It is calling for a new feminist agenda for cancer care to eliminate gender inequality.

“The impact of a patriarchal society on women’s experiences of cancer has gone largely unrecognised,” said Dr Ophira Ginsburg, a senior adviser for clinical research at the National Cancer Institute’s Centre for Global Health and a co-chair of the commission.

“Globally, women’s health is often focused on reproductive and maternal health, aligned with narrow anti-feminist definitions of women’s value and roles in society, while cancer remains wholly underrepresented.

“Our commission highlights that gender inequalities significantly impact women’s experiences with cancer. To address this, we need cancer to be seen as a priority issue in women’s health, and call for the immediate introduction of a feminist approach to cancer.”

Their investigation reveals that palliative and end of life care is ‘variable and inequitable’ across the NHS, and the report includes a series of safety recommendations and actions. To understand the impact of inconsistent palliative care, HSIB looked at the case of Dermot – a 77-year-old patient who was diagnosed with myxofibrosarcoma in March 2020, and received support from Sarcoma UK.

Here, Dermot’s brother-in-law, Richard, 60, also shares the family’s insights into Dermot’s experiences and the changes that are needed to improve care for sarcoma patients. Richard and Sarcoma UK have put together their own recommendations, which provide clear, simple and positive suggestions to improve the sarcoma patient pathway.

1. The NHS should update its key priorities and set expectations for integrating collaborative partnership working as a mechanism to achieve outcomes and deliver upon existing priorities for Cancer Alliances.
2. Health inequality strategy guidance for Cancer Alliances should closely examine the intersectionality of health inequalities for people who span multiple vulnerable groups. Integrated care boards (ICBs) should encourage dedicated training for clinicians and care commissioners to identify intersectional groups.
3. Cancer Alliances should work with integrated care partnerships (ICPs) to understand their priorities, develop a shared mission, and derive mutually beneficial approaches to developing localised and responsive cancer strategies. These should be adapted and implemented across the devolved nations to be suitably implemented across their existing cancer services.
4. ICBs should be required to evidence their understanding of local populations.
5. Patient representation panels should be better harnessed to develop new diagnosis and treatment pathways or interventions, as well as new clinical trial models for breast cancer.
6. Individual screening initiatives should seek out the experiences of others in order to reach those at highest risk for poor outcomes across different cancer pathways. An example off this might be conducting screening in mobile units to optimise accessibility, as was done by Targeted Lung Health Check services.

• patterns of care at diagnosis
• staging and treatment planning
• waiting times along the care pathway
• curative surgery
• non-curative treatments.

It also includes findings relating to the impact of the Covid-19 pandemic, including:

• In April 2020, the number of patients diagnosed with OG cancer was 43.6% of the 2019/20 monthly average, falling from 837 to 365 cases per month.
• The numbers diagnosed soon returned to normal levels, and in the period from June 2020 to March 2021, the number of monthly cases was 97.8% of 2019/20 levels.
• The percentage of patients diagnosed with stage 4 disease (advanced cancer) increased from 41.6% in 2019/20 to 44.9% in 2020/21.

The report also contains recommendations for healthcare professionals, among which is including a call to review patients diagnosed after emergency admission and undertake root cause analysis to identify opportunities to reduce rates of emergency diagnosis.

Overall, 89% of parents/carers rate NHS cancer or tumour care for people aged under 16 as 8 or above on a scale of 0-10, and 77% of children said that they felt “very well” looked after. This compares favourably to other care settings: for example, in recent surveys ratings of 8 or above out of 10 were given by 85% of parents/carers of children and young people treated in hospital for all conditions and by only 70% of adult inpatients. Coupled with positive results about interactions with individual staff members, this suggests that NHS hospitals are providing good one-on-one care for young people with cancer.

Despite these positive results, the survey shows problems around continuity of care. More than a third of respondents (34%) said that staff did not or only sometimes worked well together, and around two in five (38%) said that they were “always” or “sometimes” told different things by different members of staff, which left them feeling confused. This was particularly an issue for parents/carers of the youngest patients, those aged 0-7: 43% in this group reported being confused by inconsistent information. Problems with continuity were worse for those who received care from more than one hospital (77%); of this group, 46% said that different hospitals did not or only “sometimes” worked well together.

The detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research.

This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis.

The data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery.

This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average survival for all European cancer patients by 2035.