Cancer

Cancer is one of the greatest health challenges in the UK. One in two people are expected to develop cancer in their lifetime (Source: BMJ Lifetime risk of cancer 2015). Someone is diagnosed with cancer every two minutes in the UK (Source: Cancer Research UK).

The individual risk of developing cancer depends on age, lifestyle and genetic factors. Estimates show more than four in ten cancer cases could be prevented by lifestyle changes, such as not smoking, reducing alcohol consumption, maintaining a healthy diet and body weight, keeping active and avoiding excessive sun exposure (Source: Cancer Research UK). Risk and incidence of cancers increase with age – three in four cases are diagnosed in people aged 60 and over. More than a third of new cases are in people aged 75 and over (Source: Cancer research UK).

Cancer accounts for over a quarter of all deaths in the UK, with nearly three-fifths of all cancer deaths occurring in people aged 75 or over (Source: Cancer Research UK). However, mortality rates have decreased in the UK and people live almost ten times longer, post-diagnosis, compared to 40 years ago, meaning a projected 4 million people will be living with cancer in the UK by 2030 (Source: Macmillan Cancer Support 2025). With improvements in diagnosis, treatment and aftercare, there are now over 37,000 people living with cancer in Lincolnshire. This is expected to rise to 45,400 by 2030.

A cancer diagnosis can affect people’s quality of life beyond their physical health. Mental health, finances, family and or carer responsibilities, ability to work and continue to do the things previously enjoyed can also be impacted. Feelings of loneliness and isolation can also be exacerbated with a cancer diagnosis (Source: Lincolnshire ICB).

Living with cancer has financial implications for individuals and society. One in three people with cancer lose on average £891 a month in earnings because they are unable to work, or must reduce their working hours (Source: Macmillan Cancer Support 2025). The full economic cost of cancer has been estimated at £14.4bn for the UK (Source:  Cancer Research UK).

• 10 Year Health Plan for England: fit for the future – GOV.UK
• NHS National Cancer Plan 2025
• Chief Medical Officer’s annual report 2021: health in coastal communities – GOV.UK
• Chief Medical Officer’s annual report 2023: health in an ageing society – GOV.UK
• Overview | Suspected cancer: recognition and referral | Guidance | NICE – Evidence-based recommendations for the identification of people with symptoms that could be caused by cancer (updated May 2025)
• NICE: Cancer – A collection of NICE guidance relating to cancers.
• The Lincolnshire Living With Cancer Strategy 2023 – 2025 (with a forward view to 2028)
• Cancer Support Lincolnshire articulates how the needs of people living with cancer across Lincolnshire will be met.
• Better Lives Lincolnshire: Integrated Care Partnership Strategy
• NHS Lincolnshire Joint Forward Plan 2023-28
• Lincolnshire Palliative and End of Care Strategy 2023-2028
• NHS Long Term Plan

Average cancer prevalence rates in Lincolnshire remain higher than the national average (Source: Quality Outcomes Framework (QOF)). Patients are typically diagnosed at a later stage, meaning treatment is less effective and survival chances reduced. Encouragingly though, uptake of bowel and cervical cancer screening in Lincolnshire is higher than the national average however breast screening is slightly lower than the national average. Uptake of breast and bowel screening is on the increase in Lincolnshire whereas cervical is on the decrease, this is all in line with national trends (Source: DHSC). Effective screening leads to earlier detection. Breast cancer mortality rates in Lincolnshire have been slightly lower than the national average, demonstrating the benefit of early detection.

Cancers with the lowest survival rates are pancreatic, liver, brain, and lung cancers, with pancreatic cancer having the lowest five-year survival rate overall. Mortality rates from lung cancer in Lincolnshire are worse than the national average. Although smoking is not a direct cause for all cases of lung cancer, high smoking prevalence in Lincolnshire could be a contributing factor. (Source: DHSC) Cancer incidence and mortality rates are generally higher in deprived groups compared with affluent groups. Rates are higher for older people compared with younger people, and for men compared with women. Overall cancer incidence is higher in the east of the county and lowest in the west, reflecting a correlation with deprivation, age and potentially lifestyle, and education. Awareness and a high proportion of disengaged patients are also potentially a factor. Older people tend to be diagnosed at a later stage. Continuing issues with transport in the county may impact people’s ability to attend appointments if they live far from hospital. Early findings from the Bowel Screening Inequality Programme have identified potential inequalities for people with learning difficulties and carers. (Source: Lincolnshire ICB)

Although breast cancer incidence is higher amongst affluent groups, mortality is still higher for less affluent women. Women are more likely than men to attend health appointments, but embarrassment, family commitments, time and rurality often play a part in not going to see a GP at early stages. An inquiry into Geographical Inequalities and Breast Cancer found increasingly more women are surviving breast cancer, but stark geographical inequalities exist across England for screening, early detection, and access to treatment and services (Source: The Society of Radiographers). This picture is reflected in Lincolnshire.

Prostate cancer is the most diagnosed cancer in Lincolnshire (Source: DHSC). Incidence of lung and bowel cancers, along with premature mortality, are higher amongst men compared to women both locally and nationally. Cancers considered preventable, highlight the importance of healthy lifestyle behaviours and Public Health interventions.

Some variances in mortality can be attributed to delayed diagnosis for those who are deprived; older; or of certain ethnic groups (at least for breast cancer). The picture for ethnic minority groups varies according to cancer type and ethnic group. In general, incidence is lower amongst ethnic minority groups. In the districts of Lincoln, Boston, and South Holland there are a greater proportion of foreign-born residents than in other Lincolnshire districts. There may be a link between the proliferation of zero hours contracts and districts that have a concentrated migrant population and qualitative evidence suggests that people who do not take time off work for appointments and treatments may be diagnosed at later stages of cancer, or may not attend their treatment http://www.macmillan.org.uk/documents/getinvolved/campaigns/ageoldexcuse/ageoldexcusereport-macmillancancersupport.pdf

Cultural and socioeconomic factors influence the uptake of behavioural risk factors, such as smoking, poor diet and excessive alcohol consumption. These behaviours exacerbate inequalities in cancer outcomes. For example, 25.4% of avoidable mortality from all cancers (except non-melanoma skin cancer) occur in the most deprived 20% of the population; the incidence rate of avoidable cancers is 2.33 times higher in the most deprived, compared to the least deprived quintile (Source: NHS Lincolnshire ICB).

Smoking is most prevalent amongst the unemployed and is 2.5 times more common amongst routine and manual workers than managerial and professional groups (NHS Digital). In Lincolnshire the percentage of smokers are reducing. Cultural norms affect the likelihood of smoking initiation and quitting. Given smoking is the biggest cause of lung cancer, variation in diagnosis and mortality correspond with these populations.

Bowel cancer incidence and mortality rates are higher in the most deprived communities (Source: Cancer Research UK). Lifestyle factors—such as poor diet, obesity, and smoking—account for 54% of bowel cancer risk, and these behaviours are more common in disadvantaged groups. For instance, women in the most deprived areas are 1.8 times more likely to be obese compared to those in the least deprived areas (Source: DHSC), and men from deprived backgrounds tend to eat less fibre and more processed meat than the general population (Source: Food Standards Agency). These lifestyle-related disparities likely contribute to health inequalities. However, the pattern of bowel cancer inequality in Lincolnshire differs from national trends. When adjusted for age, premature mortality is highest in the two most deprived quintiles, but notably, the least deprived quintile also shows above-average mortality. Interestingly, morbidity is lowest in the second most deprived quintile—lower than in any other group (Source: NHS Lincolnshire ICB).

Health inequalities, or unfair disadvantage in cancer outcomes, exist across all points on cancer pathways, and are caused by the complex interplay of individual risk such as age, socio-economic, medico-structural, geographical and individual lifestyle factors. In Lincolnshire, with the aging population and rural and coastal communities, there is a risk that people may experience more profound cancer health inequalities than in other areas (Source: Lincolnshire Integrated Care Board (ICB).

Many interventions address cancer: prevention, ongoing management, and treatment:

• Lincolnshire County Council commissions an Integrated Lifestyle Service (ILS) (One You Lincolnshire) to support smoking cessation, weight management, physical activity, and reduced alcohol consumption. This is a key primary prevention tool, targeting key cancer risk factors.
• Lincolnshire will be rolling out a new screening programme for lung cancer in late 2025/Early 2026.
• The System Cancer board develops cancer pathways to enable faster, and equal access to treatment for all. This includes prevention, diagnosis, treatment, survivorship, and end of life care.
• Current focus areas are to continue to reduce the backlog of patients waiting over 62 days and improve the 28 Faster Diagnosis standard 31 & 62 day performance.
• Lincolnshire has implemented a number of Best Practice Timed Pathways to meet the 28 Faster Diagnosis Standard. The initial focus was to implement pathways for lower gastrointestinal, head and neck, gynaecological, prostate, and lung cancer.
• The Lincolnshire Living with Cancer Programme is implementing personalised care and support for people living with and affected by cancer in the county and is addressing health inequalities. The programme works across the Integrated Care System with multiple system partners and its approach is ‘we are creating a better and sustainable future for supporting people living with cancer, involving and integrating all relevant parts of the health and social care system, using the assets we already have, supporting people in the place they would like and in the way they would like, and placing people at the centre of everything we do.’ The programme is delivered via sub-programmes (Acute, Interface, Community Development) and enabler programmes including Digital and Workforce Development.
• The East Midlands Cancer Alliance aspires to improve health outcomes for cancer patients by sharing best practice, providing clinical advice, and addressing unwarranted variation across the region.
• NHS England’s cancer screening programmes aim to identify breast, bowel and cervical cancer at an early stage. Lung Cancer Screening will be added to the current cancer screening programmes in Lincolnshire early 2026.
• The countywide cancer screening board, plans and delivers works programmes to increase screening uptake, and address inequalities within screening programmes. The screening partnership comprises of representatives from NHS, Public Health and Cancer Research UK.
• A system wide Health Inequalities team has been established to address health inequalities across the system focussing on: access, digital exclusion, waiting times, emergency presentations, and reasons patients do not attend appointments.
• United Lincolnshire Teaching Hospitals NHS Trust (ULTHT) has multidisciplinary specialist teams, and local diagnostic and treatment teams, working with cancer patients. The Urgent Suspected Cancer referral pathway is a fast-track route to ULTHT services if a GP suspects cancer.
• ULTHT provides radiotherapy and chemotherapy treatments at Lincoln County Hospital, additionally chemotherapy is provided at The Pilgrim Hospital Boston and Grantham and District Hospital. Inpatient and outpatient cancer care is provided across the Trust for common cancers, but in specific localities for less usual diagnoses. A mobile chemotherapy unit travels across the county.
• In February 2022, ULTHT surgeons performed their first operation using a surgical robot. The device enables advanced, minimally invasive techniques, with a reduced risk of surgical complications. Previously, patients had to travel out of Lincolnshire for robotic prostatectomies and robotic colorectal surgery.
• Grantham, Boston and Lincoln hospitals host Macmillan Information and Support Centres offering information about cancer and cancer services plus emotional support for patients, families, carers and staff.
• People with advanced, incurable cancer, can benefit from early Palliative End of Life care (PEOL) (Source: Haun, M.W. et al., 2017). However, palliative care measures might not be instigated until it is evident that disease-modifying treatments have been unsuccessful, no treatment can be offered, or death is anticipated. Yet early palliative care interventions might have a more beneficial effect on symptoms and for quality of life than standard treatments alone.

The foundations of PEOL care in Lincolnshire are in Primary Care. A Gold Standards Framework (GSF) provides the structure for co-ordinated care. PEOL care is delivered across all settings by generalist, core teams of health and social care professionals; third sector and voluntary services; with Specialist palliative care clinicians reaching in to support complex needs.

The National Cancer Patient Experience Survey is carried out annually and findings acted upon to improve patient experience. The National Quality of Life survey is available to all cancer patients 18 months after a cancer diagnosis.

In 2023, the Living with Cancer Team ran an engagement programme for cancer patients, and their loved ones, to understand whether the experience of living with cancer in the county had changed since the last engagement programme in 2017. The Living with Cancer Programme has continued to be developed around these patient experiences with projects being developed on the identified themes. Feedback revealed the following needs:

• improved information governance
• joined up pathways
• integrated working
• more support for the cancer workforce
• clearer communication between healthcare staff and organisations
• improved information, and provision of support and advice from point of diagnosis,
• there are gaps in support services
• there is inequality of support across the county.

The Lincolnshire Cancer Co-production Group was established in May 2019 and involves patients in service development and improvement. The Lincolnshire Cancer Expert Reference Group (CERG) was established in 2022, and this group has a scrutiny function and feeds into the Cancer Board.

In 2025, patient and caregiver experience of the prostate cancer pathway was sought, and these insights are informing the Urology pathway improvement.

Support services helping people address modifiable cancer risk factors have persistent gaps. For example, smoking cessation services would not be adequate resourced, if clinical services referred all those who would benefit from the service to them. Additionally, there is no Tier 3 weight management service to provide specialist multi-disciplinary obesity services.

 A number of patients must still leave the county to access specialist diagnostics and treatments that are only undertaken at specialist centres outside of Lincolnshire. However, this is not unique to Lincolnshire – many NHS services are provided at a centralised specialist centre. Work is ongoing to reduce the need for patients to leave Lincolnshire for diagnostics and treatment.

Workforce capacity in secondary care negatively affects outcomes of initial diagnoses, treatment, and long term follow up of cancer survivors.

Patients report inequity in availability of holistic support depending on where you live (Lincolnshire Living with Cancer Strategy 2023 – 2025). Holistic Needs Assessment (HNA) data show there are areas of the county where patients do not receive an HNA, or that holistic needs are identified but patients are not referred into services for their needs. The Living with Cancer Programme is identifying and working towards filling these gaps and addressing cancer health inequalities by developing an equal balance of support (place-based support) available in the hospitals and in pharmacies, localities (including primary care), workplaces, people’s communities and at home. There will therefore be more equity in support across the county.

Financial toxicity associated with a cancer diagnosis has been identified as an issue for some Lincolnshire residents. The Living with Cancer Programme is addressing this by working with Anglian Water and other utilities providers, National Energy Action, partners from the Voluntary, Community, Faith and Small Enterprise Sector and other system partners.

The government’s Fit for the Future: 10‑Year Health Plan for England (July 2025) frames our local priorities. The plan signals three system-wide shifts that directly influence cancer care. The Cancer Programme and Living with Cancer Programme align their work to the three national shifts:

• Move care nearer to home: expand community-delivered elements of diagnostics, treatment, and follow‑up where clinically safe.
• Pivot to prevention and early detection: reduce risk, find cancers sooner, and narrow inequalities.
• Digitally enabled pathways: use AI, advanced diagnostics, and remote monitoring to streamline journeys and improve experience.

• Implement themes included in the NHS Cancer Plan:  Prevention and early diagnosis, improved treatment and personalised care, patient-centred care, reduced inequalities, enhanced aftercare and support, research and innovation, addressing rarer cancers, and community-based care.
• Invest resources in preventative work programmes. This will result in financial savings to the NHS. Use modelling to identify savings of providing prevention initiatives for cancer treatments.
• Improve cancer pathways: include opportunistic screening, earlier diagnosis mechanisms and improved treatment.
• Continue to implement personalised care and support for people living with cancer, using the Lincolnshire Living with Cancer Programme approach – transformational, whole-system, place-based, asset-based, and person-centred.
• Undertake population level education to raise awareness of prevention, symptoms, risk factors, and the importance of early presentation.
• Cancer Continuing Professional Development (CPD) delivered to health professionals.
• Gather robust data on long term conditions which are co-morbidities of cancer.
• Support the uptake of Human Papilloma Virus (HPV) immunisation by young women and promote the offer to Year 8 boys which began in September 2019.
• Address findings of National Cancer Patient Experience surveys and Quality of Life Surveys.