Cancer study reveals lower Scotland treatment levels

The results, covering 780,000 people diagnosed with cancer over the five-year period, provide the most up-to-date available international comparisons.

It is also the first time treatment differences have been examined across three continents for the eight types of cancer included: oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancer. 

Cancer Research UK, which co-funded the work, said the "worrying" findings may help to explain why cancer survival in Scotland lags behind other nations.

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While waiting times performance has deteriorated throughout the UK since the pandemic struck, the charity added that it does not expect there to have been "substantial shifts in the data given the time it takes to change clinical practice".

According to the ICBP, 29.3% of patients in Scotland received over a five-year period compared to 39.1% in Norway, 42.1% in Australia, 31.9% in England and 31.1% in Wales.

Patients in Scotland also faced some of the longest waiting times to start treatment - an average of 65 days to commence chemotherapy compared with 48 days in England and 39 days in Norway.

The average wait for radiotherapy in Scotland was 79 days compared with 44 days in Norway, between 43 and 45 in Australia, 63 in England and 53 in Northern Ireland.

Only patients in Wales waiting longer, at 81 days on average.

Patients in Scotland were much less likely than those in Norway to receive chemotherapy (Image: ICBP)

The ICBP is an international partnership of clinicians, academics, policy makers and data experts, hosted by Cancer Research UK, which conducts research to identify best practice internationally.

They found that countries with better cancer survival typically had higher use of chemotherapy and radiotherapy, and shorter waits to start treatment.

For example, five-year survival for Stage Three colon cancer was higher in Norway (70.7%), Canada (69.9%) and Australia (70.1%) than in Scotland (61.7%).

People living in Norway and Australia started their treatment for colon cancer in the quickest time.

Fewer older patients in Scotland were treated with chemotherapy and radiotherapy.

In Scotland, 1.5% of those aged 85 and over underwent chemotherapy, compared with 8.1% in Australia and 14% in Ontario, Canada.

Time to starting chemotherapy was longest in Scotland and second longest for radiotherapy, according to the study (Image: ICBP)

Cancer incidence in Scotland is projected to increase 22% by 2040, mainly due to an ageing population, increasing demand for screening, diagnostic tests, and treatment. 

Georgios Lyratzopoulos, a professor of cancer epidemiology at University College London and the lead researcher on the study,  said: "We already know that the cancer survival in the UK has fallen behind countries like Australia and Canada, and this analysis of two key cancer treatments highlights one of the likely reasons.

“With cancer cases projected to rise in the UK, the NHS must be equipped to deliver the best care for patients.

"The cancer treatment landscape is changing at pace, but capacity issues and system pressures mean that not all patients can feel the benefit of specialist cancer treatments.

“To improve the UK’s cancer outcomes, we need to continue to investigate what is driving international variation in treatment – better data collection is key to this.”

The time from referral to diagnosis is becoming longer due to increased demand for tests and scans (Image: PA)

Professor David Cameron, the ICBP deputy chair and chair of the Scottish National SACT (Systemic Anti-Cancer Therapy) Programme Board, said: “These analyses can only be done when countries are prepared to share their data so that comparisons can be made as to how, and how quickly, cancers are treated in different parts of the world.

“We now need to look at our own data and see why we appear to be different, and what we can do to improve the care offered here in Scotland.”

The Scottish Government's 10-year cancer strategy, published in June 2023, has pledged to improve survival by halving the percentage of cancers detected at a late stage and ironing out postcode lotteries in care. 

Dr Sorcha Hume, Cancer Research UK’s public affairs manager for Scotland, said it was "crucial" that the Scottish Government delivers on its promises.

She said: “A particular focus should be those set out in the strategy’s first three-year action plan, including the commitment to rolling out new pathways for patients and addressing the current workforce issues facing cancer services.”