Coronavirus has meant that cancer diagnostics and treatment have been put on hold. This pandemic has thrown our already stretched cancer services into disarray. Many patients have had their treatment rightly stopped because of the immunosuppressive impact, but we are seeing a wider scale rationing of cancer services.
Every day I receive dozens of tweets and emails from cancer patients who have had their treatment or check-ups delayed. Good friends of mine have had their chemotherapy delayed with no good reason, or even stopped altogether. Receiving a templated email telling you not to come for further treatment is not the best way to communicate such a bombshell. I have managed to help a few patients, but there is only so much anybody can do.
Our health system has come to a shuddering halt. Hospitals have become mostly coronavirus-receiving stations and cancer patients are no longer a priority. I have been one of the loudest voices in favor of a measured lockdown; it was absolutely required to get control of the virus. But now that we are past the peak, and the data suggests, we have to get the system moving again.
A group of us estimated that up to 60,000 cancer patients could unnecessarily die because of a lack of treatment or diagnosis, if the cancer diagnostic and surgical pathways remain shut for more than 6 months. This is an alarming statistic. We’ve seen a huge drop off in the diagnosis of cancer. A usual April would see 30,000 people diagnosed; I will be surprised if we make it to 5000 diagnoses in April 2020.
Cancer has not gone anywhere. I have spent a lifetime fighting it and campaigning for awareness of early diagnosis. In a month, much of that work has been undone. Matt Hancock (Secretary of State for Health and Social Care, UK Government) and Chris Whitty (Chief Medical Advisor, UK Government) seem to be getting a firmer grasp on the perilous situation we are in, but the Government needs to let people know that the NHS is open for business.
I was relieved to see my concerns raised with Boris Johnson (UK Prime Minister) at a daily press conference. Johnson committed that anyone who needs urgent cancer care will receive it.
As oncologists, we all know the difference an early diagnosis can make. Sadly, I’ve lost count of how many people we’ve lost before their time, who could have had years longer if we caught the cancer earlier. Stage progression is totally dependent on time. Much medical litigation is about breach of duty around the time of diagnosis – not reporting a key image correctly or not being sent a timely initial appointment. If breach is proven, the next step is to prove causation. The experience of such litigation is that a delay of 6 months or more, for one of the common solid tumors, justifies compensation as the outcome will, on the balance of probability, be adversely affected.
There will be thousands of people who have felt an usual lump, had abdominal pain or have lost weight unusually fast, who in normal times would have gone to their GP, but are now terrified to report it. People will die because of this. I’m always an optimist and have been outspoken on how well we are progressing through this pandemic, but I can’t sit back and watch as we wave the white flag and surrender thousands of lives to cancer.
In other countries, we have seen that you can treat cancer and coronavirus. In the heat of the pandemic in Italy and China they managed to keep cancer treatment going. If they can do it, why can’t we?
This is a ticking time bomb. We won’t know the damage caused by next month, or even next year, but when we look back in 2025 at the cancer mortality rates in 2020, we will be ashamed we didn’t do more.
So what is the solution? I’m acutely aware that it is easy to criticize, and that actions speak louder than words. My network, the Rutherford Cancer Centres (Reading, UK), have made huge efforts to assist the NHS. We are treating far more NHS patients than usual and are ready to help in any way we can. The collaboration has been successful, but we can go further. I’ve received upsetting emails from parents of young children who are in desperate need of Proton Beam Therapy (PBT) but have had their treatments delayed.
NHS England’s program of sending patients abroad for PBT has had to stop for obvious reasons, and they simply don’t have the capacity to treat everyone who needs it at the Christie Hospital (Manchester, UK).
We have three operational centers with spare capacity in North East England, South Wales and Reading (all UK). It is ludicrous that patients whose prognosis will suffer without the treatment are being forced to delay when we have the capabilities to start the treatment tomorrow.
I have been impressed with the flexibility and pragmatism shown by NHS chiefs during this crisis. If they can take it one step further hundreds of cancer patients will benefit from PBT.
Sadly, the issue is much wider than just PBT. We need to get hospitals back to doing what they do best – treating serious illnesses.
Setting up the various Nightingale hospitals across the UK has been a remarkable achievement. I’m relieved that they sit largely empty. I understand the staffing and logistical issues, but surely using them to exclusively treat COVID-19 patients would free up capacity in our usual hospitals and massively reduce the risk of infection?
To conclude, doing nothing is simply not an option. I joined Twitter to stand up for cancer patients who I saw were getting left behind – a month later and the situation is even worse.
As oncologists, we all need to shout from the rooftop about the long-term impact this pandemic will have on cancer survival in this country. We are already behind many of our neighbors, and our approach during this crisis will only make it worse.
Will the Government listen? I think it is. But I wouldn’t sleep at night knowing I hadn’t done everything possible to help stop the oncoming disaster.
Want regular updates straight to your inbox? Become a member of Oncology Central here.
To access more COVID-19 content, visit our In Focus page.
The opinions expressed in this Editorial are those of the author and do not necessarily reflect the views of Oncology Central or Future Science Group.