: The perfect storm
19 The Scale of the Challenge: The perfect storm Aging population
20 Aging Population cations=gb&start=1960&view=chart (last accessed )
21 Aging Population realising-realistic /pages/9/
22 Aging Population realising-realistic /pages/9/
23 Aging Population - Centenarians X Male 2,242 50, Female 12,328 80, TOTAL 14, , last accessed ns/estimatesoftheveryoldincludingcentenarians/2002to2015 last accessed
24 The Scale of the Challenge: The perfect storm Aging population Lifestyles less healthy: Smoking Diet Alcohol Exercise Sun exposure
25 The Scale of the Challenge: The perfect storm Aging population Lifestyles less healthy: Smoking Diet Alcohol Exercise Sun exposure Increasing survival
26 The perfect storm: Numbers of cancers % increase UK 352, , % Global 14.1 million 23.6 million 67.4%
27 The Scale of the Challenge: By the end of 2016, there were 1,000 people in the UK being diagnosed with cancer every day Mistry, M., et al., Cancer incidence in the United Kingdom: projections to the year Br J Cancer, : p
28 Cancer: why all the interest? 1 in 2 people will be diagnosed with one or more cancers in their lifetime
29 Lifetime risk of cancer:
30 Cancer: why all the interest? 1 in 2 people will be diagnosed with one or more cancers in their lifetime 10 year survival has improved to reach 50%
31 Cancer: why all the interest? 1 in 2 people will be diagnosed with one or more cancers in their lifetime 10 year survival has improved to reach 50% last accessed
32 Cancer: why all the interest? 1 in 2 people will be diagnosed with one or more cancers in their lifetime 10 year survival has improved to reach 50%, but Cancer survival in the UK still lags behind comparable health economies
33 285.4 England average Orkney Borders Highland Grampian Tayside Dumfries Ayrshire Fife Lothian Western Shetland Forth Lanarkshire Greater Glasgow 1=Lothian%20(HB)&location-1=SS9. Last sourced
34 Hasn t cancer had its turn?
35 Hasn t cancer had its turn? Cancer receives what proportion of NHS spend? % % % % % Discuss with your neighbour.
36 Hasn t cancer had its turn? Total NHS spend in 2012/3: 125,700,000,000
37 Hasn t cancer had its turn? Total NHS spend in 2012/3: 125,700,000,000 Total NHS spend in 2012/3: 2008 per head
38 Hasn t cancer had its turn? Total NHS spend in 2012/3: 125,700,000,000 Total NHS spend in 2012/3: 2008 per head Total NHS spend cancer care: 109 per head
39 Hasn t cancer had its turn? Total NHS spend in 2012/3: 125,700,000,000 Total NHS spend in 2012/3: 2008 per head Total NHS spend cancer care: 109 per head Just 5.4% of NHS spend last accessed
40 Hasn t cancer had its turn? Cancer receives what proportion of NHS spend? % % % % %
41 Why is early diagnosis important?
42 (last accessed ) RCGP and Cancer Research UK Workshop Why is early diagnosis important? All Cancers
43 (last accessed ) RCGP and Cancer Research UK Workshop Why is early diagnosis important? All Cancers Stage Shift
44 Minimum increased 5 year survival with 10% increase in stages 1 & 2 Colorectal 4.00% Ovary 4.00% Breast 3.80% Endometrium 3.70% Prostate 2.40% Melanoma 2.30% Lung 2.00% Kidney 2.00% Bladder 1.30% NHL 0.20% /fourth_annual_report.pdf (last accessed )
45 What did we do? Detect Cancer Early Campaign Get checked early campaign 2012 Research stream Primary Care Engagement Input to Cancer Network and SCNs RCGP Education Events etc
46 How did we do?
47 How did we do? 52.0% 50.0% 48.0% 46.0% 44.0% 42.0% 40.0% Detection Rate 38.0% 2009/ / / / / / /16
48 How did we do? 52.0% 50.0% 48.0% 46.0% 44.0% 42.0% 40.0% Detection Rate 38.0% 2009/ / / / / / /16 (last accessed )
49
50
51 However compared to Europe?
52 However compared to Europe? 8/05/cancer-survival-in-england-is-improvingbut-still-lagging-behind-similar-countries/
53 However compared to Europe? 8/05/cancer-survival-in-england-is-improvingbut-still-lagging-behind-similar-countries/
54 Why do we lag behind other Health Systems?
55 Why do we lag behind other Health Systems? International Cancer Benchmarking Partnership As gatekeepers the gate needs to be wider Outcomes closely linked to readiness to act Patients fear wasting GP time Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival? British Journal of Cancer (2013) 108, doi: /bjc (last accessed )
56 Gate openers
57
58
59 Prevention Tobacco Food Immunisations Exercise Environment Early detection Awareness Health care seeking Screening Access Diagnosis Investigations Access Technology Decision support Treatment Surgery Chemotherapy Radiotherapy Comorbidity Psychology Survivorship End of life Follow-up Basic palliation Late effects Specialised Rehabilitation Social Health promotion Bereavement
60 Prevention Tobacco Food Immunisations Exercise Environment Early detection Awareness Health care seeking Screening Access Diagnosis Investigations Access Technology Decision support Treatment Surgery Chemotherapy Radiotherapy Comorbidity Psychology Survivorship End of life Follow-up Basic palliation Late effects Specialised Rehabilitation Social Health promotion Bereavement Primary Care could (should?) have a part to play throughout the cancer pathway, and is well placed to do so
61 Prevention Tobacco Food Immunisations Exercise Environment Early detection Awareness Health care seeking Screening Access Diagnosis Investigations Access Technology Decision support Treatment Surgery Chemotherapy Radiotherapy Comorbidity Psychology Survivorship End of life Follow-up Basic palliation Late effects Specialised Rehabilitation Social Health promotion Bereavement Primary Care could (should?) have a part to play throughout the cancer pathway, and is well placed to do so if adequately resourced
62 The Lancet Oncology: The expanding role of Primary Care in Cancer Control For a long time, the role of primary care in cancer was largely seen a peripheral, but as prevention, diagnosis, survivorship, and end-of-life care assume greater importance in cancer policy, the defining characteristics of primary care become more important The Lancet Oncology, Vol. 16, No. 12
63 The Lancet Oncology: The expanding role of Primary Care in Cancer Control The strengths of primary care its continuous, coordinated, and comprehensive care for individuals and families are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. The Lancet Oncology, Vol. 16, No. 12
64 The Lancet Oncology: The expanding role of Primary Care in Cancer Control recommendations should be implemented by all stakeholders involved in cancer care work should start now to ensure that patients get the optimum care to prevent, receive a diagnosis of, and survive cancer, and the best possible care should they die from the disease The Lancet Oncology, Vol. 16, No. 12
65 Value in investing in early diagnosis:
66 Value in investing in early diagnosis: Why? To address our lowly cancer outcomes rank How? To lower threshold/readiness to refer with consistency When? Now
67 Value in investing in early diagnosis: Results?
68 Value in investing in early diagnosis: Results? Better medicine earlier diagnosis (not just of cancer) Fewer consultations Better outcomes Less complaints/litigation Less
69 Living with and beyond cancer:
70 Living with and beyond cancer: Rising cancer incidence Falling cancer mortality
71 Projections of cancer prevalence in the United Kingdom, J Maddams, M Utley and H Møller RCGP and Cancer Research UK Workshop Living with and beyond cancer:
72 Survivorship:
73 Survivorship: Problems faced by cancer survivors: Physical Psychological Social Financial
74 Survivorship: Problems faced by cancer survivors: Physical Consequences of treatment Immediate (eg radiation proctitis) Late (eg x5 incidence of congestive heart failure after radiotherapy or chemotherapy for NHL) 10+ years after treatment
75 Survivorship: Problems faced by cancer survivors: Physical Consequences of treatment
76 Survivorship: Problems faced by cancer survivors: Physical Consequences of treatment
77 Survivorship: Problems faced by cancer survivors: Physical Consequences of treatment
78 Survivorship: Problems faced by cancer survivors: Physical Co-morbidities Living with other long-term conditions as well as cancer reduces people s chance of survival and increases their level of support needs. It also increases the cost of treatment Macmillan Cancer Support. Routes from Diagnosis research programme. Unpublished data.
79 Survivorship: Problems faced by cancer survivors: Physical Co-morbidities Proportion of people with cancer living with one or more other long-term health conditions, by age group
80 Risk factors common to other long term conditions:
81 Risk factors common to other long term conditions: Aging population Lifestyles less healthy: Smoking Diet Alcohol Exercise Sun exposure
82 Risk factors common to other long term conditions: Aging population Lifestyles less healthy: Smoking Diet Alcohol Exercise Sun exposure Hypertension Heart disease Stroke Diabetes Dementia Mental Health Problems
83 Problems faced by cancer survivors: Physical Recurrence
84 Problems faced by cancer survivors: Physical Recurrence can be reduced
85 Problems faced by cancer survivors: Physical Recurrence can be reduced Smoking Diet Alcohol Exercise Sun exposure
86 Problems faced by cancer survivors: Second (and third ) cancers.
87 Problems faced by cancer survivors: Second (and third ) cancers.
88 Problems faced by cancer survivors: Second (and third ) cancers. Of the 1.6 million people expected to be diagnosed with cancer this year in the U.S., about one in six will have already survived a different cancer before being developing this new one, according to statistics from the National Cancer Institute (NCI). Paraphrased from:
89 Second (and third ) cancers. Many preventable (over 40%): Smoking Diet Alcohol Exercise Sun exposure
90 Problems faced by cancer survivors: Physical Psychological 21% of patients living beyond cancer had MH problems Consequences of treatment 10% develop major depression 1. Pre-existing 1. Walker, J., et al., Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. The Lancet Psychiatry, (5): p
91 Problems faced by cancer survivors: Physical Psychological Social Consequences of treatment impact on family and communities. Pre-existing deprivation gradient
92
93 Problems faced by cancer survivors: Physical Psychological Social Financial Consequences of treatment Loss of job/overtime for patient and carer
94 Survivorship - Exercise
95 Survivorship - Exercise Role of cancer rehab: Helps short term: Fatigue, stress, depression, quality of life Helps long term: Breast cancer patients 150 mins of exercise per week 40% cancer mortality Bowel cancer 6 hours of exercise per week 50% cancer mortality Prostate cancer 3 hours of exercise per week 30% cancer mortality Holmes, MD et al. Physical activity andsurvival after breast cancer diagnosis. JAMA.25 May (20): Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, Fuchs CS. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol : Kenfield SA, Stampfer MJ, Giovannucci, E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-upstudy. J Clin Oncol :
96 As survivorship increases: Co-morbidity Second cancers: previous history cancer risk other cancer Eg: Melanoma: risk of prostate cancer by 32% Complications of treatment Eg pelvic radiation
97 End of Life Care
98 End of Life Care Palliative Care increasingly seen as non-curative treatment and support
99 End of Life Care
100 End of Life Care %20of%20Death%20Index%20Oct%2029%20FINAL.pdf (last accessed )
101 End of Life Care A third of those diagnosed with cancer will die form their disease Most express preference to die at home
102 Dying at home (last accessed )
103 Dying at home (last accessed )
104 Addressing non-communicable diseases (NCDs) is critical for global public health, but it will also be good for the economy; for the environment; for the global public good in the broadest sense. If we come together to tackle NCDs, we can do more than heal individuals we can safeguard our very future. UN Secretary General Ban Ki-moon
105 Addressing non-communicable diseases (NCDs) is critical for global public health, but it will also be good for the economy; for the environment; for the global public good in the broadest sense. If we come together to tackle NCDs, we can do more than heal individuals we can safeguard our very future. UN Secretary General Ban Ki-moon
106 Key to cancer
107 Key to cancer Education Education Education
108 Key to cancer Education public Education patients Education profession
109 Key to cancer Education public Education patients Education profession Education policy makers
110 Key to cancer Education public Education patients Education profession Education policy makers Education politicians
111 Insanity:
112 Insanity: doing the same thing over and over again and expecting different results
113 Insanity: doing the same thing over and over again and expecting different results Albert Einstein
114 The ones who are crazy enough to think they can change the world, are the ones who do.
115 The ones who are crazy enough to think they can change the world, are the ones who do. Steve Jobs
116 Our common goal?
117 Our common goal?
118 Our common goal? We can do even better, individually
119 Our common goal? We can do even better, individually As a wider health community we could do so much more if resourced properly: We need to spend money now to save money (and misery) later
120 One person can make a difference, and everyone should try.
121 One person can make a difference, and everyone should try. John F Kennedy
122 Thank you
123 Any questions?
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