UK cancer treatment falls behind other countries

• Two major studies part-funded by Cancer Research UK reveal that the use of chemotherapy and radiotherapy in the UK has lagged behind comparable countries in the past decade 
• Patients faced longer waits to begin key cancer treatment, which could be impacting people’s chances of survival in the UK 
• With an upcoming UK general election, Cancer Research UK is calling on political leaders to step up and ensure patients get the level of care that they deserve   

 People in the UK were treated with chemotherapy and radiotherapy less often than in comparable countries and faced long waits for treatments, according to two new studies published in The Lancet Oncology. 

In the first research of its kind, investigators at University College London examined data from over 780,000 people with cancer diagnosed between 2012 and 2017 in four comparable countries (Australia, Canada, Norway and the UK). Eight cancer types were included: oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancer. * 

The two studies by the International Cancer Benchmarking Partnership (ICBP) are the first to examine treatment differences for eight cancer types in countries across three continents. Building on previous research, the findings provide further insights into why cancer survival in the UK lags behind internationally. 

The research concluded that: 

• There was stark variation in the treatment of all eight cancer types and people with cancer in the UK received chemotherapy and radiotherapy less often than other countries.  Fewer lung cancer patients in the UK (27.7%) were treated with chemotherapy compared to Canada (35.0%), Norway (45.3%) and Australia (41.4%) ** 
• Older patients were least likely to be treated with chemotherapy and radiotherapy, particularly in the UK. For example, 2.4% of UK patients aged 85 and over received chemotherapy, compared to 8.1% in Australia and 14% in Ontario, Canada 
• Countries with better cancer survival typically had higher use of chemotherapy and radiotherapy and shorter waits to start treatment in this study. For example, 5-year net survival for stage 3 colon cancer was higher in Norway (70.7%), Canada (69.9%) and Australia (70.1%) than in the UK (63.3%) *** 
• Overall, people living in Norway and Australia started chemotherapy and radiotherapy in the quickest time 
• Patients in the UK faced long waits for treatment, and this varied depending on where people live. The average time to start chemotherapy was shortest in England (48 days) and longest in Scotland (65 days). Northern Ireland had the shortest average time to start radiotherapy (53 days) and Scotland (79 days) and Wales (81 days) had the longest 

Chief executive of Cancer Research UK, Michelle Mitchell, said: 

“The UK should be striving for world-leading cancer outcomes. All cancer patients, no matter where they live, deserve to receive the highest quality care. But this research shows that UK patients are treated with chemotherapy and radiotherapy less often than comparable countries. 

“When it comes to treating cancer, timing really matters. Behind these statistics are people waiting anxiously to begin treatment that is key to boosting their chances of survival.  

“We can learn a great deal from other countries who have stepped up and substantially improved cancer services. With a general election on the horizon, the UK Government has a real opportunity to buck the trends we see in this research and do better for people affected by cancer.” 

Although not every patient will require them, chemotherapy and radiotherapy are key treatment options – it's estimated around 4 in 10 people with cancer in the UK should receive radiotherapy as part of their care****. With cancer cases projected to rise in the UK, demand for these treatments will substantially increase. And a wider range of people, including older people with more complex healthcare needs, will require cancer treatment. 

While some cancer patients need time to prepare for treatment, others are forced to wait too long. This can result in people’s cancers continuing to grow and spread, potentially impacting the success of their treatment and further exacerbating their stress and anxiety levels. 

Cancer Research UK said that concerning delays to begin treatment in the UK are partly a result of the UK Government’s lack of long-term planning on cancer in recent decades. Countries with more robust cancer strategies backed by sufficient funding have seen larger improvements in survival than the UK. ***** 

There are a range of factors driving international differences in the use of chemotherapy and radiotherapy. Cancer Research UK said that workforce and capacity pressures across the UK health system are barriers to delivering world-class treatment for patients.  

As outlined in the charity’s recently published manifesto, ‘Longer, better lives’, the UK’s cancer crisis could be turned around with a long-term plan to deliver investment and reform needed in the NHS.  

As part of this, Cancer Research UK is calling for a strategic approach to addressing treatment variation. Better data collection and investment in clinical audit and quality improvement would help us understand and tackle why access to timely, quality treatment differs.  

Clinical lead for the International Cancer Benchmarking Partnership and an ovarian cancer surgeon, Dr John Butler, said: 

“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. 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 next phase of our research will explore these treatment differences in more depth and look to understand the impact of the Covid pandemic on cancer patient’s care.” 

Lead researcher from University College London, Professor Georgios Lyratzopoulos, said: 

“This study builds on over a decade of ICBP research into how cancer diagnosis and care varies internationally. We already know that the cancer survival in the UK has fallen behind countries like Australia and Canada, and this analysis of two key cancer treatments highlights one of the likely reasons. 

“With cancer cases projected to rise in the UK, the NHS must be equipped to deliver the best care for patients. The cancer treatment landscape is changing at pace, but capacity issues and system pressures mean that not all patients can feel the benefit of specialist cancer treatments.  

“To improve the UK’s cancer outcomes, we need to continue to investigate what is driving international variation in treatment – better data collection is key to this.”   

ENDS  

Spokespeople are available for interview including researchers, CRUK experts and media volunteer case studies. For media enquiries please contact Anna Cawdron in the Cancer Research UK press office on 020 3469 8928 and anna.cawdron@cancer.org.uk or via press out of hours, 020 3469 8301.

Notes to editor: 

Bringing together patient data from different continents takes considerable time to ensure that it can be compared in a meaningful way. The data from this study is from 2012-2017 and its findings are the most up-to-date analysis of international treatment differences.   

Cancer Research UK said they don’t anticipate substantial shifts in the data given the time it takes to change clinical practice. Some treatment variation amongst countries is likely to have persisted and continued ICBP research will help us understand how the UK's performance may have changed in recent years. 

* The papers will be available in The Lancet Oncology when the embargo lifts.

• Chemotherapy paper: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00031-7/fulltext 
• Radiotherapy paper: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00032-9/fulltext 
• Download infographics here

The research looked at data in Australia (2 states included), Canada (8 provinces included for chemotherapy, 9 provinces included for radiotherapy), Norway and the UK. The research includes 15 jurisdictions for the chemotherapy analysis and 16 jurisdictions for the radiotherapy analysis.  

** Mentions of Australia and Canada throughout refer to all Canadian and Australian jurisdictions included in the study 

*** ICBP SURVMARK-2 data, Age-standardised 5-year net survival, both sexes, age 15-99, colon cancer, 2010-2014. Access here. Originally published here 

**** Chemotherapy is a treatment where medicine is used to kill cancer cells and radiotherapy uses radiation to target and destroy cancer cells. It’s estimated around 4 in 10 people with cancer in the UK should receive radiotherapy as part of their treatment. It’s a key component of curative and palliative care and long-term cancer control. Longer, better lives: A programme for UK government for cancer research and care p.138 

***** Exploring the link between cancer policies and cancer survival: a comparison of International Cancer Benchmarking Partnership countries. Access here

Differences in treatment use  

Sources: Chemotherapy, Appendix pages 19-25 – all 8 cancers; Radiotherapy, Appendix pages 19-25 – all 8 cancers 

Differences in treatment waiting times 

Sources: Chemotherapy, Appendix pages 28-31– all 8 cancers; Radiotherapy, Appendix pages 28-31 – all 8 cancers 

About Cancer Research UK 

1.       Cancer Research UK is the world’s leading cancer charity dedicated to saving lives through research, influence and information.     

2.       Cancer Research UK’s pioneering work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.     

3.       Cancer Research UK has been at the heart of the progress that has already seen survival in the UK double in the last 50 years.     

4.       Today, 2 in 4 people survive their cancer for at least 10 years. Cancer Research UK wants to accelerate progress and see 3 in 4 people surviving their cancer by 2034.     

5.       Cancer Research UK supports research into the prevention and treatment of cancer through the work of over 4,000 scientists, doctors and nurses.     

6.       Together with its partners and supporters, Cancer Research UK is working towards a world where people can live longer, better lives, free from the fear of cancer.     

For further information about Cancer Research UK's work or to find out how to support the charity, please call 0300 123 1022 or visit www.cancerresearchuk.org. 

About the International Cancer Benchmarking Partnership (ICBP)  

The International Cancer Benchmarking Partnership (ICBP) is a unique and innovative global partnership of clinicians, academics, policymakers and data experts. It produces high quality research to help identify best international practice, and generate insights needed for policy and practice change. The ICBP is funded by the partners representing each jurisdiction. The programme management team are hosted by Cancer Research UK. www.icbp.org.uk www.icbp.org.uk  

Funders: Canadian Partnership Against Cancer, Cancer Council Victoria, Cancer Institute New South Wales, Cancer Research UK, Danish Cancer Society, DG Health and Social Care, Scottish Government, National Cancer Registry Ireland, National Health Service England, Norwegian Cancer Society, Public Health Agency Northern Ireland on behalf of the Northern Ireland Cancer Registry, Public Health Wales NHS Trust, The Cancer Society of New Zealand, Western Australia Department of Health 

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