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Cancer Survivors

Volume 493: debated on Tuesday 2 June 2009

I am delighted to be able to raise this subject today, and I am particularly pleased that my hon. Friend the Minister is here to reply.

I became interested in this subject, and sought to introduce the debate, because it probably has not had as much discussion in this place as it should have had. In fact, it is a condition of success—many more people are surviving cancer treatment and live beyond the time that we would have expected them to survive only 10 years ago. It is almost a good problem to have, but it needs addressing.

I first became aware of the problem not only in my career as a nurse, but when the excellent Macmillan Cancer Support reception was held in the Palace. The first person that I walked into was Dr. Andreyev. He was very enthusiastic about ensuring that this problem was brought to the fore, and that cancer survivors who suffer problems after treatment are dealt with properly. I pay tribute to him, because he ensured that I am introducing this debate today.

I suppose that the worst news is when we are told of a diagnosis of cancer. That can only be overcome when someone is told by a consultant that their cancer is clear, that the treatment has worked, and that they can go out and enjoy their life. However, for 50 per cent. of people who are treated, particularly for those who are treated abdominally for a cancer, that is not possible. For them, conditions will be in place that will change their life for ever. Many of their symptoms can be severe.

I am told that there are 2 million cancer survivors and that every year an extra 3.2 per cent. live following a diagnosis of and treatment for cancer. They will have done extremely well to overcome the psychological, emotional and physical problems of the cancer but, as I said, for some that is not the end of the story.

By its nature, treatment for cancer is tough. It is tough to endure and drastic. It can involve surgery or radiotherapy, and incredibly invasive drugs are used in chemotherapy. As fantastic as those drugs are, it is difficult for the body to absorb them. The problem with radiotherapy is that the treatments are concentrated on the organ that is affected. I have two of the companies that produce linear accelerators, Elekta and Varian, in Crawley. They produce the most amazing machines, which are accurate beyond our wildest dreams of even five years ago, but no matter how good they are, other organs can be affected, including the bowel and the bladder, which can lead to problems later in life. Lifelong treatment is necessary for many people.

The big problem is that people who have survived cancer feel reluctant to complain because it may seem to them that they are being ungrateful. Although they have been treated and are free from their cancer, they might have symptoms such as urinary or faecal incontinence, yet they think, “I can’t complain about this. I’m so grateful to the NHS for treating me and making me well that I would feel bad about complaining.” Nevertheless, we need to come clean on this matter and ensure that we allow people the right to come to the NHS with their post-treatment concerns and get the treatment that they need.

Some 80 per cent. of people experience changes, and 50 per cent. of those will experience significant changes, such as urinary or faecal incontinence and painful and disabling oedema. As hon. Members will be aware, women who are treated for breast cancer often suffer from lymph oedema in their arms, which is incredibly difficult to deal with. It may be a schoolboyish thing to laugh about, but people can also suffer from extreme flatulence. We can only imagine how disastrous it is for someone who has been treated for cancer—say cervical cancer—with radiotherapy and then finds that they suffer from such a distressing condition. Their whole life may be altered because they are worried about going outside and having a social life.

Disfigurement from surgery is also a problem. Surgery is often extreme, and after it a person may feel that they are not good to look at, which means that their personal and sexual relationships are affected. I could mention many other things, but I am sure that hon. Members are aware of the conditions that I am talking about.

What can we do about such conditions? We are extremely grateful that people are surviving, and yet we have not paid enough attention to the fact that treatment and care are also needed to help with the after-effects. That is why I was so glad to meet gastroenterologist Dr. Andreyev. He is the only specialist working in the UK who deals with the post-radiation effects on people after they have been treated. He is unique, and is in a position to undertake research. He is gathering around him a team of professionals comprising dieticians, medical students and nurses to do the research into such conditions. How can those conditions be alleviated when the treatments are undertaken? Is it possible that diet may help? If diet is changed during radiotherapy, will it help to ensure that the bowel is not so adversely affected? Moreover, the team is doing lots of other research to try to reduce the thickening of the wall of the bowel during treatment, to prevent problems later. Unquestionably, all such projects cost money. However, today’s debate is not just about calling for money—it would be easy to hold such a debate and do so—but about ensuring that everyone is aware of the problems. Cancer networks around the country should consider having a specialist working alongside them when they plan individual patients’ cancer treatment. I believe that that would make an enormous difference to many people.

The second thing that I want is for people to have the space and time to declare their conditions and be honest and open about them. They should not feel that because they have had treatment, they do not deserve to be treated for the after-effects of cancer treatment.

This is a debate to raise the awareness of such issues and to talk about the work of both the Royal Marsden hospital and Dr. Andreyev. Dr. Andreyev has produced an excellent booklet that is written in plain English, which is a great relief to many people, that details just what is required to reduce the symptoms of cancer treatment. It is always important to be able to share those experiences. I am aware of organisations and self-help groups around the country that enable people to come together to share their experiences. It must feel to sufferers that such a subject is difficult to speak out loud about. It is always good to talk to others who have suffered from the same conditions. I am aware of those groups around the country and I know what comfort, help and advice they give to people.

I congratulate my hon. Friend on securing this timely debate. A group called Fighting Against Cancer Together—FACT—has been set up in my constituency. It consists of three women who have all survived cancer—Leslie Shaw, Judith Williamson and Joanne Smith—and who felt exactly how my hon. Friend described. They felt isolated, and they did not know what to do or understand the language being used. However, together they have set up this group to encourage other people and say, “Look, we are here to help.” Next week, as part of their work, they will visit a school to teach young kids about cancer and the dangers of sunburn. Such grass-roots work is really important.

I am delighted to have taken that intervention, because I know of such groups around the country. When I first raised this debate, I was inundated with e-mails from many different organisations, and I am so pleased to hear about FACT. I want to convey what such organisations have been doing. It is the same for survivors of children’s cancer, too. Some amazing work is being done to help children to get over that process. However, in the short time available to me, it is important to concentrate on some of the physical and emotional problems that come from particular treatments of cancers in the abdominal area.

Organisations have been set up to assist sufferers. There is nothing better than people being able to share their experiences. A shining example is provided by the work of Dr. Andreyev and the Royal Marsden hospital. He is embedded at the heart of the team treating people with cancer, giving advice and helping to direct the treatment in the right way. Obviously, I want that replicated. I am not even sure that that would take a huge amount of money, although it would take a lot of thought by cancer networks to incorporate specialists, such as Dr. Andreyev, in their planning for people’s treatment and care. Organisation can make this possible. The cancer network system has been one of the best things to happen to cancer treatment in the United Kingdom. It has organised, directed and improved cancer care in a way that we did not feel was even possible. Colleagues in the medical profession can now support each other in the planning of people’s care and treatment to ensure the very best outcomes.

We need to do more, however, to tackle what I think is one of the most difficult matters: talking about what can be embarrassing bodily functions. Before getting cancer, people might have been completely unaffected by such problems, but afterwards might suffer from them for the rest of their life. It should not be necessary for people to emphasise how grateful they are to have been treated and to beg for somebody to help them with their problems. We must be up front in saying that it is wonderful that people have survived cancer, but that if symptoms reappear, they must be treated in an honest, open and up-front way. This House must support those cancer networks in responding properly to those who return to GP’s surgeries or consulting rooms to say that they are developing or redeveloping symptoms of cancer. They must not be dismissed. I hope, therefore, that the Minister can give me a positive sign about how we can move this matter forward to reduce the effect that treatment has had on those who have done the most amazing thing—survived cancer and gone back out into the world.

I congratulate my hon. Friend the Member for Crawley (Laura Moffatt) on securing this debate. Before addressing in detail the issues that she raised, I want to take the opportunity to recognise and praise the good work going on in the NHS in Crawley and throughout the country. NHS staff are delivering a better-quality health service than ever before, benefiting not only my hon. Friend’s constituency but those of all hon. Members.

The significant investment and improvements that we have made in the past 10 years have meant that cancer services have improved significantly and cancer mortality has fallen. Those significant achievements include extending breast screening to women aged up to 70; the roll-out of the bowel cancer screening programme—the first programme to target both men and women; and the introduction of smoke-free legislation. During 2007-08, the NHS breast screening programme screened more women than ever before. More than 1.7 million women were screened and 14,110 cancers were detected.

There are now more cancer specialists, as my hon. Friend the Member for Crawley acknowledged. Since 1997, there are 1,879 extra cancer consultants and 3,716 extra consultants in other specialties who spend a significant amount of their time caring for cancer patients. For example, the number of consultant gastroenterologists increased from 322 in 1997 to 612 in 2008—an increase of more than 90 per cent. In 2006-07, £4.35 billion was spent on cancer services, compared with £3.4 billon in 2003-04.

As my hon. Friend also acknowledged, patients have experienced real improvements in their care. That is shown by major patient surveys in both 2000 and 2004. The National Audit Office report of March 2005 acknowledged the significant improvement in the management and provision of cancer services since the publication of the NHS cancer plan and the good progress made against all major targets. Waiting times for patients urgently referred have fallen dramatically since the two-week wait was introduced. The reductions in waiting times for patients with suspected cancer have reduced anxiety and delay. The latest figures, for January to March 2009, show that 94.5 per cent. of patients with suspected cancer were seen by a specialist within two weeks of being urgently referred by their GP.

Cancer mortality in people under 75 fell by more than 18 per cent. between 1996 and 2007, saving almost 9,000 lives. We are on course to meet our target of at least a 20 per cent. reduction in cancer deaths in people under 75 by 2010.

The “Cancer Reform Strategy”, published in December 2007, builds on the progress that I have described. It sets out a clear direction for cancer services in the next five years and shows how we intend to deliver cancer outcomes that are among the best in the world. In the strategy, we also announced that, through the national cancer survivorship initiative, we would improve the ongoing support for people living with and beyond cancer.

My hon. Friend graphically and sensitively described some of the challenges faced by cancer survivors. About one quarter of people treated for cancer will experience long-term adverse effects on their quality of life as they live on past their initial cancer scares. The national cancer survivorship initiative was formally launched in September last year. It is co-chaired by the chief executive of Macmillan Cancer Support, Mr. Ciarán Devane, to whom my hon. Friend referred, and by the national clinical director for cancer, Professor Mike Richards. We have announced that the Government will provide £1.6 million to Macmillan Cancer Support in the current financial year to support that vital work. That funding will make a real difference to people living with and beyond cancer by helping them to receive the expert care and support that they need.

Seven national cancer survivorship initiative work streams have been created to develop new models of care and support that meet survivors’ needs. The work streams include a range of cancer charities, health and care staff, academics, cancer survivors and carers for survivors. Each work stream focuses on either a stage in the survivorship pathway or a cross-cutting theme. The work streams are supported by 27 pilot sites across the country, which are testing new models of survivorship care and support.

Through the national cancer survivorship initiative, we are working to reduce the impact of unavoidable late effects of cancer and its treatment and to improve the health and well-being of cancer survivors. The work stream dealing with the late effects of cancer will improve our understanding of the risks and prevalence of longer-term consequences of cancer and its treatment. It aims to raise awareness among patients and professionals of the late effects of cancer and its treatment; to promote the early detection of late effects; and to ensure that appropriate information and services are available to those suffering late effects or undergoing treatment.

The work stream is looking at what data are available on the prevalence of late effects, so that we can better understand people’s needs and target information, services and support. It is also developing national clinical leadership roles—that includes a gastroenterologist—to raise awareness of late effects and to champion the implementation of the new models of care that will emerge from the national cancer survivorship initiative.

I am informed that the late effects national survivorship administrative work stream is learning from the work being done at the Royal Marsden hospital by Dr. Andreyev, to which my hon. Friend referred. The hospital is not only performing excellently, but is the best-performing hospital of any type in the UK, so one would expect there to be much to learn from the excellent work that my hon. Friend mentioned.

In addition, the work stream is developing an e-learning package for general practitioners and other professionals on the late effects of cancer and its treatment, including the late effects of pelvic radiotherapy.

Other national cancer survivorship initiative work streams and test sites are looking at how personalised care planning can improve follow-up care for cancer patients; how cancer survivors can be empowered to live independently through support for self-management; how we can support those with active and advanced disease; how we can help people to stay in work, get back to work or access financial assistance; what more we can do for children and young people who are cancer survivors; and how we can pull together evidence about the current picture of care and support for cancer survivors. Those work streams are developing new approaches to care and support for people after cancer treatment. We will publish a national cancer survivorship initiative vision and implementation plan at the end of this year.

The cancer reform strategy sets out a clear direction for cancer services over the next five years and shows how we will deliver cancer outcomes that are among the best in the world. I have referred to the fact that Dr. Andreyev’s work at the Royal Marsden, which my hon. Friend highlighted, is part of our work on helping survivors. As she rightly said, the impact of cancer does not end after treatment. It is vital that we do all we can to support those who have been through cancer, so that they can live as full and active a life as possible. The national cancer survivorship initiative will make a real difference to those living with and beyond cancer, as well as to their families and their carers.

Sitting suspended.