Health care use during cancer survivorship

Kelly M. Kenzik | Health care use during cancer survivorship: Review of 5 years of evidence | Cancer | First published: 18 December 2018


Improvements in treatment strategies have resulted in increasing survival rates among patients diagnosed with cancer but also result in a growing population of individuals who have greater health care needs. These needs will persist from diagnosis throughout the continuing phase of care, or the survivorship phase.

To better define models of survivorship care, there must be a strong evidence base in survivor health care use patterns. The objective of this review, which covers studies from 2012 to January 2018, was to evaluate the available evidence on patterns of health care visits among survivors of adult cancers and to understand what is known about the rate of health care visits, the physician specialties associated with these visits, and/or the types health care settings (eg, outpatient, emergency room).

The findings underscore the importance of primary care, with the majority of studies reporting that more than 90% of survivors visited a primary care provider in the prior year. Visits to oncologists and/or other physician specialties were positively associated with receiving cancer screenings and obtaining quality care for noncancer‐related conditions. High care density/low care fragmentation between physician specialties had lower costs and a lower likelihood of redundant health care utilization.

The follow‐up in almost all studies was 3 years, providing short‐term evidence; however, as the survivorship period lengthens with improved treatments, longer follow‐up will be required. The long‐term patterns with which survivors of cancer engage the health care system are critical to designing long‐term follow‐up care plans that are effective in addressing the complex morbidity that survivors experience.

Cancer in children and young people

Medical & Surgical Review Programme: Cancer in Children, Teens and Young Adults Report | Healthcare Quality Improvement Partnership

Cancer outcomes in children and young people have improved dramatically over the last few decades with over 80% of those diagnosed now being cured of their disease. Of those who die, approximately half will do so from treatment related complications many of which are avoidable.

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This report deliberately focuses on a sample of patients who were a high-risk group who died or who had an unexpected admission to intensive care. The rationale being that this is where care-planning, service provision and communication should excel. Any remediable factors in care for this group would benefit all children, teenagers and young adults receiving SACT.

One of the recommendations from this report is that the audit and quality improvement methods, with action plans, are essential for on-going improvement but require access to data. Electronic prescribing was not universal at the time of data collection and many hospitals had no ready access to information on which patients had received SACT and their outcomes.
Along with adequately trained staff, good team working and clear local leadership, such implementations are key drivers for improving care for this vulnerable population.

Full report: On the Right Course? A review of the quality of care provided to patients aged 24 years and under who were receiving systemic anti-cancer therapy and subsequently died or were admitted to critical care | Healthcare Quality Improvement Partnership

National Bowel Cancer Audit

Health Quality Improvement Programme | December 2018 | Bowel Cancer Audit

The latest annual National Bowel Cancer Audit from the Health Quality Improvement Programme (HQIP) details data from over 30,000 patients diagnosed with bowel cancer between 01 April 2016 and 31 March 2017.

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This  audit report describes some ongoing improvements such as mortality rates following both elective and emergency surgery falling over the past five years and increased numbers of operations being performed laparoscopically.

This year’s report has also described geographical variation in chemotherapy administration and further work is required to better describe and understand this. It is encouraging to see that there has been a reducing trend of deaths in hospital from 2011 to 2016 (46.2% – 34.6%) (Source: HQIP) .

2018 Annual Report 

Patient Report 2018 

Patients in Yorkshire will benefit from the only MRI-PET scanner in Yorkshire, thanks to University of Sheffield fundraising campaign

University of Sheffield | December 2018 | Patients in Yorkshire set to benefit from revolutionary medical imaging thanks to £2 million fundraising appeal

A campaign launched by the University of Sheffield in 2017 has raised £2million to make possible a revolutionary scanner in Yorkshire.  During the last 18 months, staff, current  students, alumni and members of the public and local business community, and friends of the University have supported the Sheffield Scanner campaign.

The high-tech scanner will provide unprecedented views of inside the human body by combining the power of both MRI and PET images in a single scan. It will help leading scientists and medics tackle some of the most devastating diseases facing millions of people including dementia, cancer, multiple sclerosis, Parkinson’s and motor neurone disease (MND).

The facility will also bring more clinical trials to the region, giving patients in Yorkshire access to ground-breaking new innovative treatments that are being developed. The scanner will be the only MRI-PET scanner in Yorkshire, the new Sheffield Scanner Facility will be attached to the Royal Hallamshire Hospital.

Dame Pam Shaw, Vice-President and Head of the Faculty of Medicine, Dentistry and Health at the University of Sheffield, and Director of the Sheffield NIHR Biomedical Research Centre for Translational Neuroscience, said:

“The combination of these two imaging techniques – MRI and PET – in one machine will let us detect extremely small abnormalities very accurately. We are hoping, and expecting, this will allow us to diagnose medical conditions much earlier. We will also be able to monitor how new innovative treatments are working much more nimbly than we have in the past.

Professor Koen Lamberts, President and Vice-Chancellor of the University of Sheffield, said: “The success of this fundraising campaign is a fantastic achievement and marks the beginning of an exciting journey for the University, the Sheffield city region and beyond. I am extremely proud that Sheffield will now be home to one of only eight MRI-PET scanners in the UK.” (Source: University of Sheffield)

New Quality standard: Oesophago-gastric cancer

This NICE quality standard covers assessing and managing oesophago-gastric cancer in adults. It describes high-quality care in priority areas for improvement.

Quality statements

Statement 1 Adults with oesophago-gastric cancer have access to an oesophago-gastric clinical nurse specialist.

Statement 2 Adults with oesophago-gastric cancer have their treatment reviewed by a multidisciplinary team that includes an oncologist and a specialist radiologist who both have an interest in oesophago-gastric cancer.

Statement 3 Adults with oesophageal or gastro-oesophageal junctional tumours (except T1a tumours) for whom radical treatment is suitable, have 18‑fluorodeoxyglucose positron emission tomography requested and reported within 1 week.

Statement 4 Adults with oesophago-gastric cancer have tailored specialist dietetic support before and after radical treatment.

Full detail: NICE | Oesophago-gastric cancer | Quality standard [QS176]

See also:  NICE interactive flowchart – Oesophageal and gastric cancer

£2.17m boost for pancreatic cancer research

University of Liverpool | 2018 | £2.17m boost for pancreatic cancer research

New research in progress at the University of Liverpool, has been awarded over £2 million by Cancer Research UK, to identify differences in blood samples from people with newly diagnosed diabetes, to people who will develop pancreatic cancer and those who will not. Approximately 50 per cent of all people with pancreatic cancer develop diabetes before their diagnosis. At the moment researchers lack a reliable way to distinguish pancreatic cancer-linked diabetes from normal type-2 diabetes, also known as diabetes mellitus.


Now scientists at Liverpool will look for biomarkers (molecules in the blood samples) that could help them to identify people with a diabetes diagnosis who could benefit from further tests. The samples from participants will be stored in a biobank so they can be used in future studies to further research in this area (Source: University of Liverpool).

Read the full news story from University of Liverpool 



All.Can patient survey

All.Can UK | December 2018| First findings of All.Can patient survey revealed at UK Parliament event

More than a third (36 per cent) of cancer patients reported the greatest inefficiency as being their diagnosis finds the All. Can patient survey sought patients’ and carers’ perspectives on inefficiencies in cancer care.  40 per cent of people who participated in the survey had been initially diagnosed with something else. A similar proportion (34 per cent) also responded to say that they had a surplus of medication left over following treatment.


All.Can worked with Quality Health to develop the patient survey. Quality Health was responsible for all aspects of survey administration and data analysis, with input from All.Can national initiatives and the international research and evidence working group.

The UK piloted the All.Can patient survey ahead of roll-out in other countries throughout 2018. The survey closed in the UK in August, but continued running until 30 November in Australia, Belgium, Canada, France, Italy, Poland, Spain and Sweden.  Data from an international version is also being analysed (Source:

Further details from All.Can

Bowel cancer waiting times figures revealed

University of Edinburgh | November 2018| Bowel cancer waiting times figures revealed

Bowel cancer is the fourth most common cancer type, now researchers from the University of Edinburgh have shown that it takes 10% of  patients in England and Wales more than a year from recognising the symptoms to receiving treatment for their bowel cancer. They found that 10% of people with bowel cancer in Scotland waited more than 8 months to start treatment. 



This international study included anonymised medical data from 3000 patients and their doctors in Australia, and Canada alongside the UK. Among their findings people in Wales took the longest to contact their GP once they had a health concern. Patients in Wales also waited the longest time (168 days)  to commence treatment,  which contrasts with Denmark (77 days. Researchers found that men and women in Wales took the longest to contact their doctor once they had noticed a health concern or symptom (Source: University of Edinburgh).

Full details from University of Edinburgh