NHS well equipped to deliver breast cancer care, but requires improvement for over 70s, new audit finds

Published: 14 Jul 2017

NHS services are well organised to deliver breast cancer care in line with national clinical guidelines.

“Breast cancer survival rates are at their highest ever” said Professor Chris Harrison, National Clinical Director for Cancer at NHS England.

 View full report here

However, services require improvements to meet the individual needs of older patients according to a new report. Recommendations from the report include:

  • Breast Cancer units should review whether patients and carers feel they are involved adequately in decision making.
  • Local protocols should be developed and implemented (1) to improve the formal assessment of older patients’ health and to improve the identification of patients who could benefit from access to Teams Caring for the Older Person
  • Clinicians and hospital managers should review their hospital length of stay figures.
  • Professional stakeholders such as Royal Colleges and Specialist Societies should define the contributions of specialists such as the Team Caring for the Older Person, specialist nurses, anaesthetists and palliative care, in the delivery of breast cancer services for older patients.

The National Audit of Breast Cancer in Older Patients, which is being published for the first time today by the Royal College of Surgeons and the Association of Breast Surgery, found that nationally, around 90% of women aged 50-69 years diagnosed with breast cancer had surgery. Among women aged 70 years or older, the proportion of women who had surgery fell steadily with increasing age, and was approximately 15% for women aged 90 years and over. Surgery to remove the tumour is the primary treatment for breast cancer but other therapies may be preferable for older women if they suffer from existing conditions like heart disease or are too frail.

Breast cancer is the most common female cancer in the UK. There are around 45,000 new cases of breast cancer diagnosed in women each year in England and Wales, with one third occurring in women aged over 70 years.

A comprehensive assessment of an older woman’s health is important for guiding decisions about breast cancer treatment. The audit surveyed 142 NHS breast cancer units in England and Wales about the methods they used to make these assessments.  Responses from 129 units revealed that: 84% of units had a formal assessment process for patient comorbidities, 69% had a formal assessment of frailty, and 46% had a formal assessment of cognitive impairment.

The survey also highlighted that few breast cancer units had formal arrangements for Teams Caring for the Older Patient to be involved in the assessment of older patients with breast cancer. The role of these Teams is to ensure older patients have a complete assessment of their health care needs enabling them to make informed decisions about their own care. The audit found that older woman are less involved in decision-making on their care compared to younger patients. The audit suggests that this could be one of the reasons for a variation in care.

Prof Kieran Horgan, the Audit surgical lead, said:

“Breast cancer can have a dramatic impact on patients and families. While care by NHS services in England and Wales is consistently rated highly by breast cancer patients in general, the first results from this audit have highlighted some variation in the care older patients receive around the country. One of reasons for this is that, while there is good evidence for the treatment of breast cancer, there is less advice on how this treatment should be optimally tailored for older women.”

Prof David Dodwell, the Audit oncological lead, said:

“This national audit is the first to focus on the care of older women in breast cancer. This is important because these women often have different needs compared to younger patients as they may be less suitable for surgery and chemotherapy. By starting this audit, and providing information back to breast cancer services, we can start to ensure care is delivered more consistently to older women across the country.”

The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, and is being carried out by the Royal College of Surgeons of England and the Association of Breast Surgery. The audit, which is the first of its kind, will evaluate the quality of care provided to women aged 70 years or older by breast cancer services in England and Wales. It examines the care pathway of breast cancer patients from their initial diagnosis to the end of primary treatment.