The route back to our 25 by 25 ambition

By Professor Robert Rintoul, chair of the UKLCC’s clinical advisory group, and Professor of Thoracic Oncology, University of Cambridge.

Prior to the pandemic, real progress was being made in raising five-year lung cancer survival rates in the UK. However, COVID-19 has had a devastating impact on early diagnosis of lung cancer and has put the UKLCC’s target of driving up the five-year UK survival to 25 percent by 2025 (25 by 25) in jeopardy.

Recent estimates reveal that delays in diagnosis caused by COVID-19 lockdowns will result in a drop of up to 5% in five-year survival in England – from the latest figure of 17.6% (patients diagnosed 2014 to 2018) – to around 13% for those diagnosed during the pandemic.

Indeed, lung cancer patients have been disproportionately affected by the pandemic. Government guidance to stay at home with a cough, reluctance to engage with healthcare services during lockdown, and pressures on already over-burdened health services, have inevitably resulted in a fall in referrals and increase in late-stage presentations of the disease.

While this backwards step is one of the saddening legacies of the pandemic, as a lung cancer community we must rally together and focus on making improvements going forwards.  It is simply not ambitious enough to be trying to get back to pre-pandemic outcomes, we must be looking to improve outcomes to the best in Europe, and in the world. 

Urgent measures must be put in place to continue the trend of improved five-year survival achieved prior to the pandemic.  One of the most critical things that we must do to achieve this is to move from early diagnosis to earliest diagnosis and shift the needle in long term survival for lung cancer patients.  England is already delivering a world leading pilot programme of lung health checks.  As a group of leading lung cancer experts, we believe that the roll-out of a full lung cancer screening programme across all four nations would do more to improve lung cancer survival than any other single intervention. Twice year public awareness campaigns on signs and symptoms of lung cancer – both nationally and locally – linked to a dedicated patient helpline – will help increase access to support and diagnosis. We urge the four UK governments to move quickly with implementation. 

We also know that when patients have a diagnosis of lung cancer, there are unwarranted variations both between the nations and locally across the four countries.  If the Government’s levelling up agenda was applied to lung cancer, then we would be seeing many more patients accessing potentially curative treatments – which would transform survival. 

We also know that we need to look after and build the cancer workforce better.  We need to train and retain a workforce which is currently in crisis, because without the talented and dedicated people who work across the entire lung cancer pathway, we simply won’t be able to support lung cancer patients in the way that they deserve.

This report provides a blueprint for politicians and policymakers setting out the most important areas of focus to improve lung cancer outcomes.  This is focused on solutions which the clinical community believe will have the biggest impact on outcomes.  We need to act collectively and urgently to rebuild and recover from the consequences of the pandemic on lung cancer and get back on track to deliver a step change in lung cancer outcomes.

Together, we can fix UK lung cancer. To read our full report visit: www.uklcc.org.uk/our-reports/

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