Political stalemate holds back cancer strategy

Is the current political instability in Northern Ireland impacting upon bowel cancer patients? The answer to that question is unarguably yes. Early diagnosis of bowel cancer is vital to improve the outcomes for patients. Almost everyone diagnosed at the earliest stage will survive bowel cancer however this drops significantly as the disease develops. Therefore, timely access to diagnostic tests and treatment is key to improving patient survival.

Research has established that cancer survival in Northern Ireland is behind other parts of the UK, Australia, Canada, Denmark, the Republic of Ireland, New Zealand, and Norway. Northern Ireland is consistently found to be at or near the bottom of the league table of these comparator countries which is unacceptable.

A ten-year cancer strategy was launched in March 2022, benefitting from cross-party support, with the aim of reversing this trend. The strategy established a range of measures to enhance early diagnosis and the development of rapid treatment plans to save more lives.

The absence of a working Northern Ireland Executive through which key decisions are taken, including critical funding to support the cancer strategy, has slowed progress towards achieving agreed actions delaying improved patient outcomes that we want to see.

Prior to the current stalemate, Northern Ireland already lagged well behind other parts of the UK in bowel cancer diagnosis, with suboptimal screening standards and lengthy cancer waiting times, both impacting negatively on efforts to achieve earlier diagnosis of bowel cancer.

Bowel screening programme

The evidence is clear; bowel cancer screening can save lives.  Screening aims to detect bowel cancer at an early stage when no symptoms are apparent, and treatment has the best chance of working. The test can also find polyps (non-cancerous growths), which might develop into cancer. Polyps can usually be removed, to lower the risk of bowel cancer.

The bowel screening programmes across the UK use a test called a Faecal Immunochemical Test (FIT) first introduced into Northern Ireland in January 2021 some three years behind the other UK nations.

Northern Ireland has levels of bowel screening participation which are below what we would wish to see with only three out of five of the eligible population taking part in the programme. The importance of bowel screening in saving lives cannot be over emphasised, as 21% of all bowel cancer diagnoses were detected in Northern Ireland using this facility.

Bowel cancer screening is more likely to lead to a diagnosis at an early stage where survival is greatest with 96% with stage one surviving at least 5 years.

While the UK National Screening Committee recommend that bowel screening should be offered to everyone over 50 years old on a two-yearly basis, screening in Northern Ireland is only available to people aged 60–74. This is in stark contrast to Scotland which offers testing from the age of 50, while England and Wales are already well on the way to bringing their age criteria down to 50. England and Scotland also offer screening to those over 74 if requested.

Four out of five people in Northern Ireland are diagnosed outside the screening programme with bowel cancer. Screening is one of several approaches that need to be implemented if we are to see improvements in early diagnosis.

We need to see a national programme to raise awareness of bowel cancer symptoms, enhanced use of qFIT in primary care for patients who present with symptoms, and improved Lynch syndrome testing and surveillance.

All these initiatives require a functioning Assembly in Stormont, with an Executive that drives forward progress on delivering the cancer strategy’s objectives.

Cancer waiting times

The Department of Health, within ‘A Cancer Strategy for Northern Ireland 2022-2032’, set out actions to be undertaken to improve cancer services, such as meeting longstanding cancer waiting times target.

At least 95% of patients should begin their first treatment for cancer within 62 days following an urgent GP referral for suspected cancer. The most up to date statistics indicate that from April to June 2022 Northern Ireland once again has failed to meet this target, with just 19% of bowel cancer patients beginning treatment within 62 days, this is the lowest level across the four UK nations.

Longer waiting times can lead to delays in diagnosis and treatment. Awaiting diagnosis of cancer can be stressful and cause distress not only for the patient but also for the families.  Research indicates that 73% of people living with cancer can experience poor mental health, predominantly worry, fear, anxiety, sadness, depression and loss of confidence.

It is likely that longer waiting periods can create the same feelings of distress and anxiety, particularly amongst those with a previous mental health history.  This is another reason cancer waiting times need to be reduced as priority in Northern Ireland. 

What needs to happen next?

The poor performance in bowel cancer diagnosis and treatment in Northern Ireland needs to be addressed as a matter of urgency.  NHS staff are doing their absolute best to deliver a high-quality service, however they are facing an uphill battle given the current lack of political support.  It is entirely possible, given the information we have, that people are dying needlessly which is an unacceptable situation.

We call for measures, set out within the cancer strategy, are implemented without delay to include:

• Adequate funding must be committed to support implementation of the strategy
• A sufficient number of appropriately trained staff available to deliver cancer services
• The screening age range in Northern Ireland is reduced to a minimum age of 50 years in line with NICE recommendations
• The screening threshold in Northern Ireland is reduced to initially align with Scotland (80µg HB per g of faeces), with the ultimate objective of reflecting NICE recommendations of 20µg HB per g of faeces
• All patients who are diagnosed with bowel cancer are tested for Lynch syndrome
• Pathways are developed to ensure that all people diagnosed with bowel cancer are provided with mental health support

In conclusion

We must always remember that every statistic outlined above is a family member, friend, neighbour or work colleague, none of whom need to die as bowel cancer is treatable if diagnosed early.  What the community in Northern Ireland is entitled to right now is political leadership, across all parties, to deliver the funding and support needed to deliver on this vital cancer strategy to improve bowel cancer services and save lives.

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