Cancer patients are around five times more likely to have surgery to remove their tumour, and less likely to have chemotherapy, if they are diagnosed at the earliest stage compared to the latest stage, according to new figures.
This is the first time researchers have been able to show whether NHS patients received surgery, chemotherapy and radiotherapy, alone or in combination, linked with their cancer stage. And it shows that generally patients diagnosed an earlier stage are more likely to receive surgery, and can avoid chemotherapy.
Chemotherapy and radiotherapy are the most appropriate first line treatments for some cancers, but for most types of the disease surgery to remove a tumour is the most likely way to cure it. Treating a tumour with surgery alone often minimises longer term side effects which can affect a patient’s quality of life.
Cancer Research UK and Public Health England (link is external) examined data from about half a million patients with 22 different cancer types in England between 2013-2014. It shows that 7 in 10 (70%) diagnosed at the earliest stage (stage 1) had surgery to remove their tumour. This falls to around 1 in 10 (13%) of those diagnosed at the latest stage (stage 4).
Around 1 in 10 (12%) patients diagnosed at the earliest stage have chemotherapy. This rises to around 4 in 10 (39%) of those diagnosed at the latest stage.
Prof Mick Peake, a lead clinician in the study and based at Public Health England, said: “Doctors want to offer patients the best possible treatment. For some cancers, like leukaemia and lymphoma, that’s chemotherapy. But in most cases the earlier cancer is diagnosed the more likely it is to be effectively treated by surgery, and that means chemotherapy isn’t always necessary.
“In general, the treatment of cancers at an early stage also reduces the risk of long term side effects which can affect patients’ quality of life.”
For the most common type of bowel cancer, colon cancer, more than 9 in 10 patients (94%) have surgery to remove their tumour when diagnosed at the earliest stage, when radiotherapy and chemotherapy are not usually necessary.
For patients diagnosed with stage 4 disease around 3 in 10 (32%) have surgery and those who do will often have chemotherapy as well.
Less than 1 in 20 colon cancer patients with the earliest stage disease have chemotherapy compared to nearly 5 in 10 (47%) diagnosed at the latest stage.
In breast cancer, almost 95% of patients diagnosed at the earliest stage and 25% of those diagnosed at the latest stage have surgery. Those diagnosed at the latest stage are more than twice as likely to have chemotherapy as stage 1 patients.
For patients with the earliest stage non-small cell lung cancer (the most common type of the disease) 6% have chemotherapy. This compares to 30% when diagnosis is made at the latest stage.
Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “Understandably, people sometimes fear cancer treatments as well as the disease itself. This research shows how important an early diagnosis is for simplifying the treatment options as much as possible. Until now, we’ve not been able to look at such rich data for the whole of England and analyse who’s been treated how. Now, thanks to recent improvements, it’s possible to show how stage affects the treatments patients need, giving us a more complete picture.
“We all have our part to play to increase the number of patients diagnosed earlier. People should consult their GP if they are worried about symptoms, GPs should follow clinical guidelines to refer patients, and the right diagnostic tests need to be performed and reported promptly so that patients can benefit more from treatments. This all needs greater attention and our national cancer strategy helps give this focus.”
Dr Jem Rashbass, cancer lead at Public Health England said: “This data is the most comprehensive of its kind in the world, linking stage of diagnosis and treatment for individual patients. Its wealth of knowledge will help us to better understand treatment and survival patterns and underpins the importance of early diagnosis and screening”.
The importance of early diagnosis
This shows that patients diagnosed at the earliest stage are more likely to receive treatment that has a better chance of curing them and fewer long term side effects. The challenge is boosting the number of cases diagnosed at an earlier stage.
“Surgery remains the most important treatment for cancer,” says Nordin.
“As a general rule for most cancers, the earlier the cancer is diagnosed, the more likely that it can be effectively treated by surgery alone, without the need for additional types of treatment.”
“This often provides the best chance of disease cure whilst minimising the risk of long term side effects of treatment which can impact on patients’ quality of life.”
This pattern for cancers diagnosed at the earliest and latest stage looks the same across the majority featured in the report. But the scale of the differences highlight some big opportunities for progress.
This research also reinforces that the health service needs the right staff and equipment to diagnose more cancer patients earlier.
“During the coming years we will analyse the effectiveness of different treatments, and differences in treatments between different groups in the population and different regions of the country, in order to make changes to improve outcomes in the future,” says Nordin.
“Without the knowledge of what is happening now, it is impossible to monitor the impact of any changes in the quality of care, in terms of improvements in the outcomes for patients in the future.”
Sarah Testori is an early diagnosis manager at Cancer Research UK
You can read the new data from Cancer Research here
You can read the Cancer Research Press release in full here