The pictures were graphic – showing a man with advanced aggressive head and neck cancer that was eating into his jawbone.
But when one of the top oncologists in Denmark showed these images to his country’s political leaders back in 2000 – it was to make a stark and urgent point.
‘The pictures graphically revealed how the patient’s disease advanced so rapidly that, in a mere three weeks, he had gone from looking normal to having almost his entire jaw destroyed by the disease,’ Professor Niels Kroman, medical director of the Danish Cancer Society charity, told the Mail’s Good Health.
Those startling images prompted the country’s leaders into revolutionising its cancer care.
A quarter of a century ago, Britain and Denmark shared the accolade of having the worst survival rates for cancer patients in Western Europe.
‘That patient’s case shocked the politicians into producing four successive national cancer plans,’ says Professor Kroman, who is also a cancer surgeon in the clinical medicine department at the University of Copenhagen.
‘All of these have been dedicated to creating concerted national efforts to speed up the start of best diagnosis and treatment.’
Now Danish cancer patients enjoy some of Western Europe’s best survival rates.
Professor Niels Kroman from Denmark who is a cancer surgeon in the clinical medicine department at the University of Copenhagen
Britain, meanwhile, still languishes at the bottom of the International Cancer Benchmarking Partnership’s rankings on survival rates from eight major cancers, including lung, ovary and stomach, according to research published in The Lancet Oncology in 2022.
In fact the UK ranks at 31 out of 43 nations in terms of the number of sufferers who survive five years after a diagnosis of lung cancer, according to research by the Organisation for Economic Co-operation and Development (OECD) published last November.
What’s more, this week it was revealed rates of a common cancer, oesophageal, are higher in the UK than the rest of Europe – and double the rate in France for example.
So how did Denmark succeed – and can Britain imitate the steps taken there and achieve a similar turnaround in cancer care?
Professor Kroman says there have been three main strands to the Danish plan: to create consistent care, to speed up diagnosis and treatment, and to centralise services so that patients see the most expert staff.
What’s more, he says, these plans were agreed by Danish politicians from across the political spectrum, bureaucrats and health professionals who then stuck to them, so that the policies actually came to fruition, whoever was in power.
And none of this involved vast increases in funding.
Getting politicians, clinicians and administrators to agree on plans and stick to them is key, as the same 2022 Lancet Oncology study concluded: ‘Cancer policy consistency was positively correlated with improvements in survival. Countries that scored the highest on policy consistency had large improvements in survival.’
Danish cancer patients enjoy some of Western Europe’s best survival rates, while Britain sits near the bottom of the rankings by the International Cancer Benchmarking Partnership
Central to the Danish plan are guidelines for fast-track diagnosis and treatment.
In 2008 the country’s Ministry of Health introduced a system of Cancer Patient Pathways (CPPs) – a clearly defined series of tests and treatments available through GPs, hospitals and specialist diagnostic centres.
Whenever a Danish GP suspects cancer, they can refer patients and ensure that they get quick results.
Professor Kroman says: ‘We have introduced a guideline for breast cancer patients, for example, which requires that when you are referred for diagnostic work by a GP, that has to start within two weeks.
‘If you find a lump in the breast, then by law you have to have the mammography and biopsy within two weeks.
‘Then if your results show that you have a malignant tumour, you have a right to start treatment within two weeks.’
This sounds similar to the UK rule that 75 per cent of patients should have their suspected cancer either diagnosed or ruled out within 28 days of a GP’s urgent referral – but according to Cancer Research UK (CRUK) the target has never been met.
Similarly the NHS ‘62-day referral to treatment’ target, which says 85 per cent of newly diagnosed cancer patients should start treatment within two months (or 62 days) of an urgent referral – has not been met since 2015 according to CRUK and they say only 69 per cent of cases met that deadline in November.
The crucial difference is that in Denmark those targets are sacrosanct.
As Professor Kroman says: ‘If we cannot hit that target in our own hospital then we have to find another hospital in Denmark that can.
‘If for some reason that is impossible then we have to find you treatment within two weeks in either Sweden or Germany.
‘Some patients won’t want to go that far away, and will say, “OK I will wait for three weeks”.’
Fast access to treatment is crucial for patient survival, says Paul Lambert, a professor of biostatistics at the University of Leicester, who co-authored an analysis of what’s behind cancer survival rates in countries including Denmark and the UK, published in the journal Lancet Oncology in 2019.
He told Good Health: ‘The earlier cancer is diagnosed then usually the more treatable it is, and the better are the outcomes. However, in international comparisons the UK tends to diagnose later than other countries.’
Indeed only 71 per cent of patients were within a target – introduced in 2021 by the UK government – that 75 per cent of patients should have suspected cancer diagnosed or ruled out within 28 days of a GP’s urgent referral, according to Cancer Research UK in October 2023.
As well as creating rapid access to cancer services, Denmark has ensured patients see the most experienced and best-skilled staff available – by gathering them together in specialised cancer centres rather than general hospitals.
‘Twenty years ago we had many hospitals in many different places that treated cancer patients – but some hospitals treated only a few patients a year,’ says Professor Kroman.
‘Statistics showed that your chances of recovery were significantly better if you were in a hospital that treated high volumes of patients,’ he says.
‘That prompted a very intense centralisation of cancer treatment.
‘For example, where there were 52 hospital centres treating breast cancer 40 years ago, now there are nine. By doing this we improved patients’ survival rates by 10 per cent.
‘It’s all down to having all the good surgeons, nurses, pathology scientists – everyone and everything – centralised in one place.’
While this does mean some patients having to travel farther for their treatment, ‘this is crucial for common cancers such as breast cancers and it is critical for rare cancers to have centralised specialist systems,’ Professor Kroman argues.
‘But still in the UK, however, there are hospitals that treat low numbers of cancer patients.’
A further advantage that Danish cancer care now enjoys is in specialist equipment – thanks to a policy over the past 20 years of boosting investment in this area.
As Naser Turabi, director of evidence and implementation at Cancer Research UK told Good Health: ‘Denmark has invested much more in diagnostic capacity than the UK.
‘In 2021 the Organisation for Economic Co-operation and Development (OECD) reported that the UK had ten CT scanners [which detect tumours] per million people in the UK. By comparison Denmark had 43 scanners per million.’
The Danish are not resting on their laurels.
‘Until now our main focus has been on improving hospital treatment,’ says Professor Kroman.
‘Doing that has provided the significant improvement in survival rates we’ve achieved in the past 20 years.
‘However, in the last five years those improvements look to have levelled out a bit.
‘Now we are looking at how our GPs can do better, by boosting their numbers and thus making it easier still for them to refer patients with suspicious symptoms for testing and treatment.
‘We will get more out of having 20 per cent more GPs than we will from having 20 per cent more cancer surgeons.’
Even now, Professor Kroman says, Danes can enjoy rapid GP access.
‘If you call your GP with a symptom such as a new lump or passing blood, they will see you straightaway.’
So can Britain copy the Danish example?
Professor Lambert says: ‘The good news from the Danish example is that it can be done.’
[Notigroup Newsroom in collaboration with other media outlets, with information from the following sources]
