‘Deadly postcode lottery’ denying cancer patients access to new treatments

Cancer patients in England are being denied new radiotherapy due to a postcode lottery in NHS funding and commissioning, doctors warn.

Patients are missing out on two newer forms of radiotherapy, which are effective against several cancers and widely available in other countries, because of what clinicians describe as red tape and lack of funding.

The Royal College of Radiologists and Radiotherapy UK want health secretary Wes Streeting to use the government’s new cancer plan, due this week, to make the treatments widely available.

They are urging the government to end what they say are bureaucratic hurdles that NHS England imposes, through its funding and commissioning policies, on hospitals that want to provide stereotactic ablative body radiotherapy and molecular radiotherapy.

Dr Nicky Thorp, the Royal College of Radiologists’ vice-president for clinical oncology, said: “A number of innovative cancer treatments exist and are known by cancer doctors to be effective, but they are in only limited use in the NHS in England.

“This means that some cancer patients are missing out on treatments that cancer specialists know are effective and which could treat their cancer in fewer doses with fewer side effects.

“Doctors want to do our best for our patients, so it is incredibly frustrating for us to be in a situation where some patients aren’t getting access to the full range of treatments that are proven to help tackle cancer.”

Wider access to the treatments could improve cancer survival, which both organisations say is poor in the UK by international standards.

Stereotactic ablative body radiotherapy, known as SABR, delivers precisely targeted, high-dose radiation to tumours. Molecular radiotherapy uses radioactive substances to target cancer cells.

The same red tape means only half of cancer centres in England can offer surface-guided radiation therapy, a technology that uses real-time 3D cameras to make radiotherapy more accurate and reduces its long-term effects on organs such as the heart.

Hospitals that do have the necessary equipment only have it as a result of local or health charities paying the £250,000 involved, because NHS England does not provide funding.

Pat Price, the chair of Radiotherapy UK and a visiting professor of oncology at Imperial College London, said: “The big tragedy of the UK’s poor cancer survival rates is that we know how to fix them but bureaucracy and broken funding systems keep us from making progress.

“Cutting-edge cancer treatments in radiotherapy, such as SABR and SGRT, allow for more cancer cures, more precise treatments that reduce side effects and cut down waiting lists.

“They are in routine use in other countries and can lead to better survival rates. But in the UK we have a deadly cancer treatment postcode lottery.

“The NHS is supposed to be a national health service. But that’s not true if access to modern radiotherapy, one of our most important cancer treatments, depends on where you live.”

SABR is used across the NHS for lung cancer. But, unlike in other countries, in England only a few hospitals offer it for liver, prostate and kidney cancer, despite evidence that it is effective.

The NHS’s limited use of SABR means that some patients in England who might benefit from it, for example because their cancer has spread, end up getting it from private hospitals.

Price said it was shocking that hospitals were paid for providing traditional forms of radiotherapy for cancer, but not newer ones.

That means that for certain types of cancer, those treatments are barely available at all, she added.

She blamed the situation on the archaic nature of the NHS’s tariff system, the way it funds hospitals for treatment, which means that hospitals will lose money if they do use SABR for other types of cancer apart from lung cancer.

Thorp said: “The rollout of SABR to treat cancer has been slow. It is still used for fewer types of cancer than it could be, as evidence shows it is effective for more cancers than it is used for.”

Cancer Research UK has been warning for several years that inequalities in access to treatment, including SABR, are a key reason why, despite being a world leader in cancer research, UK survival lags behind many other comparable countries, even after accounting for differences in the stage at which people are diagnosed.

It has also highlighted that lack of NHS capital funding means many radiotherapy machines are still in use, despite being past their expected lifespan, and that that is adding to the NHS waiting list.

NHS England said the cancer plan would make novel treatments more widely available.

A spokesperson said: “Every NHS trust in England delivering radiotherapy is already able to offer stereotactic ablative radiotherapy, and it is available for patients where there is strong clinical evidence that it is appropriate.

“We continue to work closely with the Royal College of Radiologists and other partners on the safe and evidence-based use of radiotherapy, including how access to proven innovations can be delivered consistently across the NHS.

“The upcoming national cancer plan will address this.”