Breast cancer is the most common type of cancer in the UK. Most women diagnosed with breast cancer are over the age of 50 and in men over the age of 60, but younger people can also get breast cancer.

Around 55,900 people are diagnosed with breast cancer every year in the UK.

That's more than 150 people a day. 15 out of 100 (15%) of all newly diagnosed cancers in the UK are breast cancer.

In Lancashire and South Cumbria, 17,000 women are living with breast cancer.

Key deliverables:

Review of cancer workforce including recruitment and training of GPs with a Special Interest (GPwSI) in breast services to:

- create first contact practitioner capacity to support the increase in demand for services

- complement existing advice and guidance provision

- lead transformational pathway improvement work

· transformation of pathways to reflect National Best Practice Timed Pathway including referral standardisation and implementation of enhanced triage across the system

· provide Primary Care education

· establish Mastalgia pathway

· improvement against constitutional CWT performance standards

· embed Personalised Stratified Follow Up (PSFU) interventions into the pathway for people living with and beyond cancer, including delivery of Supported Self-Management (SSM).

Colorectal cancer is the fourth most common diagnosed cancer in England and is the third most common cancer in both men and women.

There are 43,000 new cases of colorectal cancer every year.

The length of time to first diagnostic of a colonoscopy within Endoscopy services can be one of the biggest challenges on the front end of this cancer pathway.

LSCCA has an Endoscopy Transformation Programme dedicated to improving performance within the diagnostic service.

Key deliverables:

· recruitment and training (funded by LSCCA) is ongoing in each Trust to support the RDC specification components including improved access to a single point of contact for patients throughout their diagnostic journey; expedited triage; and swift progression to MDT and following treatment.

· support cross-Trust agreement of a suite of filter function tests to be ordered before the patient reaches secondary care. The development of an ‘intelligent button’ which GPs use to order the suite of filter function tests required for referral with suspected colorectal cancer is being built into GP systems, saving time in primary care and improving patient’s waiting time.

· ongoing evaluation against the National Optimal Timed Colorectal Cancer Pathway is taking place to understand the areas for development in each Trust.

· a focus on FIT implementation within primary and secondary care

· implementation of Colon Capsule Endoscopy within Community Diagnostic Centres to alleviate pressure within Endoscopy services

· embed Personalised Stratified Follow Up (PSFU) interventions into the pathway for people living with and beyond cancer, including delivery of Supported Self-Management (SSM).

Gynaecological cancers are the fifth most common cause of cancer in the UK affecting more than 21,000 women each year.

Gynaecological cancers in women are separated into cervical, ovarian, womb, vagina and vulval cancer with varying treatment dependent upon the site of cancer.

In 2018, patients with ovarian cancer had some of the longest intervals between referral and commencement of treatment amongst all cancers in England.

Patients with suspected gynaecological cancer are initially seen at a local Trust or Lancashire Teaching Hospital NHS Foundation Trust which is the specialist provider within the Lancashire and South Cumbria Gynaecological Cancer Network.

All complex gynaecological cancer surgery is undertaken at Royal Preston Hospital with radiotherapy and chemotherapy services provided at the Rosemere Cancer Centre (Royal Preston Hospital).

Key deliverables:

· assessment of the current Gynaecology workforce across each of the four trusts.

· streamline Gynaecological MDT meetings to make efficient use of resources, in line with local recommendations and national guidance taking account of best practice among peers.

· develop and implement Standards of Care for Gynaecology specifically starting with Endometrial cancer.

· transform pathways to reflect National Best Practice Timed Pathways, including referral standardisation and implementation of enhanced triage across the system

· improve the constitutional CWT performance on the gynaecological pathway.

· recruitment of cancer support worker posts to provide holistic support for patients receiving treatment for their cancer and living with and beyond cancer following treatment.[BI18]

· embed Personalised Stratified Follow Up (PSFU) interventions into the pathway for people living with and beyond cancer, including delivery of Supported Self-Management (SSM).

Lung cancer is one of the most common and serious types of cancer. Around 47,000 people are diagnosed with the condition every year in the UK.

Lung cancer mainly affects older people. It is rare in people younger than 40.

More than 4 out of 10 people diagnosed with lung cancer in the UK are aged 75 and older.

Although people who have never smoked can develop lung cancer, smoking is the most common cause (accounting for about 72% of cases). This is because smoking involves regularly inhaling several different toxic substances.

Key deliverables:

· transform pathways to meet the Lung Best Practice Timed Pathway including referral standardisation.

· review and develop the Lung Cancer workforce

· improve performance against constitutional Cancer Waiting Times standards

· implement CURE to provide an additional and effective smoking cessation pathway for patients.

· consider innovations in current and future technologies that will help advance the lung pathway.

Patients who present with non-specific symptoms (or combinations of non-specific symptoms) that can indicate several different cancers previously did not have an established effective referral pathway.

As a result, these patients would often go back and forth between primary and secondary care which can lead to delays in diagnosis, higher rates of late stage and/or emergency presentation and poorer outcomes for the patient.

Symptoms considered ‘non-specific’ include unexplained weight loss, fatigue, abdominal pain or nausea; and/or a GP ‘gut feeling’ about cancer.

Historically, this cohort of patients often saw their GP multiple times before referral, presented more often in an emergency setting, presented with late-stage cancer and were referred on multiple pathways with resulting inefficiencies in healthcare provision.

Key deliverables:

· recruitment and training (funded by LSCCA) in each Trust to support the RDC specification components including improved access to a single point of contact for patients throughout their diagnostic journey; expedited triage; and swift progression to MDT and following treatment.

· support cross-Trust agreement of a suite of filter function tests to be ordered before the patient reaches secondary care. The development of an ‘intelligent button’ which GPs use to order the suite of filter function tests which is of paramount importance on this pathway as this is a symptom-based approach to patient referral.

· evaluating the clinical effectiveness of the pathway, considering appropriate referral streams into NSS including A&E and other routes.

There are around 10,500 new pancreatic cancer cases in the UK every year.

Pancreatic cancer is the 10th most common cancer in the UK, accounting for 3% of all new cancer cases, 1 in 4 (25.4%) of people diagnosed with pancreatic cancer in England survive their disease for one year or more.

There are different routes to diagnosis. Often, people begin by seeing their GP, some people have many visits before they are diagnosed.

The symptoms of pancreatic cancer can be quite vague and difficult to diagnose 'emergency presentation' is the most common route to diagnosing pancreatic cancer.

Key deliverables:

· recruitment and training (funded by LSCCA) is ongoing in each Trust to support the RDC specification components including improved access to a single point of contact for patients throughout their diagnostic journey; expedited triage; and swift progression to MDT and following treatment.

· support cross-Trust agreement of a suite of filter function tests to be ordered before the patient reaches secondary care. The development of an ‘intelligent button’ which GPs use to order the suite of filter function tests required for referral with suspected pancreatic cancer is being built in GP systems, saving time in primary care and improving patient’s waiting time.

· modelling future adequate dietetics support for all 4 trusts through an alliance networked resource to ensure patient get the right dietetics input as early in the pathway as can be possible

· ongoing focus on ensuring the EUS diagnostic service at ELHT is supported with an action plan that ensures the service is future proofed with a large focus on workforce modelling. ELHT is the HPB tertiary centre for LSC

For males in the UK, prostate cancer is the most common cancer, with around 52,300 new cases every year (2016-2018).

The number of people diagnosed with prostate cancer has been increasing over the last 10 years (source: Cancer Research UK).

Key deliverables:

• ​ongoing evaluation against the best practice Timed Prostate Cancer Diagnostic Pathway[BI35] to understand the areas for development in each Trust.

• standardised referral practice and diagnostic best practice and coordination.

• work with developing Community Diagnostic Centres to utilise the resources therein as appropriate.

• support recruitment and training of workforce to improve access to a single point of contact for patients throughout their diagnostic journey; expedited triage; and swift progression to MDT and treatment.

• streamline prostate MDT meetings for efficiency and bring in line with local recommendations and national guidance.

• embed Personalised Stratified Follow Up (PSFU) interventions into the pathway for people living with and beyond cancer, including delivery of Supported Self-Management (SSM).

Soft-tissue Sarcomas are uncommon cancers that can affect any part of the body, on the inside or outside, including the muscle, tendons, blood vessels and fatty tissues.

Around 3,300 people were diagnosed with soft tissue sarcoma in 2010 in the UK, that is around 9 people every day (source: Cancer Research UK).

Patients with suspected soft-tissue Sarcoma are initially referred from GP locally to Lancashire Teaching Hospitals NHS Foundation Trust for further diagnostics. Once diagnosed, treatment is offered at the specialist centre within Cheshire & Merseyside Cancer Alliance (CMCA).

This pathway improvement is unique because it involves two alliance regions (covering 10 Trusts in total). CMCA and LSCCA are working collaboratively to identify and deliver consistency of clinical practice to achieve the best possible outcomes and experience for patients across boundaries; to ensure quality, irrespective of where patients live and where their treatment is provided.

Key deliverables:

• develop and embed a new agreed pathway cross-regionally to incorporate initial diagnostics close to patients’ homes. This will include working with CCGs to confirm new commissioning arrangements where required.

• work with developing Community Diagnostic Centres to utilise the resources therein for an improved patient experience.

• recruit to posts that will support including improving access to a single point of contact for patients throughout their diagnostic journey; expedited triage; and swift progression to MDT and treatment.

• make improvements in the MDT policies and processes between the LSCCA Trust and the Trust offering treatment in CMCA to allow greater autonomy for LTHTR to expedite suitable patients.

• develop and adopt an LSCCA recommended referral form for GP use for suspected soft-tissue Sarcoma.

• deliver robust communications and engagement to support the significant changes to the front end of the pathway for primary care and radiological services.

• improve and maintain performance against constitutional Cancer Wait Times standards.

• incorporating the advancements in genomics into the pathway. 

Oesophago-gastric (OG) cancer is currently the fifth most common cause of cancer in the UK affecting around 16,000 people each year, and the fourth most common cause of cancer death.

Patients with oesophago-gastric cancer have some of the poorest outcomes and longest intervals between referral and commencement of treatment amongst all cancers in England at present.

The patient pathway from referral to decision to treat for oesophageal or gastric cancer is one of the most complex cancer pathways.

The combination of endoscopy and biopsy, CT and PET-CT imaging, interventional staging and comprehensive comorbidity assessment highlights this complexity.

Unlike other more common cancers, the initial diagnostics are undertaken at local units and the more invasive staging investigations require specialist decision and intervention.

Key deliverables:

• recruitment and training (funded by LSCCA) is ongoing in each Trust to support the RDC specification components, including improved access to a single point of contact for patients throughout their diagnostic journey; expedited triage; and swift progression to MDT and following treatment.

• support cross-Trust agreement of a suite of filter function tests to be ordered before the patient reaches secondary care. The development of an ‘intelligent button’ which GPs use to order the suite of filter function tests required for referral with suspected pancreatic cancer is being built in GP systems, saving time in primary care and improving patient’s waiting time.

• ongoing evaluation against the National Optimal Timed Oesophago-gastric Cancer Pathway is taking place to understand the areas for development in each Trust.

• implementation of Cytosponge Endoscopy within Community Diagnostic Centres to alleviate pressure within Endoscopy services