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The past decade has shown a notable change in the way cancer services are provided within UK hospitals. It was necessary that something was done. The EUROCARE studies of cancer survival going back to the start of that period confirmed that for many common epithelial cancers survival is inferior to comparable European countries. Ten years ago I wrote an article which showed how these observations could be connected with the culture of cancer management that had developed within the National Health Service (NHS) over the preceding half century.1
Survival in the UK
Some questions have been raised as to how accurately the EUROCARE data reflect true differences in cancer survival between different countries.2 3 Much effort is devoted to assuring the quality of the data.4 In an exercise to assess the effect of under-registration in the UK, adjustment for the maximum possible error failed to overturn the survival advantage of Finland over the Thames region except for some lung and oesophageal cancer cases where the methodology used is implausible.5 It has to be emphasised that these data compared results from populations. Cancer survival is not just a matter of how excellent the top academic institutions are, but how effectively patients have access to competent services. Other studies show that poor survival is associated with advanced stage at presentation—for example, a EUROCARE study in colorectal cancer6 and a hospital based study in lung cancer.7 Furthermore, there is a clear mechanism in its reliance on primary care gate keeping to minimise demand on specialist services which explains why the UK might be so poor. Another western European nation which relies on this is Denmark which also languishes near the bottom of the EUROCARE league.8
Service development in the past decade
Strong positive developments have occurred in how patients are processed through the system once cancer …
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