COVID-19 Cancer Backlog Leaves More Than 350,000 People Untested

Liam Davenport

October 14, 2020

More than 350,000 people in the UK have missed out on being urgently referred to hospital with suspected cancer symptoms since the end of March due to the COVID-19 pandemic, show new figures from Cancer Research UK.

The number of people who started treatment also dropped by 31,000 between April and July, or over a quarter compared to the same time last year, suggests the data, which was compiled from a variety of official sources.

"My biggest fear is that I’ll be doing more home visits for palliative care because, as a GP, I am not diagnosing my patients soon enough this year as I’d like to, as I have done in the past", said Dr Neil Smith, Cancer Research UK’s GP for Lancashire and South Cumbria Cancer Alliance.

'Devastating Impact'

In a press briefing, Michelle Mitchell, Cancer Research UK’s chief executive, said that the COVID-19 pandemic has had a "really devastating impact on cancer services and patients" and cancer patients do not want to end up being "collateral damage".

She said that, even before the virus struck, cancer survival rates lagged behind those in comparable countries.

"But the pandemic has made this worse, leaving millions of patients in a backlog, waiting for cancer services, urgent referrals and treatment, and we at Cancer Research UK fear that this will mean poorer survival for cancer patients."

Michelle Mitchell continued that National Health Service (NHS) staff have "done their best to keep the service running throughout the pandemic".

"But whilst service capacity is approaching pre-pandemic levels and clinical trials are reopening…the NHS remains under severe pressure," she added, noting that, with the "resurgence of COVID-19 on top of winter pressures" it is "critical that we learn lessons" from the first wave to keep cancer services running in the next.

First Wave Legacy

Professor Charles Swanton, Cancer Research UK’s chief clinician, and group leader at The Francis Crick Institute, said that the "legacy of the first wave has created enormous problems for patients suffering from cancer".

"If you think about the key aspects of cancer care: screening, patient referrals, treatment, and of course clinical trials, each one of those steps in patient care has been affected."

He also emphasised the "need to protect cancer patients from acquiring COVID-19 during their hospital admission", adding: "For that, we think it is vital that both patients and staff have access to regular COVID-19 testing, both in the asymptomatic and symptomatic stages of the illness."

Prof Swanton said, that for patients to return to the health service, "we need to build confidence in the NHS, we need to build confidence in the referral systems, to enable patients to obtain the care they need in a safe and COVID-protected environment".

Dr Smith agreed, adding: "Fewer of my patients are coming forwards to tell me about the signs and the symptoms of cancer. They seem to be reluctant to do so. That has improved but there’s still a reticence from my patients, even when I see them."

He believes that he has referred 60 fewer patients "in the last 7 months than I would have done, so that’s frustrating me very much".

"If I translate that into actual patients with cancer, that might be 7% or 8% of those I refer," Dr Smith said. "So I know I’ve got five patients in the community, that I can’t get hold of, who have cancer, and that cancer’s going to be diagnosed next year more advanced than I would have been able to do this year."

Cancer Types

The data indicate that the impact of the COVID-19 pandemic on urgent referrals for suspected cancer, and the degree to which they have recovered since April, has varied by cancer type.

As of the end of September, the numbers of suspected lung cancer referrals were still only 60% of pre-COVID-19 levels, and it is estimated that 16,000 fewer patients have been referred for lung cancer tests since March than would be expected, a drop of around 50%.

For suspected urological cancers, including prostate cancer, referrals are 78% of those for the pre-COVID period, and 46,000 fewer patients have been referred since March, a drop of approximately 40%.

Breast cancer referrals are now at 96% of pre-COVID levels, but there have been 46,000 fewer urgent referrals for suspected cancer since March, around 20% lower than would be expected.

Finally, referrals for suspected gastrointestinal cancers are back to 98% of pre-COVID levels. However, approximately 68,000 fewer patients were urgently referred since March, a 30% fall.

There have also been huge increases in the number of people that have been waiting 6 weeks or more for one of the seven key diagnostic tests, with the biggest increase seen in May for endoscopy and radiology tests combined.

Even after a small improvement, the number of individuals waiting at least 6 weeks for a test at the end of August was 10 times higher than in August 2019, and waits for endoscopy alone have not improved.

A survey of GPs by the charity in September showed that more than half reported delays for blood test services, half reported delays for CT scans, and around two thirds reported delays for chest C-rays, none of which had improved appreciably since the last survey, conducted during the lockdown.

Delays for lower gastrointestinal endoscopy were also reported by 62% of GPs, while 69% reported delays for upper gastrointestinal endoscopy and 78% for non-obstetric ultrasound.

Lengthening Queue

Cancer Research UK pointed out that recovering to pre-COVID levels of cancer diagnosis will be difficult for an already overstretched health service.

Michell Mitchell said: "Today we see millions of people stuck in a lengthening queue for screening, diagnosis, treatment, and a pretty stressed NHS workforce, so tackling staff shortages continues to get more and more urgent."

The charity says that, even before the pandemic hit, 10% of diagnostic posts were unfilled, and suggests that staff shortages are the "biggest barrier" to meeting waiting times targets.

Moreover, in 2018, Health Education England estimated that staff numbers in seven key healthcare professions would need to grow by 45% to deliver a world-class cancer service by 2029 and meet the Government’s target of being able to diagnose up to three quarters of cancers at an early stage.

This includes histopathologists, clinical radiologists, diagnostic radiographers, oncologists, and specialist cancer nurses, among others.

While current investment levels will see numbers increase, Cancer Research UK estimates that up to £260 million extra funding will be required to increase staff numbers by the expected 45%, with the investment varying across professions.

For COIs see references.

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