Addressing the capacity crisis in oncology, progress and ongoing concerns

Six months ago, a group of leading clinicians from UK cancer professional organisations raised a red flag, highlighting the pressing issue of capacity challenges within oncology departments that is hindering the effective delivery of crucial cancer drugs. The concerns raised were multifaceted, encompassing issues with capacity to deliver systemic anti-cancer therapies (SACT) from pharmacy, nursing, and medical perspectives.

Since then, commendable strides have been made, but the escalating demand for cancer care necessitates a sustained commitment to bold action. The new Secretary of State must play a crucial role in steering the course toward accessible and timely cancer care.

Since the alarm was sounded, NHS England has taken positive steps to address the identified challenges.

Firstly, they are starting to recognise their role in tackling the problem. NHS England has acknowledged its responsibility by writing to Cancer Alliances to ensure they have SACT leadership and regular evaluation of SACT service capacity.  It is taking welcome steps towards developing regional strategies and has tasked the SACT Implementation group to develop a national plan looking at both pharmacy supply issues and SACT delivery at a wider level.

We are starting to see improvements. From the start of 2024, the National Institute for Health and Care Excellence (NICE) will be including a delivery assessment template with new technology assessments so the overall resources required to deliver and monitor new drugs can be calculated. NHS England are evaluating the various demand and capacity assessment tools on the market with a view to providing advice to Alliances on their use.

Finally, we see green shoots of tackling the unacceptable variation in SACT provision across the UK. NHS England has asked the UK SACT Board to provide guidance on standardising monitoring protocols. This move aims to ensure consistency in care across different oncology departments, fostering a more equitable distribution of resources.

While there is commendable progress, the journey toward transforming the delivery of cancer drugs requires long-term action and ambition. We are still not where we should be.

We do not know where the money will come from. The absence of clear guidance on future funding arrangements with the transition to ICBs raises concerns about the sustainability of the progress made so far. A transparent and predictable funding model both centrally and locally is essential to ensure that oncology departments can plan for the future with confidence rather than having to react and find capacity when each new drug is approved.

There are still too many gaps in our understanding. The lack of investment in the SACT dataset leaves critical questions unanswered. A robust data infrastructure is fundamental for monitoring and evaluating the effectiveness of cancer care interventions. Without proper investment in data collection, linkage and analysis via the National Disease Registration Service, the healthcare system risks operating in the dark.

We are not being supported to innovate and provide cancer services fit for our times. The potential of artificial intelligence (AI) to alleviate demand on oncology departments remains largely unexplored. We need better IT systems to improve efficiency and we need to use technology to enable patients to report side effects and benefits of treatments themselves.

While the changes made since May are commendable, there are notable gaps and areas where progress remains elusive. Sustained commitment, clarity on funding, and a strategic embrace of technology are imperative for achieving lasting improvements to cancer care.

Demand for cancer drug treatment continues to increase by approximately 6-8% every year, as cancer incidence rises, patients survive longer and more treatments are made available on the NHS. With inadequate capacity, departments are having to make difficult decisions. Right now, they are being forced to decide whether to delay access to approved treatments or prioritise which patients can receive treatment within a safe time at the expense of others.

This does not need to be the case, and while the progress so far is promising it is not yet enough to keep pace. More drugs are being approved for use. Delays in starting treatment cause huge anxieties for patients and staff and make treatment less effective – increasing the risk of death by around 10% for some patients. This is why we cannot be complacent with small steps of progress.

The new Secretary of State for Health and Social Care holds the key to steering this transformative journey. As we await further action, the urgency persists for every patient with a new cancer diagnosis. They should be ensured of the most effective cancer care available rather than having to hope for it.