The NHS must focus on the basics of cancer treatment rather than the “magic bullet” of new technology and artificial intelligence or risk the health of thousands of patients, experts have warned.
Writing in the Lancet Oncology journal, nine leading oncologists and academics say NHS cancer care is at a tipping point, with survival rates lagging behind many other developed countries.
The NHS has not met its target of 85% of cancer patients starting treatment within two months since December 2015. International studies have found that every four-week delay in treatment increases the risk of death by up to 10%. This means hundreds of thousands of people are waiting months to start essential cancer treatment, and only 67% start treatment within 62 days.
The paper highlights 10 pressure points that contribute to persistent inequalities in cancer patient survival, delayed diagnosis and treatment, and inadequate care.
Cancer experts issued a stern warning, saying that while “novel solutions” such as new diagnostic tests are being falsely touted as “silver bullets” to the cancer crisis, “none of them address the underlying issue of cancer as a systems problem.”
The authors add that a “common misconception” among NHS leaders is that new technologies can reverse inequalities – when in reality, tools such as AI can create “additional barriers for those with lower digital and health literacy”.
“We caution against adopting a technology-centric approach without a robust fairness evaluation,” the paper concludes.
Lead author Ajay Agarwal, an oncologist and professor in the Department of Cancer Services and Systems at the London School of Hygiene and Tropical Medicine, said no one was suggesting the NHS should stop investing in new technology, but it did not necessarily improve patient outcomes.
“The discussion about AI, technology, and liquid biopsies is a bit reductionist as a solution for cancer care,” he says. “AI is a workflow tool, but does it actually improve survival rates? So far, the evidence is limited. Yes, AI can help the workforce, but you still need people to take patient histories, draw blood, perform surgery, and deliver bad news.”
Instead, he added, the focus needs to be on patient care: “Without early diagnosis, quality treatment, good survival rates and follow-up, we're talking about deaths that could have been avoided.”
Co-author of the paper, oncologist Professor Pat Price, visiting professor at Imperial College London and chairman of the charity Radiotherapy UK, said the UK government “should focus on improving the fundamentals of cancer treatment”.
“We need to ensure not only rapid diagnosis but also timely treatment. If we speed up diagnosis but don't treat it in time, newly diagnosed patients will find themselves on long waiting lists. If the NHS does not focus on tackling these challenges, thousands of patients could die prematurely.”
The authors reiterate their calls for a cancer control plan that introduces measures to ensure more patients receive treatment within 62 days of being referred for suspected cancer, increased screening rates, a national cancer workforce strategy, better mental health supports for cancer patients, and a task force to address the social and commercial determinants of cancer, including housing quality, food policy, alcohol and tobacco use.
In 2022, the government published a 10-year cancer control plan for England. However, within a year, the policy was controversially scrapped as cancer was absorbed into the Major Disease Strategy. Experts pointed to research that showed a dedicated cancer control policy would lead to improved five-year survival rates, and warned that patients would die as a result.
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Then in May, Steve Bryne, then chairman of the House of Commons Health and Social Care Select Committee, wrote to then Health Secretary Victoria Atkins informing her that the committee's inquiry into future cancer had concluded that “it would be a mistake to abandon the 10 Year Cancer Plan”, and urged the Department of Health and Social Care (DHSC) to reinstate the plan.
Responding to the Lancet paper, Mark Lawler, professor of digital health at Queen's University Belfast, said: “Cancer care must be firmly at the top of the political agenda – it could save thousands of lives a year. What could be more important than that?”
“Without a dedicated cancer control plan, cancer patients will die.”
Naser Turabi, director of evidence and implementation at Cancer Research UK, said the report highlighted the investment and reform that was needed across all aspects of cancer care.
“Cancer patients deserve much more support, but change is impossible without a long-term, well-funded strategy for cancer research and treatment,” he added. The new government must deliver on its promises and provide cancer services with the extra staff and equipment they need, he added.
A Department of Health and Social Care spokesman said: “Too many patients are waiting too long for a diagnosis and treatment. The NHS has fewer diagnostic scanners per person than other countries, and many of them are old.”
“Early diagnosis and treatment are crucial to beating cancer. By doubling the number of MRI and CT scanners and purchasing AI-enabled scanners for faster diagnoses, we can detect disease earlier and save lives.”
