Improvements and efficiencies have been made in key areas of cancer care since the Cancer Reform Strategy was published in 2007. The NAO estimates that cancer cost the NHS approximately £6.3 billion in 2008-09, but it is not clear if the implementation of the Strategy is achieving value for money. Reported spending on cancer care varies between PCTs - in 2008-09 varying from £55 to £154 per head - and there is unexplained variation from year to year. Significant reductions have been made in the number of days cancer patients spend in hospital - largely as a result of increasingly treating patients as day cases. The Strategy aimed to minimise emergency admissions for cancer patients, but these are still increasing, with wide variations between PCTs and poor understanding of the reasons for those variations. There are opportunities to achieve better outcomes and free up resources. Reducing the average length of stay in hospital to the level of the best performing PCTs, efficiencies worth some £113 million a year could be achieved. If the number of inpatient admissions per new cancer diagnosis was reduced to the level of the best performing PCT, bed days equivalent to around £106 million each year could be saved. Radiotherapy machines could be used more productively to help the NHS meet increasing demand. High quality information is essential to be able to commission services successfully and to monitor performance. Some information on cancer has improved, but significant gaps still remain.

This report examines the Department of Health's and the NHS's performance in delivering cancer services; improving information on activity, cost and outcomes of cancer services; and how the Department intends to deliver cost-effective cancer services in the new NHS. The NHS spent £6.3 billion on cancer services in 2008-09. Tackling Cancer has been a priority for the Department since its ten year NHS Cancer Plan was published in 2000. In 2007 the Department published its five year Cancer Reform Strategy (the Strategy) to deliver improved patient outcomes. The NHS has made significant progress in delivering important aspects of cancer services, with falling mortality rates and consistent achievement of the cancer waiting times targets. However, early diagnosis does not happen often enough. And the gap in survival rates between England and the best European countries has not been closed. There remain wide, unexplained variations in the performance of cancer services and in the types of treatment available across the country; and significant gaps in information about important aspects of cancer services, in particular information on chemotherapy, on follow-up treatment, and on the stage that a patient's cancer has reached at the time of diagnosis. The Department cannot yet measure the impact of the Strategy on key outcomes, such as survival rates, and does not know if cancer services are being commissioned cost-effectively, due to poor data on costs and because outcomes data are not sufficiently timely. The Department must ensure the collection of high quality, comprehensive and timely data.

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.