Sanofi is calling for a comprehensive, UK guideline to improve NMSC patient care

Non-melanoma skin cancer (NMSC) is the most common cancer in the UK, with more than 155,000 cases of NMSC reported in the UK every year.^1,2 However, NMSC is significantly under-recognised and under-prioritised. While guidelines do exist, many are either outdated or don’t focus on the full NMSC pathway, including advanced disease.

Sanofi is calling for national bodies across the UK to publish a comprehensive clinical guideline in NMSC, which we believe will support clinicians in providing the best possible care and, ultimately, improve patient outcomes.

In November 2022, we conducted a survey of 95 UK skin cancer experts to understand their perspectives on the management of NMSC and how patient care could be improved. The resulting report – Non-Melanoma Skin Cancer Patient Pathway: Improving Patient Journeys and experience of Care – endorsed by Skin Cancer UK, highlighted:

• 65% felt NMSC is not adequately prioritised by NHS England
• 97% of respondents agreed the National Institute for Health and Care Excellence (NICE) should publish a specific national guideline on the referral and management of NMSC
• 96% believe that, if published, their local health system should implement the pathway set out in the national NMSC guideline³

To better understand what a comprehensive, up-to-date national NMSC guideline should include, we brought together multi-disciplinary healthcare professionals (HCPs) and patient group representatives from Melanoma UK, Macmillan, Skcin, and MASScot to discuss the report findings, their suggestions for improving the NMSC patient pathway, and how to drive advocacy efforts. A key focus of the roundtable discussions was to align on concrete actions that will bring us a step closer towards the publication of updated national guidance.

What are the opportunities to improve the NMSC patient pathway?

Clarifying and streamlining the patient pathway 

Siloed working between specialisms, and a historic lack of clear national guidance has meant that NMSC patients are referred through different pathways, depending on how they present to the health system. We know some patients are being directed via a Head and Neck pathway, as that is often the geographic site of the lesion, whereas they should be referred through a Skin pathway, as it is the tissue of origin which is most crucial to treatment.

As a result, patients aren’t being offered the full range of available treatment options, which could help avoid surgery. Delays, in part due to difficulties navigating these pathways, have also resulted in many patients’ cancer advancing, making the disease more difficult to treat.^4,5

Recommendation:

Pathways should be updated to outline more clearly the correct referral routes into secondary care, including a distinction between referral routes via the Local Skin Multi-Disciplinary Team (MDT) and the Specialist Skin MDT. These pathways should list standardised NMSC therapies, to ensure patients have equitable access to the most appropriate treatment options.

Once in place, patients should be empowered with knowledge of the correct NMSC pathway, giving them a voice to advocate for their best case. There is an opportunity for patient groups to collaborate and drive pathway education.

Enhancing and supporting the role of GPs

Skin consultations make up a significant portion of a GP’s workload, yet, many are not fully trained to diagnose NMSC.⁶ Increasing numbers of benign lesions are therefore incorrectly referred to secondary care, adding to the significant backlog in dermatology services.

On the other hand, GPs with an Extended Role (GPwER) in dermatology are effective at correctly diagnosing and referring NMSC tumours, showing they may be instrumental in optimising the pathway.⁷

Recommendation:

Enhancing and expanding GP training in dermatology is key to improving the NMSC patient pathway. Throughout the UK, the GPwER programme should be expanded to fund and train more GPs with an extended role in dermatology. Furthermore, the updated guideline should consider referral of all suspected NMSCs via a GPwER in dermatology prior to referral outside of primary care, only if this can be resourced accordingly.

If more benign lesions were diagnosed and treated in primary care, it would help to alleviate the dermatology backlog.

Formalising the role of tele-dermatology in the pathway

The pandemic catalysed rapid innovation in consulting and treating patients remotely. Tele-dermatology represents an important opportunity to improve patient access to care and increase capacity in both primary and secondary care.

Recommendation:

Since tele-dermatology and some artificial intelligence systems are effective in quickly diagnosing and referring NMSCs, there are opportunities to embed this technology into the patient pathway to streamline diagnosis and alleviate pressure on HCPs.

However, the roll-out of tele-dermatology should only be approved with reliable technology.

Clearly defining advanced NMSCs

There are no clear definitions for advanced, locally advanced, and metastatic NMSC. Without these definitions, pathways cannot be developed and subsequently followed.

Recommendation:

Definitions for advanced, locally advanced, and metastatic NMSC should be established by experts and presented to NICE. Upon agreement, suitable pathways can be developed for each variation of NMSC, in turn helping to improve the patient journey, dependent on stage of disease.

Advocating for improved and consistent NMSC patient experience and outcomes

The points discussed by experts during our Sanofi-convened roundtable reinforce the need for the development of a comprehensive national guideline on the referral and management of NMSC. Engagement with NICE is the priority for us to ensure progress is made in a guideline update.

While NICE has approved a few high-cost treatments in NMSC, we’ve noticed these are not always being used in the right place in the pathway – or being accessed by the right patients. As a result, there is low-cost effectiveness for these NMSC treatments, which we’d welcome the opportunity to work with NICE to rectify. Additionally, there is a clear need to include tele-dermatology within any national guidance. Again, developments in technology are something we’d like to speak to NICE about, with a view to improving patient care and optimising resources.

There is no better time to discuss skin cancer than right now, and focus on NMSC is particularly urgent. At Sanofi, we’re committed to improving outcomes for all people living with NMSC, their carers, and the UK health system. The evidence gained from our survey of HCPs and subsequent roundtable has highlighted several challenges along the NMSC pathway, as well as opportunities to improve patient outcomes. We look forward to driving further advocacy efforts with all relevant stakeholders to achieve our goal of securing an updated, comprehensive national guideline for the referral and management of NMSC.

For more information on the findings from our survey of UK skin cancer experts, please see here.