“We have improved because there has been pretty steadfast focus and support for cancer treatment in this country, but the reality is that Covid will have hit very hard,” says Sarah Woolnough, an executive director at Cancer Research UK. Key to Britain’s progress over the past decade, she notes, was reducing the lag time for diagnostic services; and yet that critical first step on the cancer pathway has been disrupted by Covid-19.
Britain has national screening programs to test for breast, cervical and bowel cancers. These weren’t officially suspended in England, but the NHS stopped sending out screening invitations, notes Woolnough. Unsurprisingly, there was a 78% drop in breast cancer referrals in April from the year before. Overall, Cancer Research UK estimates 3,800 cancers would have been diagnosed through screening during the first 10 weeks of lockdown. The charity also estimates that during those 10 weeks, 12,750 fewer patients received cancer surgery, 6,000 fewer had chemotherapy treatments and 2,800 missed radiotherapy.
More worryingly, Covid seems to have deterred people with symptoms from seeking help. “We spent the last decade saying to people that if you suspect symptoms, please go check it out. Covid has set that effort back,” Woolnough says. Some are worried about wasting the doctor’s time during a crisis; many fear for their safety.
Getting people back to seeking these services will take clearer guidance from the government and a protocol for testing patients and health-care providers for Covid-19. Woolnough estimates that it would take up to 37,000 tests a day for providers to operate safely. So far the government hasn’t published guidance on testing cancer patients.
Among the most vulnerable cancer patients are those who receive stem cell transplants because of their highly compromised immune systems. Henny Braund, chief executive of Anthony Nolan — a U.K. charity that matches stem cell or bone marrow donors to patients with blood cancers — told me they’ve seen a 25% reduction in the number of transplants. “There needs to be some thought about how that backlog is going to be dealt with, in ensuring we’ve got the right workforce in place, the right PPE and testing for patients and staff,” she says. All three are in short supply.
Even London’s lucrative private hospital market, where a quarter of revenues come from the cancer care, is seeing fewer patients. Robert Marcus, a consultant haematologist with the private provider HCA Healthcare, says the number of patients he’s seeing now is a lot lower than six months ago and the chemotherapy units where he works are operating at 50% to 60% capacity. “You can’t necessarily put the same number of patients on a surgical list or a radiologist’s list than you did because you can’t have the patients mixing in waiting rooms and you have to be even more scrupulous about the cleaning of the various environments,” he says.
Treatment plans are also impacted. The big post-Covid change, apart from capacity constraints, is that providers now need to weigh the risk of giving immune-compromised patients treatment that will make them more vulnerable to complications from Covid-19.
There is another potential hit to the U.K.’s cancer-fighting effort: a loss of funding. Charities fund 60% of all cancer research in the U.K. and 40% of all medical research; they also provide vital services from nursing to support lines and financial aid for patients.