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The substantial impact of COVID-19 on cancer patients and the delays in treatments

Recently, due to the COVID-19 or Coronavirus outbreak, there have been continuous delays in treatments and appointments for all patients. This is particularly a major concern for cancer patients in need of urgent treatment and care. As a result of the COVID-19 pandemic, essential diagnostic services have been suspended or operating at a hugely reduced capacity. Also, urgent 2 week wait referrals for patients with suspected cancer initiated by general practitioners have decreased by up to 80% in response to social distancing. 

Overall, since the national lockdown was introduced across the UK on 23rd March 2020, the number of people entering treatment for cancer has dropped significantly and many patients were not seen. Cancer screening has been suspended, routine diagnostic work deferred and only urgent symptomatic cases prioritised for diagnostic intervention. For comparison, in April 2019 almost 200,000 people were referred to a consultant for suspected cancer by their GPs, however, in April 2020, that figure fell to 79,573 (see graph below). In addition, substantial increases in the number of cancer deaths in the UK are to be expected as a result of treatment delays due to the COVID-19 pandemic. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on cancer patients. 

These treatment and screening suspensions were due to the perceived high risk of exposure to COVID-19, particularly to cancer patients whose immune systems tend to be suppressed due to chemotherapy and related treatments.  Furthermore, many staff were re-deployed to critical care units in order to manage the influx of patients with COVID-19. This is likely to result in further delays which could affect survival of patients in need of care and urgent treatment. 

A blog post by Cancer research UK presented the significant impact of delaying screening mentioning: “For every week that screening is paused, 7,000 people aren’t being referred for further tests and 380 cancers aren’t being diagnosed through screening programmes”.  

Figure 1 The COVID-19 outbreak resulted in a significant drop in cancer referrals. Graph from the Guardian 11th June, data source: NHS England

The UK the Stay Home and Stay Alert public health guidelines has had a huge negative effect on health-seeking behaviour and particularly, cancer treatments. Currently, there is no guarantee as to whether or not the situation will get much better or worse. Even though lockdown measures are being gradually relaxed, patients will understandably be more wary of visiting hospitals and we still cannot assume that once all restrictions have been lifted, numbers will return to pre-pandemic levels within the next 6 months or so. However, there was some hope given the recent update by the NHS that COVID-friendly’ cancer treatments are being rolled out. These would involve prescribing drugs that treat patients without having such a significant impact on their immune system or take-at-home formulas that require less frequent hospital visits. Also welcoming is the news that some of the NHS nightingale field hospitals that are no longer in use will be converted to cancer screening centres.

The future situation is still unknown, however, it is crucial that the government’s approach can give cancer patients peace of mind in screening and treatment procedures to help deal with the backlog caused by the pandemic. 

References:

  1. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30391-0/fulltext
  2. https://scienceblog.cancerresearchuk.org/2020/06/01/impact-of-coronavirus-on-cancer-services-revealed-over-2-million-people-waiting-for-screening-tests-and-treatments/
  3. https://www.england.nhs.uk/2020/08/covid-friendly-cancer-treatments/
  4. https://www.nursinginpractice.com/clinical/cancer/nightingale-hospitals-to-be-converted-into-cancer-testing-centres/