Cancer patients face 'postcode lottery' for mental health support after treatment
Nearly half of NHS trusts providing acute cancer care do not have a formal psychological aftercare pathway for cancer patients after treatment.
Nearly half of NHS trusts providing acute cancer care do not have a formal psychological aftercare pathway for cancer patients after treatment, according to new Freedom of Information research.
The results of the research
The findings, published by breast cancer charity Future Dreams, have prompted renewed calls for psychological support to become a routine part of cancer care, with one former breast surgeon describing the emotional impact of cancer as "huge".
The charity surveyed 81 NHS trusts in England and found 48 per cent did not have a formal survivorship pathway that includes psychological support, while 15 per cent said they provided no post-treatment support at all.
The research also suggests access varies widely depending on where patients are treated.
Among the trusts surveyed, 88 per cent in the South West reported having a formal survivorship pathway, compared with just 20 per cent in the East of England.
Future Dreams said the findings point to a "postcode lottery" in psychological care, despite many patients only beginning to process the emotional impact of their diagnosis once active treatment has ended.
"It affects every single part of your life"
Dr Liz O'Riordan, a retired breast surgeon, author and breast cancer patient, said she had never considered the long-term psychological effects of cancer while working as a consultant herself.
"I'm embarrassed to say that as a breast cancer surgeon, I never once considered the mental impact of a cancer diagnosis on my ladies and men," she said.
"And it's not just the cancer, it's the body image and the collateral damage and the side effects.
"It affects every single part of your life, and we need to start seeing mental health as part of physical health and survivorship."
Dr O'Riordan said she was never offered psychological support after her own diagnosis and initially believed she simply had to "get on with it".
"I didn't expect it," she said.
"I thought you just got on with it.
"But it was a year when my treatment finished... that my mental health really started to wobble.
"That fear of recurrence... dealing with the loss of your fertility and loss of your job and so much change. I really, really struggled."
Why counselling matters
She later discovered she could access counselling through a local Macmillan service after her cancer returned.
"There was a 12-week wait, but I could have eight weeks free and I had no idea that existed.
"I wished I'd had it the first time."
Dr O'Riordan said speaking to an independent counsellor allowed her to discuss fears she struggled to share with loved ones.
"I don't want my husband to know how scared I am.
"I'm scared of dying.
"I don't know who I am.
"And just a place to be vulnerable in a safe space with someone who can just listen and say, 'it's okay, this is normal'...
"I can't tell you how much that meant."
"The impact is life long"
The charity's own research suggests emotional recovery often continues long after treatment ends, with 76 per cent of people using its services seeking emotional support more than two years after completing primary treatment.
However, almost a quarter of NHS trusts surveyed said they place formal time limits on psychological support, while more than a third rely on charities as part of their support offer.
Dr O'Riordan believes that approach fails to reflect the reality of living beyond cancer.
"We need that psychological support.
"Everyone with cancer, not just breast cancer, does."
She said patients should be told from the outset that mental health difficulties following cancer are common.
"I think it would have made a massive difference to firstly know to expect mental health problems with cancer.
"To be told that depression, anxiety, PTSD, grief are all normal.
"They can come on down the line.
"We've got counselling available for you when you need it."
Changes she wants to see
Looking ahead, Dr O'Riordan said she would like every cancer patient to have guaranteed access to psychological support whenever they need it, rather than within an arbitrary timeframe.
"I would like every cancer patient to have free access to psychological support... when they need it.
"They may need it two or three years down the line.
"They may need it now.
"Mental health is part of survivorship."
She also believes hospitals should do more to make patients aware of the support that already exists.
"I think for all the hospitals that do have access to psychological support through charities like Macmillan, making sure every patient is told that it's available to them.
"I didn't know.
"It's only when I was struggling... someone said, 'Didn't you know that you could have therapy?'
"No one told me."
The findings come as the Government develops a new National Cancer Plan, which has pledged to provide more personalised support for people living with and beyond cancer.
Government Response
A Department of Health and Social Care spokesperson said:
“As part of their care, all cancer patients should be offered support for their mental health and emotional health wellbeing.
“Our landmark National Cancer Plan will drive improvements in care, making sure no matter where in the country you live or what cancer you have, everyone receives the best care possible. As part of this, patients will have a universal right to receive a complete personal cancer plan, which will include support from neighbourhood health teams in the community, and digital support through the NHS App.”
For background:
We are also increasing funding for mental health services, expanding access to NHS Talking Therapies, and have recruited 8,500 mental health workers three years ahead of schedule.
NHS England response
Amanda Pleavin, Managing Director, East of England Cancer Alliance, said:
”Across the East of England, there is recognition that recovery from cancer extends beyond physical treatment. Psychological aftercare plays a vital role in helping patients cope with the emotional impact of diagnosis, treatment, and life beyond cancer.
"The East of England Cancer Alliance continues to work with partners across the region to strengthen support for patients’ mental wellbeing, including access to talking therapies, peer support, and specialist psychological services.
"By integrating psychological aftercare into cancer pathways, we aim to ensure that every patient feels supported not just to survive, but to recover and live well. We continue to work with our Primary Care partners to ensure that Cancer Care Reviews following cancer treatment can signpost people to the support they need.”
An NHS spokesperson said:
"The NHS is working hard to ensure that everyone impacted by cancer receives support with their psychological wellbeing, and under the new National Cancer Plan, all local health teams will work with every cancer patient to develop a personal care plan that covers not just their treatment, but also their wider physical and mental health needs and social needs.”