Double jeopardy – Cancer and COVID-19

While the COVID-19 crisis continues, many hundreds of thousands of lives have been lost to the virus around the world. As attention begins to turn to the longer term outcomes of the pandemic, scientists warn that COVID-19 will indirectly cause deaths for months, if not years, to come.

A new study in England estimates that there will be at least a 20% increase in cancer deaths for newly diagnosed patients over the next year. The ‘double jeopardy’ of trying to catch up with postponed screenings, referrals and treatments – whilst simultaneously trying to keep up with new cases – will cause a huge strain on already stretched cancer pathways. Ultimately, this will cost more lives.

Wales is already behind when it comes to cancer, and while the introduction of the Single Cancer Pathway is welcomed, much work remains to be done to enable Wales to catch-up completely. Research indicates that there are several points in the pathway where delays can occur. In one study on bowel cancer, patients in Wales waited twice as long between symptom presentation and treatment, compared to the best performing country. If Wales could perform in line with the average for cancer diagnosis and treatment in Europe, we could save an additional 300 lives each year. It is likely that the current delays will make these problems worse.

The impact of COVID-19 is being felt across the entire cancer pathway in Wales. Data from England and Scotland indicates that GP referrals for urgent suspected cancer have dropped by over 70%, with Wales expected to show a similar pattern.

Surgery remains a key treatment for many cancers, but many procedures have been postponed as a result of the pandemic. Professor Dean Harris, consultant colorectal surgeon and Cancer Research Wales funded researcher, said:

“Secondary care cancer services have faced a challenging time with the arrival of Covid-19. With uncertainty about when and how high the peak would be we have had to release bed space in all major hospitals to accommodate the wave. Coupled with the concerns about worse outcomes in operated patients who have contracted COVID-19 has resulted in very little cancer surgery taking place. Patients with confirmed cancer who await surgery are naturally concerned about when treatment will happen.

Multidisciplinary cancer teams are regularly reviewing decisions about treatment. Novel oncological alternatives are being provided when possible, such as increased use of short course radiotherapy for rectal cancer. For many diagnosed cancer patients, particularly colorectal cancer, the few extra weeks delay will not change the outcome or nature of surgery.”

The creation of COVID-free (or ‘clean’) sites that can provide vital cancer diagnostics, care and treatment is much needed, but plans for these sites in Wales are yet to be finalised. While this extra resource is welcomed, the finite number of health-care workers to service the clean sites will present a significant challenge. Issues of workforce, especially related to cancer care, were a problem before the current pandemic broke. As a member of the Wales Cancer Alliance, we are calling on Welsh Government to make the development of these sites a top priority, to ensure safe provision for cancer patients around Wales.

Research focused on improving cancer pathways will be critical to prevent us falling further behind as we emerge from the COVID-19 crisis response period. One of our major flagship projects is investigating ways that cancers presenting in primary care can be spotted and referred into secondary care earlier, and with better accuracy. This research will take on even greater importance as attempts are made to relieve the bottlenecks across the patient pathways in Wales following the current crisis.

Cancer pathways in Wales were overburdened, even before the COVID-19 pandemic. It is crucial that provision is made in the short term to overcome the backlog in screening and diagnostics, whilst continuing to provide the best possible care. As we move forward, we must use the lessons learned, together with timely research, to rebuild more efficient pathways and continue to improve outcomes for cancer patients.