THE EVIDENCE BEHIND THE CANCER PLAN

The evidence behind the Cancer Plan

Background

The original aim of this project was to provide a web resource which describes the evidence behind the NHS Cancer Plan. However in autumn 2006, shortly after pilot work began, the development of the Cancer Reform Strategy was announced. As a result, the focus of the project changed to address key areas of importance to the new strategy, which were identified as: inpatient care; chemotherapy services; follow-up; and patient presentation and referral.

Findings

For inpatient care and chemotherapy services, scoping reviews were conducted to identify and collate the available evidence, rather than to review and appraise the research. 695 records were identified as being relevant to inpatient services and 230 records were identified as being relevant to chemotherapy services. Relevant records were coded according to their subject area.

A rapid review was undertaken to identify and assess evidence relating to the effectiveness and cost-effectiveness of follow-up after treatment for breast, colorectal, prostate, lung and haematological cancers, and generic, non site-specific follow-up strategies. Little relevant evidence was identified except for colorectal and breast cancer. For colorectal cancer there was sufficient good quality evidence to suggest that follow-up can result in improved survival. However, the available evidence does not provide a clear indication of which tests should be used or how often. The evidence for follow-up strategies for breast cancer is less clear as the results varied across studies. The economic evidence was limited and provided little additional information, but did confirm, as would be expected, that more intensive follow-up programmes are more costly than the standard follow-up. There were no systematic reviews or RCTs evaluating follow-up for lung, haematological or prostate cancer. One economic evaluation each was identified for lung and haematological cancer. The lack of good quality evidence highlights the need for further research of follow-up strategies to assess which specific tests should be used, how frequently they should be applied, and for whom.

The final element of the project was a rapid review of interventions to reduce delay in people seeking medical advice after noticing symptoms, or delay between a GP consultation and referral to a specialist. The review updated a previous systematic review which highlighted a paucity of evidence. Based on our searches for primary studies since 2002, the question of what interventions may reduce patient and primary care delay remains under-researched. Only four studies met the inclusion criteria for the review and none of the studies were randomised leading to a considerable risk of bias. It would therefore be inappropriate to make any recommendations for practice based on this evidence. Good quality research is required to evaluate the effectiveness of strategies to reduce patient and primary care delay.

Conducted by: CRD and the National Cancer Director

Publications

Centre for Reviews and Dissemination. The evidence behind the cancer plan. A report to the funders. 2007

Posters

Beynon S, Wade R, Norman G, Stirk L, Eastwood A. Using systematic review methodology to inform policy. Health Technology Assessment International (HTAi) Annual Meeting; 2007 June; Barcelona, Spain

Funding

Commissioned by Cancer Research UK