Delays in diagnosis of many cancers can have a detrimental effect on survival prospects for patients. So what can pharmacy do to help?

Some cancers have seen remarkable progress in survivability but others are sadly just as deadly as they were 40 years ago. Together, lung, liver, brain, oesophageal, pancreatic and stomach cancers now make up half of all common cancer deaths in the UK. 

Poorer survival prospects 

Despite accounting for 51.1 per cent of common cancer deaths these ‘less survivable cancers’ still suffer from low awareness amongst the public and health practitioners. If you have a less survivable cancer, you are twice as likely not to be diagnosed until you are in enough pain to go to A&E, compared to someone with a more survivable cancer. 

What’s more, delays in diagnosis have a detrimental effect on survival of these rapidly-advancing diseases, which are currently difficult or impossible to treat at later stages. Late diagnosis and slow progress to treatment can severely limit treatment options for patients, who then face poorer survival prospects at 12, 24, and 36 months onwards.

So why are these cancers still claiming so many lives? Dr Catherine Pickworth from Cancer Research UK says: “There are several reasons for this, including obstacles that prevent current treatment from being successful, for instance in brain tumours where the blood-brain barrier makes it hard for drugs to reach the tumour. Researchers also face difficulties in developing new treatments for cancer types where obtaining samples is challenging, often because tumours are difficult to access, or patients are frequently not fit for surgery. Recruitment to clinical trials is also harder for aggressive cancers or those often diagnosed late, as patients are too unwell to take part.”

To tackle these issues, five charities – The British Liver Trust, CORE: fighting gut and liver disease, The Brain Tumour Charity, Action Against Heartburn, and Pancreatic Cancer UK – have joined together to form the Less Survivable Cancers Taskforce to represent these cancers, all of which have a five-year survival rate of less than 20 per cent due to a legacy of neglect and underfunding. 

James Thorneycroft, policy officer, The Brain Tumour Charity, says low survival rates among this group of cancers also persist because the lower levels of research funding mean they remain difficult to diagnose.

“Increased research is critical to improving our understanding of less survivable cancers and to develop new treatments [but] successive governments have failed to properly resource and support research into low surviving cancers,” he says. “More survivable cancers receive five times more research funding than less survivable cancers and this disparity has meant that improvements have been slower to emerge. There is a moral obligation to level these cancers up.”

Taskforce on track

Between 2002 and 2014, the less survivable cancers received just 16.6 per cent of research funding for common cancers and James says the prioritisation of research into these cancers is essential. “The total number of clinical trials for more survivable cancers is double the number for less survivable cancers. Under-investment in the research infrastructure – including people, resources and facilities – has limited the scope and impact of research, and resources need to be redirected and institutions need to be incentivised to look closer at these cancers,” he explains.

To follow the footsteps of more survivable cancers, trials of screening higher-risk individuals and fast-tracking patients with relevant symptoms should also take place, but James admits that getting discoveries in the laboratory to the patient is challenging: “Enrolment in clinical trials is a challenge across many cancers, but particularly those with a generally short prognosis, so awareness of trials needs to improve.” 

After a successful launch event in Westminster earlier this year, The Less Survivable Cancers Taskforce is now calling on MPs, policy makers, research funders, nurses, GPs, and other healthcare professionals, as well as patients and their families, to help it achieve its goal by:

  • Increasing investment in research
  • Raising awareness of the symptoms of the six less survivable cancers
  • Diagnosing and treating the cancers more quickly
  • Increasing the number of clinical trials and treatments approved
  • Setting targets with Government to improve survival.

The role of pharmacy

Early diagnosis can significantly improve
survival rates

The NHS community pharmacy contract in England defines promotion of healthy lifestyles (public health) as an essential pharmacy service and pharmacy staff provide this on a daily basis to customers.

The accessibility of community pharmacy means it can play an essential role in early diagnosis of cancer, and James says the Taskforce needs and values its help. “The symptoms of less survivable cancers are vague and can mimic less serious conditions so a big part of the Taskforce’s work will be raising awareness of the signs and symptoms of less survivable cancers,” he says. “We want to work with pharmacies to ensure that all pharmacists, as well as other medical professionals, spot the symptoms of less survivable cancers, and advise and refer high risk individuals for further tests.” 

With an emphasis on early interactions with customers in their local community, Celesio’s head of clinical standards, Sanjeev Kaushal, says pharmacy is well placed to do this. 

“The entire community pharmacy team from the healthcare assistant to the pharmacist are reliable and experienced signposters and therefore have a strong ability to detect warning signs [of cancer] that need urgent referral,” Sanjeev says. “They can also highlight repeated symptoms that become non-responsive to over-the-counter or prescription-only medicines such as heartburn, stomach upsets, persistent cough, difficulty swallowing, and vague but repeated symptoms such as fatigue and insomnia. Even reminding patients to attend national screening programmes is a big step forward in lessening late diagnosis and poor clinical outcomes.” 

And with cancer not discriminating between the people it affects, Nick Thayer, pharmacy services lead at Well, stresses the importance of pharmacy teams utilising their training to look for warning signs and red flags and use their knowledge, experience and the relationships they have built up with the local community to spot those first signs of a possible problem. 

“Taking lung cancer as an example,” says Nick, “a persistent cough might be the first symptom of this and a patient regularly buying cough mixture is likely to be in regular contact with a pharmacist, allowing early identification. A pharmacist could spot this red flag and then ask the ‘WWHAM’ (Who, What, How, Action, Medication) questions to try to identify if the patient should be referred on for further examination with a GP.”

More screening programmes are springing up where pharmacy teams are receiving extra training in key areas to look for particular cancers with the aim of improving the prognosis, such as in East Cheshire where anyone who approaches a pharmacist requesting medication for chest problems and fulfils relevant criteria will be offered a direct referral to the x-ray department at the local hospital to get the x-ray immediately. 

Early detection via interventions such as this is vital and this is where community pharmacy can really make a difference, although Nick adds: “A huge step forward would be to continue to develop these pathways between pharmacy and cancer services, such as referral directly into specialist units if certain criteria are met.”

Raise awareness

In-store health promotions are another way of raising awareness of cancers and their symptoms among customers, according to Mandeep Mudhar, Numark’s director of marketing. He says: “We emphasise the importance of raising awareness through HLP [healthy living pharmacy] and targeted health promotions. That would highlight the symptoms and then if patients were suffering some of these they may be more likely to visit their GP.

“In fact very recently we had a Numark member running an HLP campaign identify a patient with lung cancer (granted not a rare cancer) who then went straight to the doctor. Unfortunately he was diagnosed with lung cancer, but we offered great support to both him and his wife and they were both extremely grateful. We also had a recent case of a patient with a worrisome looking mole that was picked up during a safety in the sun campaign.”

Sanjeev says community pharmacy teams can also encourage customers who lack motivation to seek help. “These people often fear how they will manage with false alarms from screening or the fear of time wasting and using NHS resources irresponsibly,” he says. “And in such cases, community pharmacy and other healthcare professionals need to remain united in spreading a consistent message. Community pharmacy teams understand the healthcare associated myths that patients carry and at every opportunity the pharmacy teams can explore underlying beliefs and values to support patient education and reassure patients that early detection improves the prognosis of your treatment. 

“What’s more,” says Sanjeev, “cancer can be an emotional subject for patients and community pharmacy teams understand the challenges and support patients’ needs when dealing with a long-term condition, so the more we engage patients, the greater the opportunity in finding solutions that are centered around them.” 

As well-established and essential members of the wider primary care team, community pharmacy has long had the ability to work with patients as active partners in their care to take more control of their own health and lifestyles and seek professional help to make more informed decisions. This is a vital part of helping people manage the risks of developing these less survivable cancers, and accessing earlier diagnosis and treatment if they do.

Find out more

Despite accounting for 51.1 per cent of common cancer deaths these ‘less survivable cancers’ still suffer from low awareness

Originally Published by Training Matters

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