People Living With Cancer

• Prevalence of cancer was higher than the regional average in all CCGs across Suffolk and North East Essex.
• In 2019/20, there were 6,541 new cases of cancer in the Ipswich and East Suffolk CCG, West Suffolk CCG and North East Essex areas – this is a rate of 635 new cancer cases per 100,000 population (2019/20) (compared to the England rate of 531 per 100,000).
• There is a higher percentage of over 65s in SNEE than the national average – crude rates don’t take account of age (22.2% compared to 17.4%).
• In SNEE there were In the period 2017-19, 56.9%, 56.2% and 58.4% of cancers were diagnosed at stages 1 or 2 in Ipswich and East Suffolk CCG, North East Essex CCG, and West Suffolk CCG areas respectively

• For cancers in total, two-week wait is the commonest route to diagnosis, followed by GP direct referrals.
• This does vary by type of cancer – for example lung cancer is more likely to be an emergency presentation (a third of lung cancers are emergency presentations) although this trend is gradually reducing
• There is some correlation between deprivation and later presentation

Routes to Diagnosis Graph

• More than 1 in 3 of all breast cancers, and around half for women aged between 50-69, detected through screening.
• Around half of diagnoses are of the most common cancers – breast, lung, prostate, and colorectal – and the other half are of rare or less common types.
• Less common cancers often have non-specific symptoms.
• Less common cancerResearch has shown that people in the UK are more worried and embarrassed than those in other countries about seeing their doctor with a symptom that might be serious.

Screening Coverage 2020/21 Data

• In 2021, cancer was the underlying cause of around one in four deaths in both Suffolk and North East Essex.
• Premature mortality – aged under 75.
• Preventable mortality – could mainly be avoided through effective public health and primary prevention interventions.
• 4 in 10 cancers could be prevented

• Survival varies between cancer types, ranging from 98% for testicular cancer to just 1% for pancreatic cancer.
• Many of the most commonly diagnosed cancers have ten-year survival of 50% or more (2010-11).
• More than 80% of people diagnosed with cancer types which are easier to diagnose and/or treat survive their cancer for ten years or more (2010-11).
• Early diagnosis is associated with improved cancer survival outcomes. Less than 20% of people diagnosed with cancer types which are difficult to diagnose and/or treat survive their cancer for ten years or more (2010-11).

Survival Rates Infographic

Possible explanations for the lower survival in people living in more deprived areas include differences in:

• diagnosis (delays, advanced stage of disease);
• treatment (delays, poorer access to optimal care and lower compliance);
• worse general health (worse in more deprived) and type of disease (histological type or more aggressive disease)

Cancer Survival Stats

• In the UK, approximately one in four of those who have been diagnosed with cancer at some point in their lives face poor health or disability after treatment for cancer.
• Long-term consequences of cancer and its treatment include both physical and mental effects: e.g. chronic fatigue, sexual difficulties, mental health problems, pain, urinary and gastrointestinal problems, and lymphoedema.
• The impact of cancer and its treatment affects much more than just health and wellbeing – wider implications include social isolation, financial worries caused by disruption to work, and the potential impact on education and future prospects for those who are treated for cancer as children or young adults.

• Biggest factor contributing to gap in life expectancy between most and least deprived for women (1 year), and second biggest for men (1.37 years).
  • People with cancer face significant extra costs of nearly £900 when they get diagnosed, such as buying extra clothes, food or using more heating to stay warm
• Risk factors
  • Lifestyle
  • Occupational
  • Environmental 
  • Ethnicity

• White people more than twice as likely to get some types of cancer, including melanoma skin cancer, oesophageal, bladder and lung cancers 
• Black people are more likely to get prostate cancer, myeloma (a type of blood cancer), womb cancer, stomach and liver cancers
• Asian people are more likely to get liver cancers.
• differences are likely largely, but not entirely, driven by non-genetic cancer risk factors.
• White people are generally more likely to attend screening

Cancer stigma:

• more common among men and people from ethnic minority backgrounds
• fear of finding out you have cancer, or fatalism ‘there is nothing that can be done about it’
• embarrassment or discomfort as screening involves intimate body parts or functions 

Behavioural stigma:

• for example feeling judged for being a smoker

Practical barriers:

• juggling work or caring responsibilities to attend an appointment during the day
• financial cost of attending, especially loss of wages
• carers giving priority to the people they care for rather than themselves

It recommends improving uptake through flexible appointments, text reminders and re-invitations, and publicity to ensure communities with low uptake are fully informed.

In 2018 the Race Equality Foundation found:

• Patients who are members of black and minority ethnic groups report more negative experiences of cancer care than white ethnic groups.
• Understanding the prevalence and experiences of cancer in black and minority ethnic groups is hindered by a lack of data relating to these communities.
• Health care providers have a poor understanding of the needs of black and minority ethnic communities.
• There is a lack of health education regarding cancer and awareness of the availability of support services is limited among black and minority ethnic communities.
• There is a lack of cultural competence education for health providers, especially in cancer awareness.

Macmillan highlights that for Gipsy and Traveller communities: 

• • A lack of understanding in hospitals of Gypsy and Traveller culture can result in ill-treatment, leading to many avoiding services where they have had negative experiences.
  • Displaced Travellers who are forced to stop in illegal or unsafe places have difficulty registering with a GP practice, leading to overdependence on A&E and late presentations at the point of crisis.

• Levels of literacy can lead to difficulty completing forms and accessing information. 

• A culture of self-reliance can impact on acceptance of a life-threatening diagnosis and mental health needs such as stress, anxiety and depression. 
• Gypsy and Traveller communities need culturally sensitive support recognising their needs and preferences for the ways and places that they are cared for, the importance of family networks, and gender roles in the community. 

• Integrating cancer care considerations for LGBTQ+ patients into the training and assessment of the oncology workforce.
• Co-produced education and training materials on the cancer care needs of LGBTQ+ patients.
• Local training in cultural competency and humility with feedback from LGBTQ+ patients.
• The recording of sexual orientation, gender identity, preferred name and pronouns as part of routine oncology consultations, with example scripts for how to do this sensitively.
• Increased sexual orientation and gender identity recording in primary and secondary care providers and disease registries.
• Ongoing audit and quality improvement of the care of LGBTQ+ patients within oncology.
• Encourage diversity within the oncology workforce and representative committees.

• Physical and mental effects include chronic fatigue, sexual difficulties, mental health problems, pain, urinary and gastrointestinal problems, and lymphoedema (persistent tissue swelling caused by fluid retention). 
• Certain treatments for cancer also increase the risk of other serious long-term conditions such as heart disease, osteoporosis or a second cancer 
• Wider implications include social isolation, financial worries caused by disruption to work, and the potential impact on education and future prospects for those who are treated for cancer as children or young adults. 

Source: Macmillan 

Having cancer impacts on people and families practically, financially, emotionally and physically. Research by Demos commissioned by Pfizer found: 

• Cancer patients incurred an additional £570 a month on average due to their illness.
• Some had to reduce their hours or change role due to chronic fatigue, impacting on income. 
• Many  were deterred from applying for benefits by the complexity of the system, while others had their benefits reduced or withdrawn, causing further hardship.
• Over three in four described negative impacts of cancer on their family and social life, due to side effects of medication, vulnerable immune systems or impacts on mental health. 10% said the effect was positive, e.g. a chance to re-evaluate their priorities.
• People were positive about the support they receive, but access is not always easy:
  • people with rarer forms of cancer had more difficulty accessing services, especially those in more rural areas. 
  • those with ‘watch and wait’ diagnoses had stress, anxiety and fatigue, combined with the uncertainty inherent in ‘watch and wait’, but feel they are offered less support. 

Trends in the lifetime risk of developing cancer in Great Britain

When we get ill: cancer

Essex JSNA & District Profile Reports 2019

Routes to Diagnosis

Routes to Diagnosis: Tumours Diagnosed 2006-2016

New calculations confirm lifestyle changes could prevent 4 in 10 cancer cases

Public health profiles – OHID (phe.org.uk)

Consequences of Treatment June 2013 (macmillan.org.uk)

First data in a decade highlights ethnic disparities in cancer

Cost of living: Young cancer patients ‘in a desperate situation’