Tackling variation in cancer treatment: can the National Cancer Plan deliver?

In February 2026, the UK Government introduced its National Cancer Plan, marking the first dedicated cancer strategy for England in over a decade. The new administration is tasked with implementing the plan, and it's crucial to ensure its ambitions are delivered promptly. This article by Holly Norman, Head of Health Policy and Systems at Cancer Research UK, examines the National Cancer Plan's commitments to reducing treatment variation and explores further action needed.

Diagnosis of cancer should never leave a patient uncertain about the best treatment options for them, yet evidence shows this isn't always the case in England and internationally. Some treatments are inconsistently used, and some aren't used as frequently as in other countries. This longstanding issue must be urgently addressed to achieve the government's goal by 2035 of 3 in 4 cancer patients surviving at least five years after diagnosis.

The plan acknowledges the necessity to tackle treatment variation and proposes actions to achieve this. However, the success of these steps remains uncertain. Advances in research have led to a variety of sophisticated and effective cancer treatments, so it's encouraging to see the plan commit to measures that will help put these advances into practice more rapidly.

These measures include launching new robotic surgery training standards, faster genomic testing, and streamlining the approval of groundbreaking radiotherapy. However, improving treatment outcomes depends not only on these breakthroughs but also on addressing 'unwarranted variation.' This variation arises from various factors, such as cancer stage at diagnosis, other health conditions, or personal preferences.

Audits of care in the English NHS consistently reveal differences in the proportion of cancer patients receiving best-practice treatments across hospitals. Furthermore, international comparisons suggest that patients in England are less likely to receive radiotherapy and chemotherapy than in other countries. While there is still much to understand about the causes of this variation, many in the cancer community fear it could mean some cancer patients miss out on the best treatment available.

The Cancer Plan proposes several measures that could help address this issue, such as quality improvement projects and ongoing efforts to enhance the functioning of cancer multidisciplinary teams (MDTs). One promising initiative is the introduction of 'Cancer Manuals,' which would establish standards of care for different cancer types, clearly defining what constitutes good care for individuals with cancer.

These actions represent positive and practical steps, providing solid foundations for future progress. However, these measures are merely initial steps. Achieving a comprehensive strategic approach to reducing treatment variation will not be easy, as the causes of variation are complex and many unanswered questions remain. Nevertheless, data and evidence on cancer treatments are improving, and there is a wealth of insight and expertise available across various sectors that could be utilized.

Critical areas to consider include further efforts to assist clinicians in determining the appropriate treatment options for individual patients and understanding why treatment varies across socio-economic groups. Crucially, it's essential to ensure the NHS has sufficient investment in treatment capacity to accommodate the growing number of cancer patients and increasing clinical complexity while also reducing the gap in treatment rates between England and other comparable countries.

An important aspect to explore is the plan's promise to concentrate more treatment in specialist centers. This is significant, as outcomes are often better in hospitals treating a higher volume of cancer patients. However, there are risks to consider, such as the importance of ensuring adequate transportation for patients living far from specialized centers.

In 2025, the Cancer Research UK roundtable of experts concluded that innovative solutions, like utilizing new technologies for remote care, are necessary to ensure treatment services deliver the best care for everyone without introducing further variation. In addition to developing a more strategic approach to tackling variation, the plan's success will also depend on whether the NHS is equipped to deliver change.

There are some challenges on the horizon here as well. Changes to NHS Specialized Commissioning mean that, although national standards will still be set, future decisions on planning, configuring, and commissioning most cancer treatment services will be made locally or regionally by Integrated Care Boards (ICBs) instead of nationally.

This shift could potentially introduce further variation if different ICBs adopt diverse priorities or approaches.