Don’t assume that cutting back on cancer diagnosis would improve other services

Cancer is the UK’s leading cause of death,1 and, as Mathew notes, the UK’s record compares unfavourably with those of other high income countries.2 Mathew is concerned that thresholds for two week wait referrals in the NHS have evolved without supporting health economic evaluation. But any proposed resource reallocation should also be informed by adequate evidence, rather than simply assuming that cancer funding would be better spent elsewhere.Two week wait pathways probably account for a modest proportion of overall cancer spend. Further health economic evaluation would be beneficial, but these pathways are highly likely to be cost effective given the increased costs and poorer outcomes associated with late stage disease and cancers diagnosed in emergency departments.34 The favourable outcomes associated with making more diagnoses through two week wait referrals5 and the corresponding decline in emergency presentations6 cannot plausibly be attributed to lead time bias as Mathew suggests.Restricting referrals for patients…
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