Why We Need to Start Unlocking Change Using Cancer Data Now

We can all agree that cancer does not go on holiday. Yet during the winter months, referrals for suspected skin cancer in England decline steeply.

The National Health Service (NHS) collects extensive data that presents a golden opportunity for improvement and targeted interventions. For instance, by examining the data on skin cancer referrals, we can identify a long-standing pattern that presents a significant opportunity and exemplifies the potential of routinely collected data to enhance outcomes.

In the case of skin cancer, this opportunity translates to 170 lives a year that may have been saved through earlier cancer detection.

Skin cancer referrals: unlocking opportunities through a 10-year trend

The NHS Digital Cancer Waiting Times records provide valuable insights into skin cancer referrals. A simple glance at the time trend reveals a stark cyclical pattern.

The difference between the lowest point in referrals in January and the peak in August is astonishing, with August witnessing a 60% increase compared to January.

If we were to expect referral volumes to be relatively constant across the year, 36,000 patients might have presented sooner than they did in 2022. Given the skin cancer conversion rate of 8%, that’s nearly 3,000 potentially delayed diagnoses.

Moreover, the number of 2WW referrals aligns rather consistently with the number of patients awaiting cancer treatment. Therefore, fewer referrals are a result of fewer cancers presenting and being detected, rather than an artificial summer spike in referrals.

It is not news either – the pattern was present in 2016 and is just as prevalent today as it was then. This is an area that would benefit from targeted intervention.

A Chance to Improve Patient Outcomes

The decline in winter referrals for skin cancer likely occurs because people tend to notice skin changes less often during this season, and others may also point them out less frequently (for instance, as suggested by Walter et al. ). This effect has been observed for several years, not only in the UK but also in countries like Italy and France.

What is notable about the UK, however, is that it lags behind much of Europe for cancer survival rates – this includes skin cancer, though to a lesser extent, given the generally higher survival rates compared to others.

Early detection represents the greatest opportunity for addressing this disparity. Patients who delay their presentation to a GP until the summer may be diagnosed with cancer at a stage later than otherwise.

While skin cancer survival rates are relatively high, late-stage detection significantly reduces chances of survival. For patients diagnosed at stage 1 cancer (55.5% of diagnoses), the 5-year survival rate is 100%. This, however, drops 84% for stage 2 (21% of diagnoses) and 73% for stage 3 (8% of diagnoses). Detecting melanoma at stage 1 versus later stages could save 560 lives for every 10,000 patients.
For 2022, that means an extra 170 lives could have been saved out of the 3,000 potentially delayed diagnoses.

Addressing Service Challenges

The surge in summer referrals for skin cancer also strains the capacity of healthcare providers, leading to delays in diagnosis and treatment for all dermatology patients. This issue has become even more significant in the aftermath of the pandemic, as healthcare services struggle to cope with mounting waiting lists.

The following chart highlights this challenge – as the volume of 2WW referrals increases, so do the 62-day target to treatment breaches. Although the time lag between the two is not substantial, it has widened since the pandemic, likely due to the extra burden posed on services by the elective backlog.

Patients referred just before the peak experience the most significant impact, as the capacity for 2WW referrals competes with the capacity for treatment. This indicates a healthcare system under pressure, where there simply isn’t enough capacity to handle a sudden rise in referrals. To address this issue, targeted solutions are needed.

What can we learn from this?

There is a strong case for gaining more insights across various cancer types, examining inequalities, geographies, pathways, and populations to align them with the Core20Plus5 priorities.

This knowledge can help to focus on a broader range of interventions and measure their impact.

For skin cancer, two clear opportunities emerge:

1. Implementing winter skin check campaigns, akin to successful breast cancer awareness efforts. Targeted outreach could encourage earlier presentation, improving outcomes.
2. Provider strategies to manage summer surges, such as Teledermatology and cross-site collaborations. New approaches may expand capacity for minor procedures and biopsies, speeding up diagnosis and care.

Data-driven insights can focus and maximize initiatives by revealing where needs and inequities lie. They also offer opportunities to monitor progress and assess effectiveness.

Learning to harness information will be crucial to the future of the NHS. The skin cancer example serves as a testament to how data can uncover life-saving possibilities and point the way toward realising them.