The number of people being diagnosed with and surviving cancer is increasing every year. As of 2015, an estimated 2.5 million people are living with cancer in the UK, an increase of 400,000 people in just five years.
It has long been recognised that these people have a range of practical, personal and emotional needs: however, until now, what is often less appreciated is the extent to which they are also more likely to have one or more non-cancer long term condition (LTC). Recent research commissioned by Macmillan Cancer Support (Macmillan) and carried out by Monitor Deloitte found that some 1.8 million people in the UK who are living with cancer also have at least one other LTC, such as hypertension, obesity, or chronic kidney disease.i
Living with a LTC such as these not only reduces a person with cancer’s chance of survival; it also increases their need for support and assistance with daily living. In addition, the way in which we treat people with both cancer and other LTCs in the UK may partly explain why our survival rates lag behind those of other European countries. This emphasises the importance of health and social services working together to provide a holistic person-centred approach for all people living with cancer.
In reviewing the interrelationship between cancers and other LTCs, the research found that some 70 per cent of people with cancer are living with a non-cancer LTC, and that people with cancer are 31 per cent more likely than people without the disease to be living with a LTC, even after taking age into account.ii Indeed, while the proportion of people with cancer who have one or more other serious LTCs increases with age, more than one in three (39 per cent) of people with cancer aged 25-49 are living with at least one other condition. Moreover, around 700,000 people of all ages living with cancer have three or more LTCs.
Looking ahead, the overall number of people with cancer and another LTC is expected to increase by one million over the next 15 years, placing a major strain on the NHS and local authorities. Furthermore, cancer is no longer just something that you are either cured of or will die from, instead, for many, cancer itself has become a LTC which most people have to manage alongside other conditions.
Previous Macmillan research shows that the implications for cancer patients of living with other LTCs are clear. Both survival and quality of life are negatively affected by the presence of a LTC. Women with breast cancer and men with prostate cancer who have only one other serious LTC condition before they are diagnosed with cancer are more likely to die within seven years of diagnosis than those who do not have a pre-existing condition. For example, women aged 65-69 with breast cancer are a third more likely to die within seven years if they have one other pre-existing serious health condition. For men with prostate cancer, the difference is even greater – those aged 65-69 with one other pre-existing condition are 58 per cent more likely to die within seven years.iii
Two in three (67 per cent) people with cancer who have other LTCs have practical or personal support needs, compared with around three in five (57 per cent) people with cancer who have no other conditions. Research also shows that people with cancer who have other LTCs also need more emotional support and are more likely to need formal social care than people with no other LTCs.iv
There is also an impact on costs of treatment. Hospital inpatient care for men with prostate cancer who have one other serious long-term health condition before they are diagnosed with cancer costs on average £5,000 more per patient than inpatient care for men with no other conditions.v The average cost of inpatient care for men with one other pre-existing condition is £11,700, measured for up to seven years following diagnosis, compared with £6,700 for men with no pre-existing conditions. The cost of inpatient care for women with breast cancer and one other serious pre-existing condition is on average over £2,500 more than for women with breast cancer and no other conditions (£12,600 compared with £10,000).vi
People with cancer in the UK have individual and complex needs, and our health and social care system urgently needs to reflect this. The presence of LTCs is associated with poorer cancer survival rates and higher levels of need. This requires an approach that focusses on the whole person with cancer, not just treating single diseases and their individual symptoms separately. Understanding cancer not only as a LTC itself, but in the context of other LTCs is therefore a key challenge for all policy makers, commissioners and providers as well charities like Macmillan and one that we cannot afford to ignore.
iMacmillan press release at http://www.macmillan.org.uk/Aboutus/News/Latest_News/18millionpeoplearelivingwithcancerandanotherlongtermcondition.aspx
iiiRoutes from Diagnosis, Macmillan Cancer Support, 2014
ivUnpublished data from Macmillan Cancer Support/mruk research study comprising of:
• A UK-wide survey of 1,037 people living with cancer and their carers (209 people in treatment, 573 people with cancer diagnosed up to 10 years previously, and 255 current or recently bereaved carers of people at the end of life). 219 interviews out of the 1,037 were conducted with people living with cancer in Scotland.
• 24 in-depth face-to-face interviews
• 15 week-long online diaries
The data show that 44% of people with cancer who have other long-term conditions report having needs that could be classified as ‘critical’ or ‘substantial’ according to the former England’s Fair Access to Care Services (FACS) criteria. Scotland, Wales and Northern Ireland use similar criteria, although precise definitions differ, compared with 35% of those with no other conditions. For an overview of the main findings from the research, see: Macmillan Cancer Support. Hidden at home: The social care needs of people with cancer. March 2015. http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Carers/hidden-at-home.pdf
vRoutes from Diagnosis, Macmillan Cancer Support, 2014