While the COVID-19 pandemic response has drawn focus and resources over recent months, delays have been building in other areas of the health system. In Wales, there is currently an estimated 3 month interruption across cancer services. As Wales takes the first steps towards moving out of the COVID-19 lockdown it is time to renew the effort to relieve bottlenecks in the cancer pathway, and move cancer forward again for patients.
An initial focus on getting cancer diagnostics back on track will help to relieve bottlenecks and restore patient pathways as quickly as possible. However, the backlog of patients in primary care, along with outstanding diagnostic tests and reporting of results following secondary care referral are expected to present problems for many months to come. Efficient safety netting practices will be paramount to ensure that patients and test results can be followed up in a timely manner.
The interaction between primary and secondary care is a critical point in the patient pathway. Recent research from the Cancer Research Wales funded WICKED (Wales Interventions and Cancer Knowledge about Early Diagnosis) programme has shown that there is a recognised need for better communication and safety netting at this interface. This evidence was used to build the ThinkCancer! Intervention – an educational workshop that will help to improve the quality and consistency of the approach to cancer referrals. Preparations are underway to trial the workshops in primary care, representing all 7 health boards across Wales.
Even before the current COVID-19 pandemic, dealing effectively with vague symptoms has been a major concern in primary care. Patients whose symptoms are less clear at presentation can often face longer delays to diagnosis and treatment, but around 50% of all cancer patients will first present with symptoms that are vague or non-specific. Research funded by Cancer Research Wales has indicated that GPs find the management of patients with vague symptoms to be the greatest challenge in primary care, from a cancer perspective.
Professor Clare Wilkinson, who leads on the WICKED programme, said:
“The unprecedented NHS and public response to the COVID pandemic has taken a heavy toll on people’s health when it comes to other medical conditions. Cancer is a particular concern; we know that the 2 week urgent referral rate is down by 25% across the UK. The support for rapid action from Cancer Research Wales is highly valued, and the primary care project ThinkCancer will continue to take an agile approach to finding solutions in Wales. The need for urgent investigation into vague symptoms, which don’t always fit the 2 week rule criteria, is very clear from emerging research.”
The worry over vague symptoms has become even more heightened given the further unexpected delays that patients across Wales will now face. The introduction of the Rapid Diagnostic Centres (RDCs) in South Wales has helped to transform this element of the cancer pathway. The RDCs are designed to quickly investigate serious but non-specific symptoms, where cancer is suspected – and in trials have been found to cut diagnosis waiting times by up to 92%.
After COVID-19, the RDCs will be key to help drive diagnosis and alleviate pressure on both primary care and non-oncological units in secondary care. However, these centres currently only exist in two jurisdictions – both in South Wales. There is a real and pressing need to establish RDCs for all health boards across Wales, and for GPs to be better informed on their use. There is also a feeling within primary care that patients who experience vague symptoms will be the last to come forward when normal practice is resumed. Targeted awareness studies will also be critically important to help drive health-seeking behaviour in the population of Wales.
At Cancer Research Wales, we continue to invest in research on the delays that cancer patients face at various stages of their diagnosis and treatment journey. The findings from these studies will help provide the frameworks on which quicker and more streamlined pathways can be built, and improve the speed and efficiency at which cancer is diagnosed. As we emerge from the shadow of COVID-19, we urgently need this work to continue more than ever.
It is understandable, but undeniable, that COVID-19 has introduced additional unwelcome delays to cancer services. As lockdown eases and we return to a ‘new normal’ it is crucial that we start moving cancer forward in Wales once again. Ensuring the swift rollout of the successful RDC model and establishing a centre in each of the 7 health boards around Wales will help to regain lost ground on diagnosis. Ongoing research is critically important to help drive health-seeking behaviour, efficient referral, and speedy diagnosis, to achieve the best possible outcome for patients.