The NHS must concentrate on the basics of cancer treatment rather than the “magic bullets” of novel technologies and artificial intelligence, or risk the health of thousands of patients, experts have warned.
In a paper published in the journal Lancet Oncology, nine leading cancer doctors and academics say the NHS is at a tipping point in cancer care with survival rates lagging behind many other developed countries.
The NHS has not met its target for 85% of cancer patients to start treatment within two months since December 2015. International research shows that every four weeks of delay in treatment increases the risk of death by up to 10%. It means hundreds of thousands of people have to wait months to start essential cancer treatment, and only 67% begin treatment within 62 days.
The paper highlights 10 pressure points that are contributing to entrenched cancer survival inequalities, diagnosis and treatment delays, and inappropriate care.
In a sharply worded warning, the cancer experts say “novel solutions” such as new diagnostic tests have been wrongly hyped as “magic bullets” for the cancer crisis, but “none address the fundamental issues of cancer as a systems problem”.
A “common fallacy” of NHS leaders is the assumption that new technologies can reverse inequalities, the authors add. The reality is that tools such as AI can create “additional barriers for those with poor digital or health literacy”.
“We caution against technocentric approaches without robust evaluation from an equity perspective,” the paper concludes.
Ajay Aggarwal, the paper’s lead author and a consultant oncologist and professor of cancer services and systems research at the London School of Hygiene & Tropical Medicine, said while nobody was suggesting the NHS should stop investing in new tech, it was not necessarily going to improve patients’ prognoses.
“The discussion around AI, tech, liquid biopsies, is slightly reductionist as a solution to cancer care,” he said. “AI is a workflow tool, but actually, is it going to improve survival? Well, we’ve got limited evidence of that so far. Yes, it’s something that could potentially help the workforce, but you still need people to take a patient’s history, to take blood, to do surgery, to break bad news.”
Instead the focus needed to be on patient care, he added. “Without early diagnosis, good quality treatment, good survivorship and follow-up, we’re talking about avoidable deaths.”
The UK government should “concentrate on improving the basics of cancer care”, said Prof Pat Price, a co-author of the paper and oncologist, who is a visiting professor at Imperial College London and the chair of the charity Radiotherapy UK.
“We need to ensure timely treatment as well as quick diagnosis. If you boost diagnosis but don’t treat people on time, the newly diagnosed patients just end up stuck on long waiting lists. Unless the NHS focuses on tackling these challenges, thousands of patients may die prematurely.”
The authors repeat calls for a cancer control plan that would introduce measures to ensure more patients are treated within 62 days of referral for suspected cancer, improved screening rates, a national cancer workforce strategy, better mental health support for cancer patients and a taskforce to tackle the social and commercial determinants of cancer, such as housing quality, food policy, alcohol and smoking.
In 2022 the government announced a 10-year cancer plan for England. The policy was controversially abandoned less than a year later, when cancer was absorbed into a major conditions strategy. Experts warned patients would die as a result, pointing to research showing that dedicated cancer policies were associated with superior five-year survival outcomes.
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And in May, the then chair of the Commons health and social care select committee, Steve Brine, wrote to the then health secretary, Victoria Atkins, to inform her that the committee’s future cancer inquiry had concluded that “it is a mistake to abandon the 10-year cancer plan” and called on the Department of Health and Social Care (DHSC) to reinstate it.
Responding to the Lancet paper, Mark Lawler, a professor of digital health at Queen’s University Belfast, said: “Cancer care should be firmly placed back at the top of the political agenda; doing this could save thousands of people’s lives a year – what could be more important than that?
“Without a dedicated cancer plan, cancer patients will die.”
Cancer Research UK’s director of evidence and implementation, Naser Turabi, said the report highlighted the investment and reform needed in all aspects of cancer care.
“Cancer patients deserve more, and change won’t be possible without a long-term, fully funded strategy for cancer research and care.” The new government must deliver on its pledges and give cancer services the much-needed additional staff and equipment they need, he added.
A Department of Health and Social Care spokesperson said: “Too many patients are waiting far too long to be diagnosed and treated. The NHS has fewer diagnostic scanners per person than other countries and many of these are older machines.
“Early diagnosis and treatment are vital for beating cancer. By doubling the number of MRI and CT scanners, and buying AI-enabled scanners which diagnose faster, we will catch illness earlier, and save lives.”