Fragmented care and guideline gaps

One in five cancers in the UK is first found in an emergency, usually late. Adding a cancer test to the blood already taken in A&E for over-60s with vague symptoms could catch some earlier.

A positive leftover-cancer blood test leaves patients frightened and their doctors unsure what to do. A specialist clinic could give them a plan and a trial.

People with dementia who develop cancer are often either overtreated or written off, and decisions are made without them. A clear pathway for assessment, consent and treatment planning would improve both.

Malnutrition is the commonest untreated complication in cancers of the gut, throat and pancreas. Putting a dietitian in the meeting where treatment is decided means it is seen and treated before chemotherapy starts, not after weight has been lost.

Any oncologist could send a difficult case, with the records, to a specialist centre and get a written expert opinion back within three days, free to the patient.

Many people never receive treatments already proven to work. Cooperative trial groups would have to spend a tenth of their budget testing how to close that gap.

Set a legal limit: anyone referred with suspected cancer should be told within 28 days whether they have it. Publish how every hospital performs each month.

Patients moving between hospitals often carry paper folders or nothing. A standard electronic summary of diagnosis, treatments, and doses that any system can read would stop repeated tests and dangerous gaps.

Patients wait weeks for a manufacturing slot while other slots go unused when a patient drops out. A shared booking system would match spare slots to waiting patients.

Every newly diagnosed patient gets a named person whose job is to get them through appointments, tests, paperwork and money problems. Insurers should pay for it because it prevents delays and dropouts.

Patients would carry their full cancer history, scans and test results in a standard digital bundle they control and can hand to any doctor anywhere.

Rare cancers are often misdiagnosed, which sends patients down the wrong treatment path. Digital slide sharing could get every case to an expert within days.

People are invited separately for bowel, breast, cervical and lung screening and many miss some. One appointment offering all eligible tests, plus a risk assessment, would raise uptake.

Errors happen when patients move from hospital to home, from surgery to chemotherapy, or from oncology back to their family doctor. A short standard checklist and a pharmacist medication review at each move would prevent many of them.

A cancer patient with a fever or severe sickness during treatment should be seen quickly by a team that knows chemotherapy, not wait hours in a general emergency room.

Every patient newly diagnosed with advanced cancer would have their records reviewed by an expert centre within a week, without travelling. The review often changes the plan.

Hospitals hold weekly meetings to decide each patient's plan but rarely check what happened afterwards. A simple loop that records the recommendation and checks it against what was done would catch dropped plans.

Palliative care given from the start of treatment for advanced cancer improves quality of life and may extend it. Instead of waiting for an oncologist to remember, the system should refer automatically when the diagnosis is recorded.

Pay hospitals a single amount for a whole course of cancer treatment, with extra for following the evidence, rather than paying per visit and per drug, which rewards fragmentation.

Computers can combine minor symptoms, blood tests and age into a cancer risk score in the background. Showing that score to the GP could get more people referred earlier.

When a hospital's real limit is the number of chemotherapy chairs and nurses, guidelines should favour treatments given by mouth or in fewer, shorter visits, if they work about as well.

Hepatitis C is now curable in weeks. Testing and treating where it is concentrated, and keeping those with scarring in surveillance afterwards, would cut liver cancer.

Choices like mastectomy versus lumpectomy, or whether to have chemotherapy after surgery, depend on what matters to the patient. Good decision aids exist but are rarely used; building them into the clinic workflow would change that.

Many young patients are never told that chemotherapy may end their fertility, or are told too late to do anything. An automatic referral, triggered when treatment is ordered, would make the conversation routine.

Family doctors often do not know who is responsible for a cancer patient's blood pressure, diabetes or new symptom. Written agreements plus a same-day electronic question line to the oncologist would fill the gap.

Getting fitter and better nourished before an operation reduces complications and speeds recovery. It is cheap, but only a few hospitals do it.

For frail older patients, the journey to hospital can be the hardest part of treatment. Nurses can safely give some cancer treatments at home, which may help more people complete their course.

Many hospital stays for cancer patients, such as for fever after chemotherapy in low-risk cases, could be delivered at home with daily nurse visits and remote monitoring, which patients prefer and which is cheaper.

Hospitals rarely know what fraction of their patients got the recommended treatment. Software reading the electronic record can show each team, every month, where care deviated from guidelines.

Cancer treatment guidance changes constantly and takes years to reach many clinics. Make guidelines live documents that software can read, updated as evidence arrives and adapted to what each country can afford.

A patient with a rare cancer treated at a small hospital should have their case reviewed by the national experts by video before treatment starts. Make that referral automatic.

Instead of one overwhelmed national cancer hospital, organise care in tiers: district hospitals diagnose and give simple treatment, regional centres give chemotherapy and surgery, and the hub handles radiotherapy and complex cases.

Manage fevers, dehydration and other treatment side-effects at home with visiting nurses, wearables and video, instead of admitting people to hospital wards.

Let specially trained cancer pharmacists prescribe anti-sickness drugs, growth-factor support and routine dose adjustments under protocols, freeing oncologists for decisions only they can make.

A woman with a breast lump should be examined, scanned and biopsied on the same day, and hear the result within a few days, rather than visiting four times over two months.

Many patients with advanced lung or bowel cancer start treatment without the gene tests that would show whether a targeted drug would work. Let the pathologist order the full test the moment cancer is confirmed, without waiting for an oncologist.

Every person told they have cancer gets a named navigator, by law, who helps them understand options, book appointments, find trials and deal with money and work.

Antibiotics given in the weeks before immunotherapy are linked to much worse results. A simple stewardship rule could preserve benefit at no cost.

The WHO set three simple goals for breast cancer: most cancers found early, diagnosis within 60 days, and most patients finishing treatment. Every country should publish how it is doing on each, every year.

Where you have your cancer operation strongly affects whether you survive it. Publishing each hospital's adjusted results would push complex surgery towards the centres that do it well.

Labs already get tested on whether they score biomarkers correctly, but the results are private. Publishing them would let hospitals and patients avoid labs that get it wrong.

Weight loss, fatigue and unexplained pain do not point to one organ, so patients bounce between specialists. A single clinic that investigates such symptoms quickly finds cancers that would otherwise be found late.

Show each hospital, every month, how often its patients received the recommended treatment, compared with peers, so gaps are seen and closed.

How long people wait between first noticing something wrong and being diagnosed is barely measured. Recording it routinely and publishing it by hospital would expose where the system loses time.

Cancer survivors are a huge and growing population with specific long-term risks. Give each a plan matched to their risk, run automatically and shared with their family doctor.

Cancer often ruins families financially, and money worries make people skip treatment. Ask about finances at the first visit, as routinely as asking about allergies, and route people to assistance.

Hospitals rarely know which step, the scanner, the biopsy, the pathologist or the clinic slot, is causing the queue. Modelling the pathway like a factory line shows where a small change would remove weeks of waiting.

For each cancer type, agree the set of stains and tests that are always needed, and have the lab run them automatically on diagnosis rather than waiting for someone to ask.

Every patient finishing treatment should get a clear document listing what they had, what to watch for, and when to be checked. Software can write it from the record so it actually happens.

Hospitals have fast, standard responses to sepsis and heart attacks. Cancer wasting has no such pathway, so it is noticed late and treated inconsistently.

Patients on chemotherapy who report their symptoms weekly through an app, with nurses acting on alerts, live longer and visit emergency rooms less. This should be routine and paid for.