Senior doctors overseeing cancer care in England and Wales have expressed concerns that service deficiencies within the National Health Service (NHS) may result in as many as half of cancer patients not receiving the correct treatment for certain cancers.
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02-24, 2025Evidence obtained by the BBC reveals that the National Cancer Audit Collaborating Centre (NatCan) has highlighted specific issues with prostate, kidney, and colon cancers. The expert group stated that they found significant variations between hospitals and warned that the failure to access nationally recommended treatments is endangering lives.
NatCan conducts audits on nine major cancers, which account for 80% of all cases. The audits found shortfalls across various cancer types and stages. Data shows that 30% of high-risk prostate cancer patients did not receive radical treatment such as surgery or radiotherapy, with significant performance variations between different services, ranging from 20% to 43%; 34% of stage III colon cancer cases did not receive chemotherapy within three months of surgery, with this figure exceeding 60% in some hospitals; and 50% of stage IV renal cell carcinoma patients (a type of kidney cancer that has spread to other parts of the body) did not receive drug treatment, with performance variations also significant, ranging from 20% to 85%.
NatCan stated that while a minority of patients may choose not to receive treatment, or other patients may be too unwell, this does not fully explain the scale of the shortfalls or the variations between hospitals. Both governments have stated that improving services is a key priority, and England is developing a new cancer strategy, which ministers say will transform services.
Ian Pattison's case highlights the value of receiving the correct treatment. He was diagnosed with high-risk prostate cancer in 2020, at the age of 65. The cancer had started to spread to nearby organs, and he received nationally recommended hormone therapy and radiotherapy. He said the treatment was painful, but now, at 70, his cancer is in remission, and he is enjoying life. Pattison said: "I was lucky to live near a specialist cancer centre in Newcastle, where I could get the best treatment. It was tough going through it all and dealing with the side effects, but I am so grateful that I got the treatment. I feel fit and well, and I enjoy going for walks, spending time with my family, and looking after my grandchildren."
Professor Ajay Aggarwal, clinical director at NatCan, said it was concerning that so many patients were not receiving recommended treatments, and that the variation was difficult to understand. "We need to do better," he said. "With cancer, we often hear people talking about what the next breakthrough is, but the reality remains that better use of what we have can make a huge difference. It can extend and save lives."
Professor Aggarwal said there could be several reasons for the problems and variations, including some services unfairly assuming that older patients would not cope with treatment, and issues with staffing and capacity. He said there was evidence that smaller hospitals were not always referring patients to specialist centers where they could receive treatment, but that even some large centers had shortfalls in certain cancers. He added, however, that the problems were not uniform, and that treatment rates for some cancer types were much better.
Tim Mitchell, president of the Royal College of Surgeons (RCS), echoed the same concerns, stating, "The NHS has access to world-class cancer treatments and care, but inconsistent delivery means that too many patients are missing out. At worst, this could mean some patients are dying unnecessarily or suffering needlessly." Cancer charities have stated that addressing these issues may be more important than reducing waiting times.
Eve Byrne of Macmillan Cancer Support said the findings were "appalling," adding that tackling the variation should be a "top priority" in the upcoming national cancer strategy. She said: "Access to the best care for the best chance of survival should not depend on which hospital you visit or where in the country you live." Ms. Byrne said that patients should receive the correct care for their specific type of cancer, no matter where they are. "We worry that people from deprived, rural or ethnically diverse communities may be particularly disadvantaged," she said.
Amy Rylands of Prostate Cancer UK said patients were effectively being robbed of "the best chance of a cure," adding: "This needs to change now." Professor Peter Johnson, national cancer director for NHS England, said: "We know that patients' experiences of cancer care do vary too often - and we are working to address this." A spokesperson for the Department of Health and Social Care said: "Patients should be able to access the cancer care they need, no matter where they live, and we are committed to tackling health inequalities as we recover services." A new cancer strategy is expected to be published later this year, with Health Secretary Wes Streeting saying it will transform services. A Welsh government spokeswoman said it was working with the NHS "to plan, deliver, recover and improve cancer services." She said the audit highlighted areas where further effort was needed.
