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House of Lords Hansard
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Health: Pancreatic Cancer Treatment
19 December 2018
Volume 794

Question

Asked by

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To ask Her Majesty's Government what plans they have to ensure that patients with pancreatic cancer begin treatment within 20 days of diagnosis.

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My Lords, NHS England will soon introduce a faster diagnostic standard of 28 days for all cancer patients, including those with pancreatic cancer. Taken together with the 62-day referral-to-treatment standard, this will mean that all patients should expect to start their treatment within 34 days of diagnosis. This is a maximum, and trusts should continue to treat patients more quickly where there is a strong clinical need.

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My Lords, I thank the Minister for his comments, but the need for a paradigm shift on pancreatic cancer is now urgent. It is the deadliest cancer, with a dismal prognosis that has hardly changed in the last 45 years. It remains both the least survivable and the quickest killing cancer. It is hard to diagnose and, once it becomes clinically detectable, there is a rapid progression to an advanced stage. Therefore, for people facing a pancreatic cancer diagnosis, every day matters. For potentially curative and life-extending treatments such as surgery and chemotherapy, there is an optimum window of 20 days from diagnosis, when people with pancreatic cancer will have the option to be treated and the chance to live longer. It is ambitious to aim for 2024 but, for those people waiting, each day has deadly consequences. With a forecast of an extra £20 billion being injected into the NHS, does the Minister agree that it would be pleasing if some of that extra funding could be put towards improving those dismal survival rates?

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I agree with my noble friend and am grateful to her for raising this topic. The truth is that outcomes of pancreatic cancer are very poor, and have not improved, as she said. We are determined to change that through a number of routes. The Prime Minister has committed herself and the Government to improving early diagnosis of cancer, so that more cancers are caught earlier, which will be critical for those often caught at a late stage, such as pancreatic cancer. The faster diagnostic standard that I mentioned will help, as will a series of rapid diagnostic centres that have been rolled out around the country. I take the point that we need to do a lot more, and the NHS long-term plan gives us an opportunity to do that.

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Can the Minister inform the House how access to treatment will be rapid, given that many people with pancreatic cancer need highly specialised techniques, such as a celiac plexus block from integrated specialist services, but who are currently at the mercy of random commissioning by clinical commissioning groups, or even for the gaps to be filled by different charities? I declare an interest as a vice-president of Hospice UK and of Marie Curie.

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I am grateful to the noble Baroness for that question. Obviously, rapid diagnosis is important, but she is quite right that it needs to progress to treatment. The main way we are trying to address that issue is to increase the cancer workforce at every level—nurses, radiologists, endoscopists, oncological doctors, and others. Unless there are the staff to carry out those procedures, we will not get the outcomes that we want.

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My Lords, as speed is of the essence, will the Minister tell the House what work has been done to ensure that the public and GPs do not ignore often innocuous symptoms? Is he confident that there are sufficient centres of excellence across England and that they are adequately staffed to start treatment as a matter of urgency?

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The noble Baroness makes a very important point. I am sure that she is aware of the 14 Be Clear on Cancer campaigns that have been run over the last eight years, which are absolutely about raising the salience of these issues and making sure that people know the signs they should be looking for and can come to GPs earlier. We are seeing fewer people presenting with cancer diagnosis through emergency departments, which have the worst outcomes, and more coming through GPs. Of course, as I said, we are investing in these rapid diagnostic centres as well.

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My Lords, the problem with pancreatic cancer is that, by the time a patient has symptoms and a diagnosis has been made, it is almost always too late. It hides itself away for far too long. The only way to make a real impact is by having some sort of method of determining whether someone will get pancreatic cancer by having a screening programme. That depends very much on new research into the ways in which we can detect cancer cells from DNA and the peripheral blood. Research into that area is vital if we are to make any impact on pancreatic cancer. Does the noble Lord agree?

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I absolutely agree on that point. I hoped we would pass the “Lord Young test” with a jargon-free and, at least, succinct White Paper—the Life Sciences Sector Deal 2, which we published recently. It outlines some very important commitments to research in this area, including the creation of new early diagnosis cohorts, using a cohort of healthy people to look for early signs. That is one of the investments we are making, as well as investment through the National Institute for Health Research. We are looking for those exciting innovations, like liquid biopsies, that can help us get the signs earlier.

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My Lords, as has been pointed out, it is not about the time to treatment but the time to diagnosis. Clearly, early diagnosis is the key. In Europe, the outcome for pancreatic cancer is often better than in the UK because patients have access directly to specialist care, whereas we rely on our GPs to be the gatekeepers, and that is where the problem lies. What measures will be taken to ensure that patients can have access to specialist care much earlier?

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My noble friend speaks with great wisdom on this topic, and he is absolutely right. I would point to two improvements that have happened in recent years. First, the NICE standard threshold for when GPs should make referrals has been lowered, so they ought to refer more often. Secondly, we are seeing a big increase in referrals to cancer specialists: there have been over 115% more referrals since 2010. We are starting to see much greater referrals from GPs to specialists.

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My Lords, the Birmingham service has shown that a one-stop clinic for diagnosis and treatment for pancreatic cancer has improved survival rates. Does the Minister agree that our long-term ambition over the next five years should be to develop one-stop clinics and immediate treatment for all cancers, if we are to improve our cancer outcomes?

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The noble Lord makes a very powerful case. Indeed, I believe that is the precise model for the rapid diagnostic centres, which are multidisciplinary and not disease specific. They are looking for often vague and hard-to-find signs and developing expertise in that. In October, the Prime Minister announced that is precisely what will be rolled out nationwide.