Can we dare to hope we are winning the war on cancer?

CANCER is the one word that no patient receiving a diagnosis wants to hear.

Each day in Scotland, more than 70 people are told they have the disease. And during our lifetime, we all have a one in three chance of developing it.

Cancer is still the leading cause of death in Scotland, with more than 15,000 people dying from the disease every year.

These numbers are undoubtedly frightening – and cancer is the most feared of diseases.

But what is sometimes overlooked is the fact that cancer survival rates are improving so much that some experts have suggested it could one day be seen as just another chronic disease, like diabetes, which can be managed with treatment.

As the Scottish Government prepares to publish a new cancer strategy this summer, The Scotsman has visited cancer patients in hospitals, hospices and their homes to discover the truth about what it is like to live with the disease, and spoken to the key players shaping the future of cancer care in Scotland.

The consultation on cancer care, launched last week, poses serious questions about the way forward – are more challenging targets needed to cut waiting times for treatment? Is there more to be done to reduce cancer? How can we improve the care of the dying?

But for most patients the key question will remain: What are my chances of survival?

And while cancer survival is improving overall, for some cancers it is improving faster than for others.

In the last 20 years, the cancers with the biggest improvements include prostate, breast, leukaemia and Hodgkin's disease. In comparison, lung and throat cancer survival has improved very little.

The challenge for Scotland is now to address any deficiencies in cancer care, increase survival rates further and prevent cases of the disease in the first place.

Nicola Sturgeon, the Health Secretary, has a clear vision of where she would like to see cancer care heading.

"I would like to see cancer services that have state-of-the-art buildings and equipment and have staff that are as good as we have today," she said.

"But I would also like to see cancer services that are more patient-focused, that give people more information and have patients treated in their own home or as close to their own home as possible," she said. "One area where we do need to improve is palliative care, giving people choice and dignity about where they want to die."

Speaking to The Scotsman, Ms Sturgeon said there was a possibility of more challenging targets for NHS boards to cut treatment waiting times.

Boards have already struggled to meet a two-month target from a doctor urgently referring a patient suspected of having cancer to treatment starting.

Figures are expected to show this target was finally met at the end of 2007 – two years late.

Ms Sturgeon added: "It is going to lead to more challenges. While cancer mortality is going in the right direction, cancer incidence is going up. That is understandable. Cancer is a disease predominantly associated with ageing and we've got an ageing population."

But the new strategy will be about more than just targets.

Ms Sturgeon also wants to look outside the clinical setting, helping patients to get on with life while fighting cancer by giving advice on finances and other areas where they need support.

"We need to develop that side of cancer care much more than we have done in the past," she said, a call echoed by charities.

Elspeth Atkinson, Macmillan Cancer Support's director for Scotland, said: "More people are surviving cancer but can feel abandoned when they leave hospital and finish their treatment.

"Cancer affects every aspect of a person's life and Scotland's cancer services need to adapt to meet the complex needs of people living with cancer, through the integration of health and social care services."

The financial impact of cancer also has a major effect on the NHS itself.

With the incidence of cancer increasing, the health service has to treat more patients. But another concern is the rising cost of cancer drugs, as the pharmaceutical industry develops new, expensive treatments.

The Scottish Medicines Consortium (SMC) decides which drugs are cost-effective for the NHS to use.

She said even where the SMC did not recommend a drug, doctors were free to prescribe it if they thought it appropriate.

Doctors, however, are sceptical about this claim, saying if a health board refuses to fund a drug, their hands are tied.

Ms Sturgeon said she wanted to work with drug manufacturers to try to drive prices down.

"I'm keen that we do look to talk to drugs companies about how they can help in terms of making drugs more available, more cost-effective," she said.

But whatever happens with treatment, a key focus of efforts to tackle cancer must now be on prevention in an effort to cut costs as well as suffering.

Ms Sturgeon said: "We are doing work now to develop a five-year anti-smoking plan and we are doing a lot of work around alcohol.

"We have got to continue with that because primary prevention is absolutely critical."

While politicians and doctors search for the much-needed answers to cancer prevention and treatment, the public continues to worry about the disease.

But with survival rates improving year-on-year, the future is starting to look brighter. Dr Grahame Howard, the clinical director of the cancer centre at Edinburgh's Western General Hospital, said: "We can now give the message to patients and the public that the results of cancer treatments and the outcome for patients is improving for almost all cancers."

'I don't want to know about the future'

WHEN Sophie Flood had pains in her knee, she blamed a fall she had suffered a couple of months earlier.

But when it failed to improve, her doctor referred her for further tests.

Finally, an MRI scan last August revealed the 19-year-old had osteosarcoma – a type of cancer affecting the bone, most common in the under-25s.

Being a medical student, Ms Flood knew immediately what the diagnosis could mean. "It was awful," she said. "I was in complete shock."

Speaking while having chemotherapy at the Beatson Cancer Centre in Glasgow, Ms Flood said the treatment had been tough, adding: "I do get sick, but the worst part of it is feeling tired and faint."

Patients with osteosarcoma also face surgery to remove the tumour, which can, in some cases, involve amputation. However, improved treatments have led to improving survival rates from the disease.

Despite this, Ms Flood, who lives in Glasgow's West End, said she had been reluctant to ask her doctors about the future. She explained: "I don't want to know, so I haven't asked."

Ms Flood has now had surgery to remove the tumour, which showed it had responded well to chemotherapy. She is now having physiotherapy to help improve movement in her leg.

She is also looking forward to getting back to her studies at the National University of Ireland in Galway.

She said: "I liked science at school, but I didn't want to do a lab-based job.

"I wanted a people job, so I decided to do medicine. It is really hard work, but I really enjoy it."

Liz Watt, a teenage and young-adult cancer nurse specialist at the Beatson, said a cancer diagnosis had a major impact on young people and their families.

She said: "They wonder whether they can be cured; is the chemo going to work? That is a scary thought for a young person to contemplate.

"Nobody thinks about dying at that age. Then someone is there telling you that you have a life-threatening illness and you have to start thinking about these things."