Cancer kills hundreds of thousands of people in the UK every year and creates countless suffering to millions more. The recent announcement kicking off the development of a new 10 Year Cancer Plan for England is very welcome, particularly given the dramatic impact of Covid-19 on cancer care and services.

Frontier has been working on improving decisions about cancer care on the frontline for many years. We would highlight four very important elements of any plan:

• Ensuring the approaches are tailored to each specific cancer. For example, some cancers, such as lung or pancreatic cancer, are more likely than others to present with vague, non-site-specific symptoms including weight loss or fatigue. This means that they are more often diagnosed at later stages (stage 3 or 4), decreasing chances of survival. One way of addressing this issue is by continuing the rollout non-site specific rapid diagnostic pathways, where patients with vague symptoms are offered in-depth consultations with specialists before being referred for the appropriate combination of tests. This approach can be contrasted to pathways where the site of the suspected cancer is clear from a patient’s symptoms. For example, in skin cancer diagnostic pathways, it may be preferable for both patients and doctors to reduce the number of times a patient is seen face-to-face, and to make greater use of technology and photography services.

• Getting the right balance between investment in early detection, diagnosis and treatment. It is tempting – and may indeed be appropriate – to invest most heavily in the ‘backlog’ of patients awaiting diagnosis or whose treatment has been delayed.  However, there is a risk that by focusing on ‘catching up’ there is insufficient attention paid to (or investment in) earlier detection. In particular, outreach and related programmes work to get people to come forward for tests and treatment early enough. Outreach isn’t just about promoting understanding of the signs and symptoms of cancer but allowing flexibility in services, for example, by providing cervical cancer screening clinics at times when individuals with work or care responsibilities may be more able to attend, offering conveniently-located Lung Health Checks in supermarket car parks, or providing extra support for people who have had difficult experiences of the health care system in the past, or communities which historically have been less likely to engage with NHS services. This is crucial to tackle inequality issues linked to cancer care. Any cancer plan will have to recognise the costs and benefits of different approaches: outreach programmes may have high costs up front, but can result in savings in the long term if cancers are caught at an earlier stage and treatment is therefore less expensive.

• Getting the balance right between funding for research and development, in new treatments and in the existing set of treatments requires proper assessment of the costs and benefits of each to ensure we get the balance right over the next ten years. From a public investment perspective, there may be a strong rationale to focus support on new, forms of treatment where the private returns are very uncertain (reducing private sector appetite to invest) but the potential public returns are high. For example, the government has recently invested in R&D programmes applying whole genome sequencing to the analysis of cancer, with the aim of creating new products and services that diagnose it earlier and more efficiently. Decisions around prioritising of these kinds of investments versus addressing other pressures such as the cancer backlog will require careful economic analysis.

• Involvement of patients and their lived experiences in designing, communicating about and delivering services. Patients are at the heart of the health service and they need to be at the centre of these proposals. In turn, context-specific factors are vital because what works in one area may not work well in another, depending on what those patients need, in part due to the demographic characteristics of the population. Some patients may engage well with digital engagement, but it may be more effective to engage others face-to-face, either in hospital or in community settings. One size certainly doesn’t fit all, and as new pathways are identified, trialled and implemented, the role of monitoring and evaluating these new pathways is essential to ensure the health service can learn quickly and adapt and that cancer patients don’t fall between the gaps.