UK COVID-19 Update: How Cancer Treatment Delays Increase Mortality Risk

Tim Locke

November 05, 2020

These are the UK coronavirus stories you need to know about today.

How Cancer Treatment Delays Increase Mortality Risk

Each month cancer treatment is delayed increases the risk of cancer death by around 6%-13%, according to a UK and Canadian review of evidence published in The BMJ.

Data covered surgery, systemic therapy (including chemotherapy), and radiotherapy for seven cancers: bladder, breast, colon, rectum, lung, cervix, and head and neck cancer.

The study team included researchers from Guys' & St Thomas', King's College London, and the London School of Hygiene and Tropical Medicine.

An NHS lockdown cancer prioritisation algorithm that rated several indications as safe with a 10-12 week delay with no predicted impact on outcomes was also taken into account.

"We note that a delay of less than 4 weeks should not be justified as safe based on our findings," they write.

Dr Jodie Moffat, Cancer Research UK’s head of early diagnosis, commented: "Different cancers behave in different ways but for some, just a matter of weeks can be enough for the cancer to progress. This is why swift diagnosis and treatment of cancer is so important.  Predicting the impact of treatment delays is very difficult to do because of all the different factors involved – this study didn’t take account of all the things that may have played a part so there is more to be unpicked.

"Worryingly, the latest England cancer waiting time data for August shows that targets for patients beginning treatment within 62 days of an urgent cancer referral are still being missed. As health services are now having to manage a resurgence of COVID-19 on top of usual winter pressures, investment is urgently needed to make sure the NHS has the staff and equipment it needs to provide patients with life-saving diagnosis and treatment."

Highest Alert Level Requires More Resources

The BMA has responded to NHS England's move to the highest alert level 4 saying it highlights the need for more resources.

Consultants Committee Chair, Dr Rob Harwood, commented: "Failure to address shortages of beds and staff over time mean the NHS is now a poor position going into the winter, and we can expect to see further serious disruption to routine care, increasing the already very large backlog that has built up since the pandemic began. The impact of this will be incredibly destructive, with potentially serious consequences for patients as many will face even longer waits to receive care.

"Every day healthcare workers go above and beyond to keep services running and minimise disruption with the limited resources they have."

Meanwhile, the Royal College of GPs is stressing that primary care remains open for business during lockdown.

Chair, Professor Martin Marshall, said: "We do not want slogans such as 'stay at home' or 'protect the NHS’ to deter patients from seeking medical care, if they need it. We do not want to see patients hesitant to access our services, and in doing so potentially missing out on vital care."

BAME Health & Social Care Workers Inequality Investigation

The Equality and Human Rights Commission (EHRC) is beginning a statutory inquiry into racial inequality of BAME health and social care staff in lower paid roles in Great Britain.

The inquiry will cover workplace conditions, policies, and training that may have contributed to COVID-19 risks.

EHRC Chief Executive, Rebecca Hilsenrath, said in a news release: "The pandemic has exposed racial inequality across the country. We know that ethnic minority groups are over-represented in lower-paid roles and the effect of the pandemic on those working in these jobs in health and social care is a life and death issue.

"We need to understand the structural issues which have left people from a range of ethnic minorities at greater risk. This inquiry will help to answer those questions and make recommendations that can be applied to a number of other working environments where ethnic minorities are over-represented at the lowest paid levels.

"This includes those on the frontline who have been supporting all of us through the immense challenges we have faced this year."

Test and Trace

The latest performance data for England's Test and Trace programme show that between 22 October and 28 October, 61.8% of in-person test results were given within 24 hours.

Also, 82.7% of positive cases referred to the service were reached and asked to provide information about their contacts. However, taking into account all contacts identified, only 59.9% were reached.

Commenting via the Science Media Centre, Professor James Naismith, director of the Rosalind Franklin Institute, and University of Oxford, said: "Based on what I see in this release I would not expect to change my previous assessment that system is not meaningfully impacting upon the disease."

Adam Briggs, senior policy fellow at the Health Foundation, commented:  "Today's data shows that NHS Test and Trace is still struggling to reach the number of cases and contacts needed to help slow the spread of COVID-19."

NHS England's weekly surveillance report showed case detections decreased slightly probably due to half-term.

Case rates have fallen slightly in 5-39 year olds but increased in over 40s.

The COVID-19 hospitalisation rate was 13.23 per 100,000 compared to 10.36 the previous week.

Today's daily data were not available at the time of publication.

Nurse Arrested

A 73 year old nurse, Ylenia Angeli, was arrested for a period of time for trying to take her 97 year old mother out of a care home in Market Weighton in East Yorkshire yesterday ahead of today's lockdown.

The family had not been able to see the elderly woman for 9 months. However, police said they had a legal duty to return the woman to the care home.

Humberside Police Chief Constable, Chris Noble, said in a statement:  "We understand that this is an emotional and difficult situation for all those involved. We sympathise with all families who are in this position and will continue to provide whatever support we can to both parties."

COVID-Secure Visiting for Care Homes

Despite England being under a new lockdown, care home visits should continue in a COVID-secure way, new guidance said.

England's Health and Social Care Secretary, Matt Hancock, commented: "It is vital high quality, compassionate care and infection control remains at the heart of every single care home to protect staff and residents' lives, but we must allow families to reunite in the safest way possible."

In other new guidance, secondary school and college students and staff in England will now have to wear face coverings in communal spaces, outside of classrooms, where social distancing cannot be maintained.

Convalescent Plasma Recipient Becomes Donor

John Curtis, 58, from Romford was given convalescent plasma when he became ill with COVID-19. Now he's become the first recipient to also become a plasma donor.

Credit: NHSBT

In a news release he said: "I am surprised to be the first recipient donor albeit I am very happy to be able to take part in such an important programme. I think everyone who had COVID should be asked about donating during follow up care."

NHS Blood and Transplant said around 1750 patients have now received convalescent plasma as part of the RECOVERY and REMAP-CAP trials.

A study in India recently reported no benefit of the treatment. But UK experts said the trial was too small to give clear results.

See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.

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