According to the charity, Cancer Research UK, the COVID-19 pandemic has led to a huge decrease in the number of patients starting cancer treatment.
Cancer Research UK reports that around 40,000 fewer patients started cancer treatment across the UK in 2020. Although this estimate relates specifically to treatment, this figure is higher than in previous years and driven largely by a reduction in cancer diagnoses during the year. A major concern for the charity is that without adequate access to screening, patients are likely to be living with an undiagnosed cancer so that by the time patients are seen, their cancer will probably have reached a more severe stage and which is associated with a worse prognosis. In fact, a recent study of colorectal cancer published in the Lancet, has shown how the monthly average number of 2-week referrals was reduced by 63% in April 2020 compared to the same period in the previous year.
As well as a reduction in cancer treatments, the pandemic has seen fewer patients accessing diagnostic services e.g., endoscopies, CT scans, non-obstetric ultrasounds and MRI. While these services are not exclusively reserved for cancer services, they can help identify patients with cancer but a backload of cases has arisen during the pandemic. For example, there have been around 600,000 fewer endoscopies performed in England between March and November 2020, which is below pre-pandemic levels. Moreover, the waiting list for endoscopies hit 200,000 in November 2020 in England, representing a rise of 49% compared to the previous year. While the waiting time figures for the devolved nations are smaller, they are still higher than compared to 2019. Furthermore, the current waiting list figures are only available up to November 2020 and as a result of the second wave of the pandemic, the situation will undoubtedly worsen.
A further disruption to cancer services has occurred with surgery since procedures cannot take place without access to post-surgery intensive care beds. With a huge surge in COVID-19 hospitalisations and use of intensive care beds, there have been inevitable delays in cancer surgery. In addition, the reduction in cancer surgery is further compounded by the lack of available staff, many of whom have been deployed to front-line services to deal with the increased number of COVID-19 cases. Nevertheless, Cancer Research UK does report that other cancer treatment services such as radiotherapy or chemotherapy require fewer staff and it has been possible to maintain these services to some extent during the second wave of the pandemic.
Finally, while mass vaccination offers a route out of the pandemic and a potential return to some level of normality, cancer services will need to play catchup. Whether this can be achieved through access to faster and earlier diagnostic testing, improving a person’s prognosis, remains to be seen but is essential if services are to be in a position to offer suitable cancer care for all those who need it.