ONCOLOGY
Cancer care and the coronavirus
Around 2.4 million people in the UK are waiting for cancer screening, further tests or cancer treatment according to analysis by Cancer Research UK. COVID-19 has caused enormous disruption to cancer services across the UK, including delays to cancer treatment, screening and diagnosis, and huge decreases in patients being urgently referred to hospital with suspected cancer symptoms.
Delays to cancer screening have had a significant impact, with a backlog of around 2.1 million people left waiting for breast, bowel or cervical screening. During this time, 3,800 cancers would normally be diagnosed through screening. Urgent cancer referrals, often known as the two-week wait, have been severely impacted with up to 290,000 people missing out on further testing, which would normally catch up to 20,300 cancers in the same time period.
There will also be a backlog of treatment to catch up on, with up to 12,750 fewer patients receiving surgery, 6,000 fewer for chemotherapy and 2,800 fewer receiving radiotherapy since lockdown began. Cancer Research UK also reported that, as of 30 May, there were more than 180,000 people in England waiting for an endoscopy – a rise of 44% from the same time in 2019. Of these people, 66% are waiting six weeks or longer for tests. Compared to last year:
l 51% more people are waiting for colonoscopies and 46% more for flexi- sigmoidoscopies, which are used to detect bowel cancer.
l 44% more patients are waiting for gastroscopies, which help diagnose oesophageal and stomach cancer.
l 23% more people are waiting for a cystoscopy, used for bladder cancer diagnosis.
Cancer Research UK also reported that around a quarter of GPs surveyed said that urgent referrals for suspected cancer had been inappropriately turned down by hospitals ‘more often than before the pandemic’. Over 1,000 GPs across the UK were surveyed in June and asked to compare how the past month had differed to before the COVID-19 pandemic.
NOVEMBER 2020
Worryingly, nearly 40% of all the GPs did not feel that adequate safety-netting had been put in place, leaving patients in limbo between the GP practice and secondary care when referrals were rejected. In some areas, cancer referrals dropped by 75% at the peak of the pandemic, mainly because people weren’t coming forward with symptoms and staying home to protect the NHS. The survey showed that referrals being rejected was also a problem, with the impact varying in different regions of the UK. Up to 40% of GPs in some regions, like the West Midlands, said they felt this was happening more regularly than before the pandemic. On average, around 233,000 people with suspected cancer symptoms are urgently referred for further investigation each month across the UK, and an estimated 16,300 of these people would turn out to have cancer. However, since the start of the lockdown, it’s
estimated that there have been 300,000 fewer urgent suspected cancer referrals than normal. “It’s deeply concerning that suspected cancer patients are being refused hospital appointments despite being referred by their doctor, and even more worrying that they may be slipping through the net,” commented Michelle Mitchell, Cancer Research UK’s chief executive.
Predicted rise in cancer deaths According to new modelling research published in The Lancet Oncology journal, disruption to cancer diagnosis services and people avoiding healthcare because of the COVID-19 pandemic could result in around 3,500 potentially avoidable deaths from the four main cancers in England by 2025. The authors called for policy makers to focus on three key areas: providing public health messaging that puts the
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