Improving non-melanoma skin cancer patient journeys and experience of care

Non-Melanoma Skin Cancer (NMSC) is the most common cancer in the UK.¹  Around 230,000 cases are diagnosed every year,²  with the number likely to be higher for various reasons, including people not reporting their symptoms and health systems not optimally set up for data collection.¹ NMSC accounts for 20% of all new cancers,¹ and 90% of all new skin cancers,¹ with incidence rates for NMSC rising and forecast to reach almost 400,000 per year by 2025.³  The costs associated with NMSC are significant and expected to be between £338-£465 million in 2025.⁴     

Despite the substantial burden of NMSC, the cancer is under recognised and under prioritised by policy makers and the NHS. There are clear challenges around lack of appropriate resourcing and significant variation in care, which are exacerbated by having too many pieces of inconsistent and out-of-date guidance.

At Sanofi, we’re committed to improving outcomes for people living with NMSC, their carers, and the UK health system. That’s why we’ve launched a report – endorsed by Skin Cancer UK – in the hope of raising awareness of the disease and the clear, achievable steps that can be taken moving forwards. 

"There is no better time to discuss skin cancer than right now, and focus on NMSC is particularly urgent. This report shares powerful new evidence about the NMSC patient pathway, explores the barriers in depth to improved patient care, and provides concrete recommendations for achieving change and making the greatest impact”

Gill Nuttall, CEO, Skin Cancer UK

The report is guided by survey responses from 95 UK experts in skin cancer care including Dermatologists (n=35), Oncologists (n=30), and Surgeons (n=30) in the UK,* to understand their perspectives on the management of NMSC and what could support them to improve patient care. Key insights from this multidisciplinary group of clinicians on the NMSC pathway are:⁵

Critical recommendations identified from the report include:

• National bodies in the nations of the UK must update and publish comprehensive national guidelines on the referral and management of NMSC
  While guidelines and pathways do exist, many are either outdated or don’t focus on the full NMSC pathway, including those with advanced disease. The lack of a comprehensive national guideline has led to multiple, inconsistent local and national pathways and guidelines, with some areas not having any pathway in place for these patients.⁵ 
  
  “Due to the lack of elaborate guidelines, there is no national consensus on treatment.”
  England (East Midlands) Oncologist⁵
   
• NMSC should be established as a priority in national cancer policy, and progress monitored through improved data collection
  Despite the scale of NMSC in the UK, there is a lack of accurate and reliable data collection ranging from prevalence, routes to diagnosis, and time to treatment.¹ Patient experience is not routinely collected for NMSC patients. In England, the Cancer Patient Experience Survey does not include NMSC patients,⁶ and the Welsh Cancer Patient Experience Survey groups cancers by tumour type and not by specific cancer.
   
• The workforce crisis must be addressed to successfully improve NMSC patient care in the long-term
  Workforce shortages are especially present in skin cancer, with shortages across all the specialisms involved in the NMSC patient pathway and skin MDTs. The increasing prevalence of NMSC, and ongoing impact of COVID-19 mean services are struggling to meet demand.^3,7,8  Without progress in workforce capacity, it is estimated that more than 340,000 people between 2019 and 2028 will miss out on an early cancer diagnosis.⁹ 
  
  “There has been a doubling in patient referrals from primary care, often patients have not been seen face to face. This is clogging the system with obviously benign lesions.”
  England (North West) Dermatologist⁵

"The insights gathered from this report provide a powerful reminder that the UK is falling behind on the treatment and management of NMSC. The good news is that there are corrective steps that can be followed to get care back on track, which starts by ensuring our health system prioritises NMSC from today”

Elliot Colburn, MP

For full findings and recommendations, download the report here

1. National Cancer Registration and Analysis Service, Non-melanoma skin cancer in England, Scotland, Northern Ireland and Ireland. Available at: http://www.ncin.org.uk/publications/data_briefings/non_melanoma_skin_cancer_in_england_scotland_northern_ireland_and_ireland Last accessed: November 2022
2. British Association of Dermatologists (BAD), 84 per cent of dermatologists think that Brits have an unhealthy relationship with tanning, May 2018. Available at: https://www.bad.org.uk/84-per-cent-of-dermatologists-think-that-brits-have-an-unhealthy-relationship-with-tanning/ Last accessed: November 2022
3. Goon et al, Predicted cases of U.K. skin squamous cell carcinoma and basal cell carcinoma in 2020 and 2025: horizon planning for National Health Service dermatology and dermatopathology, British Journal of Dermatology, 2017; 176:1351–1353. doi:10.1111/bjd.15110
4. British Association of Dermatologists (BAD), Doctors forecast a steep rise in skin cancer cases, December 2016. Available at: https://www.skinhealthinfo.org.uk/doctors-forecast-a-steep-rise-in-skin-cancer-cases/ Last accessed: November 2022
5. Sanofi Data on file
6. Cancer Patient Experience Survey, National Level Data Tables, 2021. Available at: https://www.ncpes.co.uk/2021-national-results/ Last accessed: November 2022
7. Venables, Z.C et al, The impact of the COVID-19 pandemic on skin cancer incidence and treatment in England. Br J Dermatol, 2020; 185:460-462. https://doi.org/10.1111/bjd.20409 
8. NHS GIRFT, GIRFT recommendations address dermatology workforce shortages and call for wider use of technology. Available at: https://www.gettingitrightfirsttime.co.uk/wp-content/uploads/2021/11/Dermatology-overview.pdf Last accessed: November 2022
9. Health and Social Care Committee, Cancer Services, Twelfth Report of Session 2021-22, 2022. Available at:  https://committees.parliament.uk/publications/9562/documents/161967/default/ Last accessed: November 2022