Categorising cancers to enable tailored care planning through a secondary analysis of cancer registration data in the UK.

OBJECTIVES: The aim of this study is to categorise cancers into broad groups based on clusters of common treatment aims, experiences and outcomes to provide a numerical framework for understanding the services required to meet the needs of people with different cancers. This framework will enable a high-level overview of care and support requirements for the whole cancer population. SETTING AND PARTICIPANTS: People in the UK with 1 of 20 common cancers; an estimated 309 000 diagnoses in 2014, 1 679 000 people diagnosed in a 20-year period and still living in 2010 and 135 000 cancer deaths in 2014. PRIMARY AND SECONDARY OUTCOME MEASURES: Survival and stage at diagnosis data were reviewed alongside clinically led assumptions to identify commonalities and cluster cancer types into three groups. The three cancer groups were then described using incidence, prevalence and mortality data collected and reported by UK cancer registries. This was then reviewed, validated and refined following consultation. RESULTS: Group 1 includes cancers with the highest survival; 5-year survival is over 80%. Group 3 cancers have shorter term survival. Five-year survival is not >20% for any cancer in this group and many do not survive over a year. Group 2 includes cancers where people typically live more than a year but are less likely to live >5 years. We estimate that the majority (64%) of people living with cancer (20 year prevalence) have a cancer type in group 1 'longer term survival', but significant minorities of people have cancers in group 2 'intermediate survival' (19%) and group 3 'shorter term survival' (10%). CONCLUSIONS: Every person with cancer has unique needs shaped by a multitude of factors including comorbidities, treatment regimens, patient preferences, needs, attitudes and behaviours. However, to deliver personalised care, there needs to be a high-level view of potential care requirements to support service planning.

Addressing future challenges for cancer services: part I.

Jane Maher & Gina Radford speak to Gemma Westcott, Commissioning Editor Jane Maher has been Macmillan's Chief Medical Officer since 1999 and now shares the role as Joint Chief Medical Officer with general practitioner Rosie Loftus, reflecting the growing need for specialists and generalists to work more effectively together. She has been a National Health Service (NHS) Improvement Clinical Leader for over 10 years and is a Consultant Clinical Oncologist at Mount Vernon Cancer Centre where she has worked for more than 20 years, during which she helped develop nonsurgical oncology services in five district general hospitals. Jane chaired the Maher Committee for the Department of Health in 1995, led the UK National Audit of Late Effects Pelvic Radiotherapy for the Royal College Of Radiologists (RCR) in 2000 and, most recently, chaired the 'National Cancer Survivorship Initiative, consequences of treatment work stream'. She co-founded one of the first Cancer Support and Information services in the UK, winning the Nye Bevan award in 1992 and there are now more than 60 units based on this model. She is a member of the Older People and Cancer Clinical Advisory Group. She has written more than 100 published articles and is a UK representative for cancer survivorship in Europe and advises on Cancer survivorship programs in Denmark and Canada. Gina Radford is Deputy Chief Medical Officer for England, a post she took up in January 2015. Prior to that, she has held a number of roles in public health, at local and regional level. Most recently she was as Centre Director for Anglia and Essex for Public Health England, and as part of that role helped lead nationally on the public health response to Ebola. She was until very recently Chair of one of the NICE public health advisory committees. She has previously worked on a number of national projects, including leading the Department of Health's response to the Shipman Enquiry, undertaking a review of specialist public health for CMO Scotland, chairing a national short life working group looking at the issue of making difficult decisions in NHS Scotland, and undertaking the evaluation of the first pilot (regional bowel cancer detection pilot) for the Be Clear on Cancer National Awareness and Early Diagnosis campaign, on behalf of the Department of Health and Cancer Research UK. Outside work, Gina is a Licensed Lay Minister in the Church of England, and is training to be ordained. She enjoys riding, walking the somewhat aging dog, reading and is the village duck warden!

Addressing future challenges for cancer services: part II.

Jane Maher & Gina Radford speak to Gemma Westcott, Commissioning Editor Jane Maher has been Macmillan's Chief Medical Officer since 1999 and now shares the role as Joint Chief Medical Officer with general practitioner Rosie Loftus, reflecting the growing need for specialists and generalists to work more effectively together. She has been an National Health Service (NHS) improvement clinical leader for over 10 years and is a Consultant Clinical Oncologist at Mount Vernon Cancer Centre and Hillingdon Hospital where she has worked for more than 20 years, during which she helped develop nonsurgical oncology services in five district general hospitals. She is a senior Clinical Lecturer at University College London and Visiting Professor in Cancer and Supportive Care at the Centre for Complexity Management at the University of Hertfordshire. Jane chaired the Maher Committee for the Department of Health in 1995, led the UK National Audit of Late Effects Pelvic Radiotherapy for the Royal College of Radiologists (RCR) in 2000 and, most recently, chaired the National Cancer Survivorship Initiative Consequences of Treatment work stream. She co-founded one of the first Cancer Support and Information services in the UK, winning the Nye Bevan award in 1992 and there are now more than 60 units based on this model. She is a member of the Older People and Cancer Clinical Advisory Group. She has written more than 100 published articles and is a UK representative for cancer survivorship in Europe and advises on cancer survivorship programs in Denmark and Canada. Gina Radford is Deputy Chief Medical Officer for England, a post she took up in January 2015. Prior to that, she has held a number of roles in public health, at local and regional level. Most recently she was Centre Director for Anglia and Essex for Public Health England, and as a part of that role helped lead nationally on the public health response to Ebola. She was until very recently Chair of one of the NICE public health advisory committees. She has previously worked on a number of national projects, including leading the Department of Health's response to the Shipman Enquiry, undertaking a review of specialist public health for CMO Scotland, chairing a national short life working group looking at the issue of making difficult decisions in NHS Scotland, and undertaking the evaluation of the first pilot (regional bowel cancer detection pilot) for the Be Clear on Cancer National Awareness and Early Diagnosis campaign, on behalf of the Department of Health and Cancer Research UK. Outside work, Gina is a Licensed Lay Minister in the Church of England, and is training to be ordained. She enjoys riding, walking the somewhat aging dog, reading and is the village duck warden!

Health care policy and cancer survivorship.

The United States and the European Union (EU) vary widely in approaches to ensuring affordable health care coverage for our respective populations. Such variations stem from differences in the political systems and beliefs regarding social welfare. These variations are also reflected in past and future initiatives to provide high quality cancer survivorship care. The United States spends considerably more on health care compared to most European countries, often with no proven benefit. In the United States, individuals with chronic illnesses, such as cancer survivors, often experience difficulties affording insurance and maintaining coverage, a problem unknown to EU countries with national health insurance. This article reviews health policy development over time for the United States and EU and the impact for cancer survivors. For the United States, the impact of the Affordable Care Act on improving access to affordable care for cancer survivors is highlighted. For the EU, the importance of multiple-morbidity disease management, cancer plan development, and pan-European data collection for monitoring cancer outcomes is addressed. Given predicted workforce shortages and ever-increasing numbers of aging cancer survivors on both sides of the Atlantic, sharing lessons learned will be critical.