The safe delivery of health care is just one of the many parts of normal life which has been challenged by the Covid-19 pandemic which has gripped the UK since last March. While cancer services around the country have worked with astonishing speed to minimise the impact on cancer treatment, patients continue to slip through the growing cracks in cancer care.
The word “cancer” can evoke a wide range of responses and feelings, but this diagnosis is not a death sentence. Disruption of urgent cancer services was a key risk that national policy guidance across the UK has aimed to protect against throughout the Covid-19 pandemic. Nevertheless, services have been impacted, and work is now ongoing to recover the standard operation of services as quickly as possible.
The best way to go about bringing back vital cancer treatment is under some debate: UK Health Secretary Matt Hancock stated in October that “the best way to keep cancer services running is to suppress the disease” [coronavirus], a suggestion which has been disputed by oncologists who need to provide treatment now – not simply when the virus is no longer a threat.
Suspected cancer referrals have gone down by 350,000 between April and August 2019 and the same period in 2020, and an estimated 3 million people have missed cancer screenings. During the next 5–10 years, upwards of 60,000 life-years could be lost due to delays in diagnosis and referral – although the exact numbers are uncertain, an outcome of excess early cancer mortality is indisputable. An incalculable impact on novel treatment development and individual patient outcomes is also expected due to the halting of clinical cancer trials in the UK early in the pandemic, though these are now starting to reopen.
If your cancer becomes widespread before it is diagnosed, your treatment is less likely to be successful than it would be if you received your diagnosis at an early stage. In a drive to encourage people to come forward if they have symptoms and counteract the drop in people visiting their GP for cancer test referrals, programmes like the “Help Us, Help You” campaign have been introduced. The 2020 gap in cancer care has continued despite these directives, campaigns and efforts from the government and health service, however.
It is worth noting that the devastating impact that Covid-19 is having on cancer care in the UK is not being felt by all countries infected with the virus: many other countries have managed to continue with provision of cancer care. Coordinating the redistribution of medical resources has allowed several countries including Australia and Germany to respond to local outbreaks, for example, while France has successfully handled workforce issues by drawing on a voluntary reserve force of medical professionals. Pre-Covid-19 levels of cancer treatment (including blood tests, surgery, medical oncology and radiation oncology) have continued in New Zealand throughout the Covid-19 lockdown.
Across the UK, backlogs in diagnosis and treatment have developed to varying degrees. To reduce this backlog and meet increased demand, cancer services will need to ramp up capacity, but it’s not clear that the NHS in all nations have the resources or ability to do this. And all the while, Covid-19 cases continue to develop throughout the country.
The NHS’ ability to to deal with the pandemic is not due to a lack of care and competence among its workers, of course. The Health Service here has been severely hampered by years of austerity, meaning we entered the pandemic with fewer capital assets, doctors and nurses than many other high-income countries. As the pandemic has progressed through subsequent waves, the NHS has been working hard under its own guidance to prepare more appropriately for the growing strain placed on health services.
Other innovative solutions to reduce the impact of Covid-19 on health care have been considered by NHS staff, who have worked tirelessly to protect and care for their patients. In September 2020, it was announced that non-COVID care – including cancer care – would be carried out through autumn and winter at NHS hospitals which had been declared COVID-free treatment hubs. This plan required higher Covid-19 testing capacity to ensure the safety of all staff and patients.
Long-term ambitions for improvement including increased workforce and new technologies were recommended by Cancer Research UK as ways to preserve high-quality cancer care.
In October 2020, Macmillan Cancer Support estimated that there were around 50,000 “missing diagnoses” (i.e. 50,000 fewer diagnoses had been made than would be expected based on previous years) across the UK, a number which will have risen once again between October 2020 and the current day.
In the same report, Macmillan found that the backlog in cancer treatment has been added to by activity levels remaining below pre-pandemic levels. In England, urgent referrals statistics for August 2020 showed that the activity was 11% behind 2019 levels. The charity estimated that, even if activity was increased to 10% above pre-pandemic levels, it would take 20 months to work through the diagnosis backlog. If the NHS was able to increase to 20% over pre-pandemic levels, it would take 11 months.
It is vital that as the pandemic continues, adaptations are made and the government and health service are able to learn and grow from mistakes made in 2020. After all, hundreds of thousands of people have been and will be impacted by the disruption to cancer care across the UK.
If you suspect you may have cancer symptoms, it is vital that you seek medical attention and do not put off calling the doctor until after the pandemic. Cancer treatment is most successful when the condition is caught early, and we still can’t know for sure when services will return to “normal”. You can learn more about cancer treatments – as well as symptoms and warning signs – from Need2Know Books’ collection of books about cancer.