A National Cancer Plan for England: remember the needs of people in rural and coastal areas
We welcome the recent news that the UK Government is proposing to publish a National Cancer Plan for England, bringing it in line with the devolved nations. The unfathomable decision by the previous administration to abandon a national cancer plan and subsume cancer into a Major Conditions Strategy has been met with much criticism1 2, and disappointment from UK cancer charities, including Cancer Research UK and Macmillan Cancer Support. England’s lack of a dedicated national cancer policy is at odds with the overwhelming evidence from the International Cancer Benchmarking Partnership (ICBP), showing that countries with the best cancer outcomes have dedicated cancer plans and consistent cancer policies.3 The importance of the announcement by Stephen Kinnock, the Minister of State for Care, on the 31st October, 2024 that a National Cancer Plan would follow the release of the 10-Year Plan for Health in Spring 2025 cannot be understated, although it is important that this timeframe does not slip –a dedicated national cancer plan is urgently needed.
While these developments are encouraging, cancer policy in England has historically tended to neglect, or at least, not explicitly consider, the significant proportion of people living in areas classified as rural, which, in England amounts to nearly ten million people. This sizeable rural population presents considerable challenges, given the notable workforce shortages with fewer NHS staff per head in rural areas compared to urban. Rural people face increased travel times and barriers to accessing cancer care, that is, for the most part, located in larger urban towns and cities.4 Existing evidence within the UK and internationally suggests that rural residence can be associated with poorer cancer experiences and outcomes.4-7 Recent research in England has highlighted that people with cancer who live in deprived rural areas face the longest travel times to treatment centres, 7 while poorer geographical access to care has been associated with poorer outcomes.6 A systematic review shows that people living with cancer in rural areas have unique unmet psychosocial needs concerning finances, travel and accessing care.8 It is, therefore, essential to include in a National Cancer Plan how access to preventative, curative and rehabilitation services can be enhanced in rural areas with health, social and economic deprivation.
In addition to rurality, coastal areas have received explicit national policy attention concerning place-based health inequalities, mainly through the Chief Medical Officer for England’s annual reports in 2021 and 2023. In England, some of these once desirable and economically prosperous coastal seaside towns, are now frequently characterised by deprivation, alcohol and drug abuse, and poor physical and mental health. There is an emerging9 10, but limited body of published work that specifically acknowledges the needs and challenges of people with cancer in coastal parts of the UK. After adjusting for the older age profile of coastal communities, data from the 2021 census in England and Wales, demonstrate that people in coastal areas report poorer health, a higher degree of disability and lower educational attainment, than those in non-coastal areas. Whilst the nuances and differences between rural and coastal communities need to be specifically recognised, both settings share explicit synergies when it comes to reduced access to cancer services, presenting considerable challenges for people living with and affected by cancer. It should also be noted that there can be health benefits to rural and coastal living (e.g. access to nature, green and blue spaces), and we welcome future cancer research in this area. Where cancer policymakers are concerned, coastal and rural areas, that are characterised by high deprivation, should be prioritised for investment and interventions, versus their more affluent counterparts.
Despite these health inequalities among coastal communities, specific data on cancer outcomes are lacking in the United Kingdom due to the absence of a clear definition of ‘coastal’, although, there is much promising work happening in this space, led by the Centre for Coastal Communities at the University of Plymouth. Coastal communities are included in NHS England’s Core20PLUS5 framework, the current absence of a standardised definition or methodology has prevented any analysis of cancer outcomes in coastal regions. However, a methodology paper with suggestions was published last month.10 We urge continued research in this area in addition to published outcomes for coastal patients.
Given these considerations, it is of critical importance that any newly published National Cancer Plan does not neglect or disregard the rural or coastal context when it comes to the future delivery of the best quality primary, secondary, and tertiary cancer care. Based on our work, Figure 1 emphasises five key messages that we would like to highlight to the UK Government when developing its National Cancer Plan. Many feasible innovations4 can be at the plan’s core; these include monitoring outcomes for coastal patients, enhancing remote and mobile access to most diagnostic procedures and the safe, remote delivery of many cancer treatments, including survivorship and psychosocial care. Improvements in telemedicine will be central to the care of future rural and coastal communities. Cancer policies must also be co-produced by people affected by cancer and this needs to include those from rural and coastal areas.
History
School affiliated with
- Lincoln Institute for Rural and CoastalHealth (Research Outputs)
- Lincoln Medical School (Research Outputs)
- School of Health and Social Care (Research Outputs)
- School of Health and Care Sciences (Research Outputs)
- College of Health and Science (Research Outputs)
Publication Title
Journal of Cancer PolicyVolume
43Issue
March 2025Pages/Article Number
100553Publisher
ElsevierExternal DOI
eISSN
2213-5383Date Submitted
2024-12-15Date Accepted
2024-12-18Date of First Publication
2024-12-21Date of Final Publication
2025-03-01Open Access Status
- Not Open Access
Date Document First Uploaded
2025-01-02Will your conference paper be published in proceedings?
- N/A