1. Dr James Carlton, Medical Adviser
Cancer
Dr James Carlton, Medical Adviser

2. What we know
More people are diagnosed with cancer each year. The rate of increase is higher than the England average in DDES CCG. We also have a higher percentage of people living in DDES who are aged 65+ compared to the England average. So what does that mean for our population? (next slide)

3. Incidence & mortality
This table shows how the rates of cancer incidence and premature mortality differ from England and also how rates have changed over time (percentage increase or decrease). Lung cancer incidence and mortality are significantly higher than the England average however for males the trend is decreasing. This is not the case for females where both incidence and mortality is increasing. Incidence of lung cancer incidence is strongly linked to deprivation. Interestingly, incidence of bowel cancer amongst women in DDES is increasing however premature mortality is decreasing although not at the rate it is in our male population.
*Figures show percentage increase/decrease over time
Source: Durham County Council in partnership with Macmillan Cancer Support:
2017 Cancer Health Equity Audit County Durham, North Durham CCG and Durham Dales, Easington and Sedgefield CCG

4. Incidence & mortality
Two different approaches to reducing premature mortality from cancer:
Prevention
reduction in lifestyle factors e.g. smoking, obesity, alcohol consumption, sun exposure
takes time to affect mortality rates
Awareness and earlier diagnosis
finding and treating more cancers earlier (including screening)
may result in a faster reduction in cancer mortality rates
There are two recognised approaches to reducing premature mortality from cancer. Both methods have been shown to be effective however the awareness and earlier diagnosis approach represents the quickest way to reduce premature mortality. NHS England commissioned national cancer screening programmes play a major role in diagnosing cancers early and uptake of screening in this CCG is above the England average. We’d like to target hard to reach groups more as we know that not only is there a higher incidence of cancers in deprived areas but the survival rates are also lower.

5. Our priorities Early diagnosis
Increase detection rates of stage 1 & 2 cancers (including better use of 2ww referrals)
Improve cancer screening rates in hard to reach groups
Survivorship
Increase survival rates of patients with a cancer diagnosis
Patient experience
Improve the quality of life for people living with and beyond cancer
Achievement of cancer waiting time targets
2 week wait (from referral to 1st outpatient appointment)
62 days (from referral to 1st treatment)
With that in mind here are our commissioning priorities. We need to detect more cancers at an earlier stage, encouraging better use of 2ww referrals. Combined with this we would like to increase the numbers accessing cancer screening programmes, especially those hard to reach groups and those living in areas of high deprivation.
If we get that right we will start and see survival rates increase for patients with a cancer diagnosis.
Whilst patients are on a cancer pathway or having received cancer treatment we want to ensure that their experience of care is as positive one. The latest National Cancer Patient Experience Survey results show that there are areas for improvement including better use of holistic needs assessments for patients.
Our final priority area to address is to improve performance against cancer waiting time constitutional indicators. In particular the 2ww from initial GP referral to first consultant outpatient appointment and the 62 day waiting time standards to receiving first cancer treatment from initial GP referral. Despite being better than the England average we need to ensure we meet these targets consistently each month.

6. What we are doing Improving lung cancer pathway
Abnormal chest x-ray – direct referral to CT scan
Supporting optimal lung pathway implementation
Cancer champions (community posts)
Raising awareness of signs & symptoms
Promoting cancer screening in hard to reach groups
Increasing the number of people seeking help with concerns
Cancer navigators (secondary care posts)
Coordination and streamlining of diagnostic imaging
Additional focus on upper GI, lower GI and head & neck pathways
Improved patient experience
Improved communication between primary & secondary care
Improvements have been made to the lung pathway to speed up ordering of the diagnostic CT scan from abnormal x-ray result. This means that the local Acute Trust (CDDFT) can move closer towards the national optimal lung cancer pathway.
We are utilising national transformation funding to introduce Cancer champion and cancer navigator posts to promote cancer screening, raise awareness of the signs and symptoms of cancer as well as coordinating of diagnostic tests, focusing on problem areas and increasing the quality of patient and primary care contact.

7. What we are doing Working in partnership with Cancer Research UK
GP Practice visits to support:
Strategies to improve uptake of cancer screening
Practice level cancer improvement plans
2ww e-referral proforma advice
Training on safety netting of patients
Working in partnership with Macmillan Cancer Support
Commissioned Macmillan Primary Care Nurses
Supporting patients through diagnosis and treatment
Working with Durham County Council
Co-production of Joining The Dots model of holistic support for patients with a cancer diagnosis
We are working with Cancer Research UK health professional engagement facilitators to support practices to proactively improve screening rates, appropriate use of 2ww referrals and safety netting.
In DDES we commission a Macmillan Primary Care Nursing team to support patients and their carers from initial referral, through diagnosis and treatment.
Finally we’re working with Durham County Council on the co-production of the Joining the Dots holistic model so that patients are able to receive the level of support outside that of a traditional clinical setting.

8. Table top discussions How can we…
Promote awareness of cancer screening programmes and engage with people who do not initially take up their screening offer?
Make every contact count?
Finally…
Which services/providers/organisations should the CCG be talking to/working with to improve early diagnosis/survivorship?
In your tables we’d like you to consider these three questions linked to our priority areas.