1. Nicola Barnstaple Programme Manager

2. Key challenges in Scotland Increasing cancer incidence – predicted 35,000 cases per year in 2020 Ageing population -proportion of over-75s up 25% by 2023 Impact of health inequality - mortality rates from cancer in the 10% most deprived areas are around 1.5 times those in the 10% least deprived areas Survival for some cancer types is lower in Scotland than in other European countries

3. Scotland: age-standardised incidence and mortality rates (EASRs), by SIMD 2009 deprivation quintile

4. Scotland: age-standardised cancer incidence and mortality rates (EASRs), by SIMD 2009 deprivation quintile

5. Cancer staging by deprivation 2010/2011 (baseline) Stage 1Stage 2Stage 3Stage 4Not known 1=most deprived 19.8%21.4%19.3%30.2%9.3% 2 21.8%24.1%18.6%26.4%9.2% 3 22.6%26.1%18.0%23.7%9.6% 4 25.0%27.5%16.2%22.9%8.3% 5=least deprived 27.2%28.0%15.6%21.1%8.0% 2011/2012 Stage 1Stage 2Stage 3Stage 4Not known 1=most deprived 20.3%22.1%18.6%30.9%8.1% 2 23.0%23.6%18.8%27.0%7.6% 3 23.5%25.9%17.5%25.6%7.4% 4 26.9%26.7%16.5%23.1%6.9% 5=least deprived 27.5%27.1%16.4%21.8%7.1%

6. Key challenges Increasing cancer incidence – predicted 35,000 cases per year in 2020 Ageing population -proportion of over-75s up 25% by 2023 Impact of health inequality - mortality rates from cancer in the 10% most deprived areas are around 1.5 times those in the 10% least deprived areas Survival for some cancer types is lower in Scotland than in other European countries

12. Five-year age-adjusted relative survival (%) with 95% confidence intervals for adults diagnosed during 2000-2007, by selected country and cancer site/type

14. Source: Lancet Oncol 2014; 15(1): 23-34

18. So what is the explanation for this apparent excess of early mortality? Unfavourable stage distribution due to delays and/or tumour biology? and/or Poor general health/lifestyle factors laid down over decades?

20. Source: Lancet Oncol 2014; 15(1): 2-3

23. Source: BMJ 2010; 341: c5133

24. Eurocare 5 findings Survival from major epithelial cancers seems to be lower in Scotland (and the UK) compared to all of the Nordic countries except Denmark The excess risk of death seems to occur early on and is more apparent in oldest age groups Some evidence suggests that, on average, UK patients may be presenting with more advanced disease at diagnosis But we don’t know for sure whether this is due to later presentation, later referral, delays in diagnosis or staging, or more aggressive disease We know that lifestyle factors can influence survival, but we don’t really know to what extent, if any, this contributes to European survival variations The reasons for reported survival differences seem most likely to be multifactorial

25. Cancer: approx 6% total NHS spend Cancer services: estimated activity and costs: Scotland 2007/08 Acute Services episodes Geriatric long stay episodes Out patient services Pharmaceutical items dispensed GMS visits Activity188,141517144,6241,153,614195,363 Cost£390M£8.5M£25M£46M£6.3M

26. Costs Projected 65% increase in costs of treating cancer by 2021 For colon cancer: treatment in Stage 1 costs £3131 and treatment in stage 4 costs £12519

28. DCE HEAT Target to achieve a 25% increase in the proportion of breast, colorectal and lung cancers (combined) diagnosed at stage 1 by December 2015 when compared to the 2010 and 2011 (combined) baseline (23% → 29%).

29. Social Marketing

30. Primary Care Review of Scottish Referral Guidelines for Suspected Cancer New sGMS contract initiative for bowel screening Primary Care education sessions Improvements in e-Health, eRAT Development of practice profiles for cancer

31. Evaluation – key points Data on cancer diagnoses not yet available 4.7% increase in cancers diagnosed at Stage I (2012/13 compared to baseline) Priming Campaign - just under half (48%) of all respondents feel more confident about approaching their GP with signs or symptoms which could possibly be cancer Breast Campaign – 50% increase in attendances at GP for breast symptoms Bowel Campaign- increases in requests for replacement kits and calls to screening helpline, increase in screening programme participation ( 56.1% from 54.9%) Lung Campaign - Significant improvement in relation to key campaign message of importance of getting cough checked Other measures of success – emergency admissions, ICBP, TCT, other studies

32. DCE Next Steps Consolidation Breast Screening Campaign Updated bowel and lung cancer campaigns Interim Evaluation Consideration of new tumour groups

33. Early diagnosis is important relations with patients and families RCGP/Patient Safety Agency report best chance for long-term survival. still well enough to tolerate disease modifying treatments emergency diagnoses don’t do as well more time to manage symptoms allows more to join clinical trials

34. Scottish Cancer Taskforce DCE Treatment capacity TCAT QPI

35. Acknowledgements EUROCARE-5 slides mostly reproduced from the Lancet Oncology papers Data are also now available to download from the EUROCARE website: http://www.eurocare.it/http://www.eurocare.it/