Cancer is even more deadly when you're homeless. This innovative new project aims to change that

A cancer diagnosis is a dizzying and distressing event in anyone’s life, triggering a whirlwind of appointments and gruelling, life-saving treatments.

Now imagine confronting that without the stability and security of a home.

Homelessness can mean no registration with a GP to manage your care or being struck off from NHS treatment after no-showing appointments because letters couldn’t be delivered to a home letterbox.

This is a reality that a new pilot is trying to change.

The East of England Cancer Alliance is working with Anglia Ruskin University to install specially trained ‘health navigators’ in homeless hostels operating in Cambridge, Peterborough, Wisbech and King’s Lynn.

The idea is that navigators build up a rapport with people experiencing homelessness and help them register for GPs and attend basic health checks and screenings. They book and accompany people to appointments, explain in understandable terms what clinicians are telling them and also advocate for healthier lifestyle choices and organise health workshops.

The project is still in its early stages after kicking off at the end of 2024.

Big Issue visited Wintercomfort hostel in Cambridge situated just off the banks of the River Cam to meet Vikki Maddison and Louise Thorne, the two health navigators at the hostel.

The pair have spent three months building up relationships with hostel residents, helping 15 register for a GP and are now embarking on training to allow them to do basic medical checks such as taking blood pressure readings.

They will be tasked with encouraging residents to undergo checks for liver cancer in the months ahead.

“It’s just about talking to them, just having a normal conversation at first really,” said Maddison, an ex-service user who used to be homeless on the streets herself.

Thorne added: “If someone appears to be angry or anxious, just listen to them. There is a reason they feel like that.

“And then little steps. Little things like getting a fist bump off someone, I was walking around town the other day to go to one of the hostels, and four homeless people stopped to have conversations with me. It’s an honour to be trusted into that world.”

Maddison continued: “For me, it’s a little bit easier because I’m an ex-service user myself and I’ve worked at Wintercomfort before I was doing this so I know a lot of the people anyway. I’ve been in Cambridge for nearly 20 years and I’m not techno, I’m not paperwork, I’m a people person so it is about knowing how to talk to people as well.”

The programme is placing a particular focus on raising awareness of symptoms to boost early detection of liver cancer, which claims the lives of more than 500 people every year in the East of England.

Across the region, around 560 liver cancers are diagnosed in local hospitals each year.

But, significantly, 40% of liver cancers are diagnosed through NHS emergency settings such as A&E departments. This compares to an overall emergency diagnosis rate of 18% for all cancers combined.

By the time symptoms are picked up in A&E, it is more likely that the illness will have progressed. 

That’s one of the reasons, along with keeping up with treatment, why people experiencing homelessness are twice as likely to experience cancer-related mortality than the rest of the population.

The pilot programme aims to tackle both issues, Lee Smith, a professor of Public Health at Anglia Ruskin University, tells the Big Issue: “When you combine those two models into one intervention, that means you can address the here and now through health navigation and potentially reduce the risk of developing cancer in the future through patient empowerment and patient education.”

The East of England project is a result of another European Horizon 2020 funded project that took place over four years called Cancerless.

Smith was a part of the project working with public health and clinical experts in England, Spain, Greece and Austria.

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Data from the project is still being investigated, but initial results have been promising. Experts have seen an increase in screening uptake and diagnosis of different types of cancer as well as evidence that cancer-related behaviour has been curbed.

“What was really exciting for us is often you get to do these research projects, you get all this funding to do the science, you build your intervention, you show promising findings. But that research project comes to an end,” said Smith.

 “What will happen is you may publish some peer-reviewed journal articles, you might present it at some conferences, but quite rarely does someone take it forward into the actual implementation where it can make a significant impact. So that’s what’s really exciting for me with this whole work.”

The programme caught the attention of Gini Melesi, head of transformation East of England Cancer Alliance, who greenlit the two-year pilot project currently underway in the region. 

The long-term goal is to have the service commissioned more widely.

It’s hoped the programme can change how people experiencing homelessness can engage with a health system that doesn’t work for them.

That’s the transformational change that will be needed as part of efforts to change a situation where the average age at death is just 45 for men and 43 for women experiencing homelessness.

“The whole ethos is that we design healthcare for “normal people” and what is normal?” said Melesi.” It’s about how we design services differently, not how we expect them to conform. Instead we deliver a service that meets their needs.”

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