It is estimated that two out of five people will develop cancer in their lifetime. Over the last decate, cancer incidence has risen in Scotland, however the mortality rate has fallen. Much of this can be explained by our ageing population and the fact that cancer is a relatively common disease among the elderly.
Cancer remains a national clinical priority for us and NHSScotland. With effective population-based screening programmes, earlier detection, better diagnostic methods and advances in treatments, more people in Scotland are surviving cancer than ever before. We will improve the experience of and outcomes for people affected by cancer across Scotland by improving service delivery and reducing health inequalities.
We published Beating Cancer: ambition and action, our cancer strategy, in March 2016. The overall aims of the strategy are:-
- more people surviving cancer for 1, 5 and 10 years
- closing the gap in survival rates between Scotland and the best countries in Europe
- a reduction in cancer health inequalities
- people with cancer and their families feeling involved in decision making
- a radical improvement in experience and quality of life, including at the end of life
- a reduction in the growth in the number of people diagnosed with cancer
- more equitable access to services and treatment
We committed to spend £100 million over 5 years to improve the prevention, detection, diagnosis, treatment and aftercare of those affected by cancer.
Scottish Cancer Taskforce
The Scottish Cancer Taskforce (SCT) is responsible for overseeing the actions in the cancer strategy. The SCT isn't responsible for delivering the strategy but it does provide oversight for all issue relating to cancer in Scotland. It is also responsible for liaising with other bodies/groups as necessary and it may be asked to provide advice to the Scottish Government on matters relating to cancer care in Scotland.
The National Cancer Clinical Services Group (NCCSG) and Radiotherapy Sub Group (RTSG) support the SCT by advising on specific areas of work which are needed to deliver specific actions as set out in the strategy.
Detect Cancer Early (DCE)
We launched the Detect Cancer Early Programme in February 2012. The aim of the programme is to improve survival for people with cancer in Scotland to amongst the best in other European countries by diagnosing and treating the disease at an earlier stage.
The programme focuses on lung, bowel and breast cancers as they account for around 43% of all cancers diagnosed in Scotland. The programme has an associated HEAT target to increase the proportion of stage ones diagnosed by 25%.
The programme adopts a whole-systems approach with five workstreams:
- primary care
- secondary care
- data and evaluation
- public awareness
Latest figures (comparing 2010/2011 and 2016/2017 combined) show that 550 more patients are diagnosed at the earliest stage each year since the programme began. A number of other positive results have been reported since the beginning of the programme, including:
- Scotland’s most deprived communities have seen the largest increase in people diagnosed at the earliest stage – an 11.8% increase (since baseline in 2010/2011)
- a 31.0% increase in stage one lung cancer diagnoses in the most deprived areas
Melanoma was added to the programme in 2016 following an extensive stakeholder and clinical engagement exercise. This has seen a number of small scale pilots running in health boards across Scotland to increase early detection rates.
Latest DCE staging data can be found on ISD Scotland’s website.
The University of Edinburgh carried out an independent evaluation of the first three years of the DEC Programme (2012-2015). You can request the report from the research team (email: email@example.com).
Detect Cancer Early Programme Board
We established the Detect Cancer Early Programme Board in 2012 to advise on the expansion of the programme and monitor ongoing projects with the aim of increasing the proportion of stage one bowel, breast and lung cancers diagnosed in Scotland.
Cancer waiting times (CWT)
Our current position on waiting times has been to focus on ‘whole cancer pathway’ standards. There are two waiting times standards which are applicable to adults (NHSScotland patients over 16 at the date of diagnosis), with a newly diagnosed primary cancer against the ten major cancer types:
- 31-day target from decision to treat until first treatment, regardless of the route of referral
- 62-day target from urgent referral with suspicion of cancer, including referrals from national cancer screening programmes and A&E, until first treatment
There is currently a 5% tolerance on each standard in Scotland.
For patients with cancer, our waiting times policy applies to first treatments. The first treatment standards provide assurance to patients that the immediate cancer control measures are being started as soon as possible and reduce the period of uncertainty whilst awaiting clarification of a diagnosis.
The 31-day standard was introduced as around 45% of all cancers diagnosed in Scotland are through non-Urgent Suspected Cancer (non-USC) referral routes. A 31-day treatment standard is in place to ensure that access from decision-to-treat to first definitive treatment is equitable for all cancer patients, regardless of their flow into the system.
Patients are excluded from the standard who have died before treatment, refused all treatment or are regarded as clinically complex. On reflection of a whole patient pathway there may be some areas of delay not attributable to a NHS Board’s performance - these pathways may be adjusted to discount periods of patient unavailability, for patient-induced delays and/or medical suspensions.
Cancer Waiting Times performance across NHSScotland is published every quarter on the ISD Scotland website.
Clinical Review of CWT
Our cancer strategy for Scotland included an aim to ‘examine whether additional targets for treatment or diagnosis would improve outcomes for people with cancer.’
We published a clinical review of cancer waiting times (CWT) standards in Scotland in May 2018 which provides a series of steps towards improving cancer pathways and patient experience in NHSScotland. The report included 24 recommendations across the following five themes:
- cancer pathways
- primary care
- secondary care
- patient support
An implementation group was formed and first met in November 2018 to ensure all recommendations are fully explored and considered. The group is Chaired by Calum Campbell, Chief Executive of NHS Lanarkshire, and Professor Aileen Keel, Director of the Innovative Healthcare Delivery Programme (IHDP).
We published updated Scottish Referral Guidelines for Suspected Cancer in January 2019 (also available as a quick reference guide) to support primary care clinicians.
Information about screening tests in Scotland is available on the NHS Inform website
The Information Services Division (ISD) website provides a wealth of statistics, data, and information about cancer in Scotland.
You can find out about identifying, treating and managing cancers on the NHS inform website.
Detect Cancer Early's website - Get Checked Early - provides information about possible signs and symptoms of cancer and screening programmes as well as early detection stories.
DCE Email: firstname.lastname@example.org