HSJ Cancer Forum: Top 20 Takeaways

Overview

March’s HSJ Cancer Forum brought together NHS leaders, clinicians, policymakers, industry partners and patient representatives to examine the future direction of cancer services in England. 

Part of our wider HealthSHIFT event series, the forum was co-located with our HSJ Modernising Diagnostics Forum and HSJ Genomics Forum.

Discussions reflected a system at a turning point: moving from recovery and performance management toward earlier diagnosis, risk stratification, and prevention, while facing significant workforce, financial and infrastructure constraints.

Across sessions, a consistent message emerged: innovation alone will not improve outcomes unless accompanied by pathway redesign, workforce capacity, and integrated data infrastructure.

System Pressures and Strategic Direction

1. Cancer services remain under sustained operational pressure

Demand continues to rise faster than capacity, with diagnostic bottlenecks, workforce shortages and increasing case complexity constraining performance recovery.

2. The system is shifting from treatment to earlier intervention

Policy focus is increasingly centred on prevention, early diagnosis and risk identification rather than solely improving treatment pathways.

3. Recovery alone is not a sufficient ambition

Speakers emphasised that restoring pre-pandemic performance will not address long-term demand growth or outcome gaps.

4. Variation remains a defining challenge

Significant regional inequalities persist across access, diagnosis stage and outcomes, reinforcing the need for locally tailored delivery within national strategy.

Workforce and Delivery

5. Workforce constraints are now the primary limiting factor

Technology and clinical innovation are advancing faster than workforce expansion, creating implementation risk.

6. New roles and multidisciplinary models are essential

Cancer pathways increasingly depend on advanced practitioners, diagnostic specialists and cross-professional collaboration.

7. Service redesign matters as much as investment

Several speakers stressed that pathway optimisation and operational coordination can deliver substantial gains without major new funding. Hospitals need to address the left shift, with one speaker commenting: “We need to turn the hospital inside out”.

Diagnostics and Early Detection

8. Diagnostic capacity remains the critical bottleneck

Imaging, pathology and endoscopy pressures continue to shape overall system performance.

9. Current referral pathways are inefficient

Urgent suspected cancer referrals convert at roughly 6–7%, indicating limited precision in identifying high-risk patients.

10. Earlier diagnosis requires better risk targeting

Improved triage tools and diagnostics are needed to focus resources on patients most likely to benefit.

Inequalities and Inclusion

11. Cancer outcomes for people with serious mental illness are worsening

Individuals with severe mental illness experience higher cancer mortality, later diagnosis and poorer access to care, representing one of the starkest inequities discussed.

12. Physical and mental health integration remains incomplete

Despite longstanding recognition, structural separation between services continues to undermine outcomes.

13. Intersectional inequalities amplify risk

Geography, deprivation and comorbidity combine to produce compounded disadvantage within cancer pathways.

Genomics and Risk Stratification

14. Genomics is a major opportunity, but not a standalone solution

Testing alone does not improve outcomes; benefits depend on complete pathways including counselling, follow-up and treatment capacity.

15. Policy ambition may be running ahead of evidence

Speakers cautioned against large-scale implementation without demonstrated mortality benefit and clear clinical pathways.

16. Risk must be understood holistically

Effective risk stratification requires combining genetics, family history, lifestyle, imaging data and medical history rather than relying on single indicators.

17. Family history assessment is currently inadequate at scale

Existing approaches are inconsistent and often too crude to support population-level risk management.

Data and Infrastructure

18. Integrated data systems are the key enabler of future cancer care

Progress depends on interoperable records, shared coding standards and research-ready datasets spanning primary to specialist care.

19. The NHS is transitioning toward a predictive model of care

Cancer services are moving from reactive treatment toward proactive identification of risk. This will require new ethical, operational and communication frameworks.