“Worryingly, we have some of the worst survival rates in Europe for older people”
Macmillan Cancer Support, 26 March 2012
“Then the Prime Minister said that cancer services were failing people, compared with other countries. That was before new research in November 2011 which showed that the NHS in the past decade achieved the biggest drop in cancer deaths of any comparable health system in the world”
Andy Burnham MP, Hansard, 20 March 2012
The Daily Mail turned up the heat in the debate on cancer treatment when the newspaper released an article claiming that by “writing off” the life chances of patients over 70 years of age, UK doctors were effectively resigning 40 elderly cancer sufferers to death every day.
The source of the claim came from a recently published report from charity Macmillan Cancer Support, who also stated that such discrimination against elderly patients has led to Britain having one of the worst cancer survival rates in the Western world.
In defence of the previous government’s record on health, Shadow Health Secretary Andy Burnham MP said that, far from failing people, research in November 2011 showed that “the NHS in the past decade achieved the biggest drop in cancer deaths of any comparable health system in the world”.
So is the UK getting better or worse at treating cancer?
On close inspection, Macmillan Cancer’s report The Age Old Excuse: the under treatment of older cancer patients appears to focus mainly on elderly patients, because the rate of survival for that age cohort is significantly worse than their younger counterparts. This is attributed to a “growing body of evidence” suggesting that older people with cancer are under-treated.
Macmillan Cancer Support provided Full Fact with details of what data they used to draw their claim. Based on comparative evidence with twenty-three European countries, the relative cancer survival rates (RSC) of elderly UK patients are indeed worse than their continental compatriots within a five-year time span:
A few points about how this data is compiled are worth making. First of all, the number of UK cases sampled is 5.78 million – five times greater than that of the next highest contributor Italy, with 1.17 million, and therefore makes for a considerable proportion of the 13.7 million cancer cases recorded in total.
In addition, the data is only presented from 1995-1999. This could be due to problems in comparing the EU countries as data exists outside of this time period for some of the countries. In any case, the data is now over a decade old and may not be indicative of comparable rates today.
The Macmillan report then goes on to say: ”This may explain why, while mortality rates are improving significantly for the under 75s, they are improving at a much slower rate in those aged 74-84 and actually getting worse for those aged 85 and over”.
The evidence for this comes from a study by the North West Cancer Intelligence Service comparing the cancer mortality rates of patients from the UK, the USA and 11 European countries. It concludes that “From 1995-97 to 2003-05, UK rates decreased by 16-17% in those aged <75 years, but increased by 2% in those ≥85 years compared with decreases of 4-16% for the other geographic areas”.
However, a different set of figures suggest the NHS offers a relatively efficient service in treating cancer, compared to other advanced countries’ healthcare systems.
In a study published by the British Journal of Cancer, Professor Colin Pritchard and Dr Tamas Hickish challenged the view that the NHS is failing cancer patients over a 27 year period and found that, relative to GDP spend on healthcare, England and Wales saw the greatest drop in cancer mortality rates compared to countries like Germany, France, Spain, the US and Japan.
Their report was used by Andy Burnham MP to refute the notion that the NHS is failing cancer patients. Unfortunately, access to it lies behind the British Journal of Cancer’s paywall, so Full Fact cannot assess their statistics in detail. The Guardian published an article on their report.
It is entirely possible that all sides of the debate are talking at cross-purposes, for they use different samples from different time periods in their analyses. Macmillan’s argument centred around the evidence that showed older cancer patients’ survival rates were not improving, whereas Professor Pritchard and Dr Hickish showed that the NHS has contributed to the single largest drop in mortality rates of any advanced healthcare system in the world.
There are, of course, several other studies conducted in the area, some of which are discussed further by Straight Statistics.
Macmillan specifically focused on an age group for whom a poor cancer survival rate – caused in part by under-treatment – would inevitably have a more acute impact on mortality rates. Meanwhile, the overall UK outlook on cancer survival rates, while still not as good as some countries, could be said to have improved considerably over the past three decades.