‘Deadly postcode lottery’ restricting new cancer treatments in England, doctors say

Cancer patients are being denied access to cutting-edge treatments on the NHS because of a “deadly postcode lottery” in access, doctors have warned.Patients in England are missing out on two innovative forms of radiotherapy that are known to be effective against several forms of the disease and are widely available in other countries, due to “red tape” and lack of funding.The Royal College of Radiologists (RCR) and Radiotherapy UK want Wes Streeting to use the government’s new cancer plan, being published this week, to make them widely available.They are urging the health secretary to end what they say are “bureaucratic hurdles” that NHS-england" class="entity-link entity-organization" data-entity-id="722" data-entity-type="organization">NHS England imposes, through its complex funding and commissioning policies, on hospitals that want to provide stereotactic ablative body radiotherapy (SABR) and molecular radiotherapy (MRT).Unlocking the potential of the novel treatments would help improve cancer survival, which is poor in Britain by international standards, both organisations said.The same “red tape” means only half of cancer centres in England can offer surface-guided radiation therapy (SGRT), 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" class="entity-link entity-organization" data-entity-id="722" data-entity-type="organization">NHS England does not provide funding.Dr Nicky Thorp, the RCR’s 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.”Pat Price, the chair of Radiotherapy UK and a 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,” she added.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" class="entity-link entity-organization" data-entity-id="722" data-entity-type="organization">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.”