Cancer

In our latest update, we look at trends in the quality of cancer care.

Indicator update

Published: 27/05/2021

Cancer services were under increasing pressure even before the coronavirus (Covid-19) pandemic. The headline target that 85% of patients should start a first treatment for cancer within two months of an urgent GP referral has not been met since 2015, and while cancer survival rates in the UK are improving, they still lag behind in international comparisons.

Despite efforts to maintain cancer treatment during the pandemic, there has been a significant impact on services. Referrals and first consultant appointments for suspected cancer fell, while emergency presentations increased. Cancellations to treatment for cancer were also reported. New guidance published in March 2021 outlines plans to fully restore cancer services, including meeting the increased level of referrals and treatment required to address the fall in first treatments for cancer by March 2022. Activity is recovering to near normal levels, but a considerable backlog of patients waiting for diagnosis or treatment remains.

With almost four in 10 cases of cancer linked to known risk factors, we’ve looked at trends in smoking, alcohol use, and obesity. We’ve also updated our indicators looking at the quality of care along the cancer pathway, including screening, diagnosis and treatment, as well as survival and mortality rates. A summary of our cancer indicators is below. Click on the links for more detailed content and analysis.

Smoking

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  • The percentage of people using NHS Stop Smoking Services who self-reported that they were successful in quitting at four weeks remained relatively steady between 2007/08 and 2019/20, at around 50%. In Q1 and Q2 2020/21 (April to September 2020), following the onset of the Covid-19 pandemic, it increased to 58%.
  • The number of people using NHS Stop Smoking Services who set a quit date has fallen for eight consecutive years, from 816,444 in 2011/12 to 221,678 in 2019/20.

Alcohol-related harm and drinking behaviour

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  • In England, the alcohol-related deaths rate has remained roughly constant over time, fluctuating between a high of 48 deaths per 100,000 population in 2008 and a low of 46 deaths per 100,000 population in 2014.
  • According to the Health Survey for England, between 2006 and 2019 heavy drinking fell for people aged 16 to 54 years old, but increased for people aged 65 and over.
  • Between 2006 and 2019, there has been a large decrease in the percentage of 8 to 15-year-olds who reported that they have had an alcoholic drink. The largest decrease was in 13 to 15-year-olds, where the percentage who had drunk alcohol fell from 67% to 35%.

Obesity

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  • The proportion of adults who are obese has increased from 15% in 1993 to 28% in 2019.
  • Between 2006/07 and 2019/20, the proportion of children aged 10-11 who were obese increased from 17% to 21%.

HPV vaccination coverage

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  • In the 2019/20 school year, coverage of two doses of the HPV vaccine (which helps protect against cervical cancer) fell to 65%, following school immunisation programmes being paused when schools closed during the first national lockdown. This compares to coverage of 84% for two doses in the 2018/19 school year.

Cancer screening

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  • Breast screening coverage in England increased from 64% in 2001/02 to 77% in 2009/10, then remained stable until 2012/13, when it began to decrease. In 2019/20, breast screening coverage was 72%.
  • Cervical screening coverage for the total target age group (25 to 64 years) fell from 76% in 2010/11 to 72% in 2019/20.
  • Bowel screening coverage in England increased from 35% in 2009/10 to 64% in 2019/20.

GP referrals

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  • Between the weeks starting 16 March and 13 April 2020, the number of two-week wait referrals for suspected cancer fell by 67%. Over the summer and autumn of 2020, referrals increased to similar numbers as before the Covid-19 pandemic. By the week starting 19 April 2021, there were 60,095 referrals for suspected cancer.

Diagnostic test waiting times

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  • The proportion of patients waiting six weeks or more for a diagnostic test increased from 0.7% in February 2010 to 2.8% in February 2020. In March 2020, it began to increase dramatically, reaching 58% in May 2020. Since then, performance has improved but remains worse than before the pandemic. In March 2021, 24% of patients had been waiting six weeks or more for a diagnostic test.
  • Since 2008, the waiting list for a diagnostic test has been steadily increasing. However, in March 2020, the waiting list fell to 838,569 (22% lower than in March 2019). It has since increased to over 1.2 million in March 2021.
  • The number of diagnostic tests carried out has been increasing over time, but fell sharply from 1.9 million in February 2020 to 612,232 in April 2020. The number of tests carried out increased to over 1.9 million in March 2021.

Cancer waiting times

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  • Between 2009 and 2014, the percentage of people with suspected cancer having their first consultant appointment within two weeks of an urgent GP referral fluctuated around 95%. Since then, performance has declined. In Q4 2020/21, 89% of patients had their first consultant appointment within two weeks.
  • The proportion of patients waiting less than 31 days for a first treatment for cancer following a decision to treat decreased from 98% in Q3 2009/10 to 96% in Q3 2020/21. The 96% threshold has not been met since Q3 2019/20.
  • The proportion of patients waiting less than two months to start cancer treatment following an urgent GP referral for suspected cancer has decreased considerably over time, from 87% in Q4 2008/09 to 72% in Q4 2020/21.

Patients’ overall experience of cancer services

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  • In 2019, 39% of Cancer Patient Experience Survey respondents rated their overall experience as 10 (very good) and only 0.1% rated their experience as 0 (very poor).

Cancer survival rates

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  • The cancers with the lowest five-year survival estimates are mesothelioma (7%), pancreatic cancer (7%) and brain cancer (12%). The cancers with the highest five-year survival estimates are testicular cancer (97%), melanoma of skin (92%) and prostate cancer (88%).
  • In 2018 and 2019, the proportion of cancers diagnosed at each stage remained roughly constant, with an average of 44% diagnosed at stages 1 or 2. Between March and May 2020, the proportion diagnosed at stage 1 or 2 fell from 45% to 38%, where it has remained since.

Cancer mortality rates

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  • Breast cancer mortality has been declining in the UK, falling from 38 deaths per 100,000 women in 2001 to 28 deaths per 100,000 women in 2016. However, the UK consistently has a relatively high breast cancer mortality rate compared to other countries.
  • In 2001, the UK had one of the highest cervical cancer mortality rates of all the comparator countries, but by 2016 the UK’s ranking had improved to about average.
  • Colorectal cancer mortality has been slowly decreasing over time in the UK, falling from 26 deaths per 100,000 population in 2001 to 22 deaths per 100,000 population in 2016. The UK’s performance is about average for the comparator countries.

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