For the latest figures, read our updated blog post on the impact of coronavirus on cancer services.
We’re in unchartered waters for delivering cancer care in this pandemic era of COVID-19.
At Cancer Research UK we’re working hard to support people affected by cancer at this unprecedented time. We’ve teamed up with charity partners to create advice, we’re listening to patients, carers and supporters to understand their concerns and we’re providing information and a nurse helpline for those wanting to chat things through.
And what we’re hearing is that many of you are understandably anxious and confused.
It’s undoubtedly a grave time for the NHS across the UK. We’re trying to build a full picture of the challenges to help identify and share solutions for getting cancer services back on track – and quickly.
It’s a variable and rapidly changing landscape, much of it bleak, but peppered with shining examples of innovation, creativity and dogged determination.
In our discussions with clinicians, patients, health leaders and experts across the UK, some key themes have repeatedly emerged for cancer services – from screening and diagnosis to treatment and care.
And while it’s vital to support the NHS through one of the most challenging times in its history, we also need to be talking about COVID-19’s impact on cancer services to ensure as few lives as possible are lost to cancer during the pandemic.
Screening services are being put on hold
Screening services have been formally ‘paused’ in Scotland, Wales and Northern Ireland and are effectively paused in England as invitations are not currently being sent out from screening hubs.
Screening for breast, bowel and cervical cancer can detect the disease before any symptoms show, in the early stages when treatment is more effective. But with around 200,000 people per week no longer being screened for bowel, breast and cervical cancer across the UK, there will be a significant number of early cancers left undetected before these programmes can be reintroduced.
The NHS must develop plans for how to ramp up screening services as quickly as possible once practical. And it’s vital these plans should include how to re-introduce the necessary diagnostic test, for example colonoscopy for bowel screening, without overloading the service.
Cancer diagnosis has been heavily impacted – from GP appointments to tests
The first thing that’s become clear is that people aren’t coming forward with signs or symptoms that could be cancer. It’s not particularly surprising, many of us are giving health services a wide berth at this time.
But cancer doesn’t stop just because we’re in a coronavirus pandemic, and early diagnosis is as important as it’s ever been.
GPs are still virtually open for business even if the practices are not seeing so many people in person and they want to hear from you if you’re worried about something not being right.
The fact that fewer people are going to their GP with symptoms is impacting the whole diagnostic pathway. There’s been a significant drop in the number of ‘urgent referrals’ for cancer, often reported as ‘two-week wait’ figures. Overall, the number of urgent referrals has dropped to around 25% of usual levels in England.
This is largely because fewer people are going to their GP, but some GPs are also reluctant to risk sending their patients to the local hospital for fear of COVID-19 infection. But what it means is that for every week that this goes on, over 2,300 cancer cases are likely to be going undiagnosed across the UK – and these will be stacking up over time.
There are no easy decisions here. We’ve heard great examples of GP practices using ‘triage tests’ to help decide if people with symptoms should be referred for further tests or not.
GPs are conducting virtual appointments in a way that didn’t seem possible pre-COVID and the use of certain tests – such as FIT – in primary care to help GPs decide who’s at highest or lowest risk of bowel cancer is being accelerated.
What’s clear is that, for the growing group of people who might have cancer that aren’t being referred for further tests at this time, it’s crucial that there is a ‘safety net’ in place. To help with this, our teams have developed guidance to support GPs.
And finally, many diagnostic tests aren’t happening for fear of spreading the virus to patients and staff.
This appears to be especially impacting the diagnosis and care of lung cancers – the most common cause of cancer death – as well as cancers of the gastrointestinal tract and any that require investigation via tests such as endoscopy, bronchoscopies, guided biopsies and CT.
We’ll be working with the NHS to try to minimise the impact of this and help get these services moving again.
Cancer treatment has been severely disrupted
Despite national guidelines stating that urgent and essential cancer treatments must continue, unfortunately this is not the case in some hospitals across the UK. Surgery has been worst hit, and clinicians are needing to have very difficult conversations with patients to explain risks vs benefits.
It’s a mixed picture across the UK, with many hospitals and centres working innovatively to ensure as many people with cancer as possible are safely treated.
But we’ve been hearing that patients requiring major surgery aren’t able to have it as either there are no recovery beds with ventilation, no ICU beds if surgery were to go wrong or because the surgery is just too risky for patients and staff. Unfortunately, these issues are heavily affecting those who might benefit from surgery the most, as many ‘curative’ operations are complex.
Doctors are concerned that some people with early cancers are having their treatment delayed for 3 months or more, after which time the chances that surgery can be curative become less likely.
Chemotherapy and palliative care have also been affected by COVID-19. In some cases this is because the risks were deemed too high, in others because of a lack of staff to provide even some priority therapies. The good news is that these can – and will – recover quickly once COVID-19 pressure eases.
Doctors have continued to innovate to try and mitigate some of this disruption. Alternative treatments are being used where possible – e.g. hormone therapies for breast and prostate cancer or radical radiotherapy in place of surgery. For other cases, however, there are fewer options – especially for faster-growing, non-hormone responsive cancers.
Encouragingly, certain hospitals in England have now been designated as ‘cancer hubs’ – such as in London, Manchester, Leeds and several other locations – and are creating ‘COVID-free zones’ for cancer treatment. But right now it’s not clear whether they have access to sufficient testing to prove they’re safe for both patients and staff.
This is one reason why we’re calling for an urgent increase in testing capacity across the UK.
Read more: Cancer care needs mass COVID-19 testing
And while every effort is being made to allow clinical trials to continue – with patients on the trial able to continue to receive experiment treatments where possible – other trials are being paused or discontinued, especially for treatments that might be risky should a patient develop COVID-19 or need urgent intensive care.
Current trials have stopped recruiting and many new trials are being put on hold, which will set clinical research back considerably.
Clinicians are largely working without the data they need
We’ve repeatedly heard that staff do not have the data they need to make fully evidence-based decisions about cancer care and how to balance risk.
Many cancer patients – particularly those currently being treated or with certain medical histories – are at increased risk of complications should they develop a COVID-19 infection.
But many ‘fitter’ patients, especially those with less advanced disease that could benefit from treatment or surgery, are at no greater risk from the epidemic than the general population. We’ve been concerned to hear about cases where these patients are missing out on potentially life-saving treatment.
This is why it’s so important that the testing can be ramped up and plans are in place to treat these patients as capacity becomes available.
NHS staff health and morale are major concerns
We’re aware of the huge anxiety many people with cancer are facing. And many NHS staff are struggling too with the psychological impact of the decisions they’re to make with and for their patients because of the disruption the virus has caused.
And, with most consultations held over the phone, doctors aren’t able to offer the comfort and reassurance they’d like to. They’re aware of and greatly saddened by the distress this is causing patients.
Physical and mental health are growing issues, and staff numbers may reduce yet further, due to long-term sickness and the stress of working through the pandemic.
More COVID-19 tests are urgently needed as many staff feel these are still being ‘rationed’ in a way that is not giving an accurate picture of asymptomatic (or pre-symptomatic) cases, meaning we’re not fully protecting patients and staff. There’s also a huge need for a reliable antibody test to allow hospitals to judge who is safe to return to work.
‘Post Peak Planning’ is crucial
Dealing with the present realities of COVID-19 is challenging enough, and staff across the NHS have been working flat out to reconfigure cancer services to copy with this unprecedented outbreak.
But we also need to the look to the future too. Health leaders across the UK need to develop a comprehensive and evidence-based plan for how to deal with the huge backlog of people who need care – for cancer or any other serious disease – after the first COVID-19 peak passes.
The patient tracking lists on which hospitals usually rely for planning care will become even more critical now to enable them to tackle the extraordinary demands that the ‘tsunami’ of non-COVID-19 patients will present.
A developing picture
With our health service seemingly stretched beyond capacity and a rapidly evolving health crisis, we’re yet to uncover the full extent of the disruption COVID-19 will have on cancer services and people affected by cancer.
And while health bodies and governments have noble ambitions for cancer treatment and care, change won’t materialise without adequate resource and a coordinated response combined with mass COVID-19 testing.
Our chief clinician, Professor Charles Swanton, has seen the impact the pandemic is having on patients first hand. “This pandemic is having a major impact on patients with cancer and the direction it’s heading is really concerning. Delays to diagnosis and treatment could mean that some cancers will become inoperable. But it’s not too late to turn this around. Cancer patients shouldn’t need to wait for the pandemic to pass before getting the treatment they need.
“We can create a safe environment for both staff and cancer patients now that testing efforts are escalating quickly. Staff in hospitals around the country are working extremely hard and with more testing of staff and patients – with and without symptoms – we will have hospitals and centres relatively free from COVID-19 where patients can be treated safely, and post-operative complications can be minimised.”
Sara Hiom is the director of cancer intelligence, early diagnosis and clinical engagement at Cancer Research UK
If you have questions about cancer, you can talk to our nurses Monday to Friday, 9-5pm, on freephone 0808 800 4040.
We want to hear from people affected by cancer about the challenges of day to day life and changes to treatment and care due to COVID-19. Tell us how COVID-19 is impacting your life with cancer through our survey.
- Impact of coronavirus on cancer services revealed
- COVID-19 and cancer – latest updates
- Testing for COVID-19 coronavirus at the Francis Crick Institute
- Protecting our future by taking action now: why we’re making cuts to our research funding
- Opinion: ‘Today our researchers are helping to beat COVID-19 so that ‘tomorrow’ we can get back to beating cancer’
David Asquith May 27, 2020
Are there any Covid-‘free’ hubs for Cancer treatment in Scotland? What do you have to do or be to get into one? How many cancer patients are they treating right now?
Katie Roberts June 1, 2020
Thanks for your question about cancer hubs. Given the geography of Scotland and the fact that some Boards have limited hospital grounds, it’s unlikely that there will be separate ‘COVID-free’ hubs in every Health Board in Scotland. But plans are underway to review how patients can access sites that are protected as much as possible from COVID-19. And in recovery plans outlined by the Cabinet Secretary for Health and Sport yesterday, cancer has been recognised as a priority when it comes to returning NHS services.
Katie, Cancer Research UK
Julie Payne May 18, 2020
I am waiting for surgery of rectal cancer which was postponed due to coronavirus. Do you know when surgery will start in Wales
Katie Roberts May 19, 2020
The Welsh Government have said several times that urgent cancer treatment should be going ahead during the COVID-19 pandemic, but we know that some treatments have been disrupted. We have been calling for COVID-free sites to be established to enable more cancer treatments to return to normal and we know that Health Boards in Wales have been planning how to do this.
In the meantime, we would suggest getting in touch with your cancer specialist and asking them for an update on your surgery. If you have any additional questions, you can also talk to our nurses Monday to Friday, 9-5pm, on freephone 0808 800 4040.
Katie, Cancer Research UK
Mattie Eason May 15, 2020
How long do chemotherapy stay in your body
Katie Roberts May 18, 2020
Thanks for your question about chemotherapy, we can’t answer detailed questions about cancer here on the blog, but if you’d like to chat more about chemotherapy you can contact our nurses on 0808 800 4040, Monday to Friday 9-5pm.
Kelly Simms May 10, 2020
I get annual screening for my BRCA2 gene and luckily I had my screening just before lockdown but I think there’s lots of people out there that need to read reports like this as lockdown is going to have a horrible impact on cancer patients in long term. Is there anyway of getting this information to media for public to see? I only found it as media in Sweden published it and my partner is Swedish as a way to confirm their light restrictions on covid is better in long run for other illnesses such as cancer.
Julie May 7, 2020
I’m in a mixed dilemma, I am currently waiting for bcg forvmy bladder and it has been put on hold even though I am 58 I feel 100%fit to accept this treatment. I have had a test saying I haven’t got covid 19. So why can’t I have this?
Alan rocket May 6, 2020
I’m waiting for stoma reversal, my chemo has ended half way through. It’s nice to be updated thoughm
Anthony Wood May 4, 2020
Its a good report! One key element that struck me was “But many ‘fitter’ patients, especially those with less advanced disease that could benefit from treatment or surgery…. where these patients are missing out on potentially life-saving treatment.”, since I was diagnosed with prostate cancer myself and was due for a prostatectomy 4 weeks ago, but couldnt go ahead due to covid19. This is pre-advanced stage but the long delays may change this outcome. Im not sure of the number of people in the same boat. Im quite fit for a 58 year old and would be willing to take the chance but I dont have any information about the hospital and staff situation, if things will be moved around to allow some services to be re-opened.
Janet Deakin May 4, 2020
Mrs KM Judge May 3, 2020
My dear Husband Died of Cancer in 2014 he was a lovely kind man.
He was kind & gentle Christian person who said he knew where he was going before
he passed away. Those things he said to me have given me great hope! I will always treasure what he said!!
David Ewen May 3, 2020
Just had psa check last week all ok think positive great people looking after people with cancer
Janet May 1, 2020
When are the bone jabs starting up again
Tom Smyth May 1, 2020
In 2010 I had a Bi-lobectomy operation at Guys followed by chemo, radiotherapy and a year later had a newly found tumour removed by Stereo Tactic Radiotherapy. Forever grateful for all you do. I am not in a position to make my normal donation, It won’t be long.
brian douglass May 1, 2020
I think services should continue otherwise there,s going to be significant increase in deaths. luckily my treatment is still going ahead at the moment.
Kenan gokaydin May 1, 2020
I was diagnosed prostate cancer November 2019.since then I have not heard anything from hospital.i am worried .it was stage 2.now may be stage 3 so worried
Kev April 30, 2020
I think it’s horrendous that cancer screening etc has taken a backseat due to Covid 19 I agree minor stuff can and should take a backseat but major surgery and important lifesaving screenings such as cancer need to carry on as normal
Lance Rooney April 29, 2020
Alicia Morgans : Things are not normal recently and we wanted to talk about why that is and how COVID-19 continues to evolve and impact your cancer center and your practice. Can you give us some updates since we talked last?
Stephen berry April 29, 2020
It’s disgusting cancer patients are being overlooked due to the Coronavirus out break I know it’s hard times unknown times but cancer will still be around when corona virus has gone and people’s lives with cancer are being put at risk it should not happen in this day and age
Katie Roberts April 27, 2020
Thank to everyone for sharing your experiences, they’re incredibly helpful for us to get a better understand of what’s happening across the UK.
If you would like to share your story with us, please visit our website.
If you have any questions about cancer or the impact of coronavirus on cancer services, you can talk to one of our nurses on freephone 0808 800 4040, Monday to Friday.
Katie, Cancer Research UK
Maria Petrou April 26, 2020
I was diagnosed with high grade DCIS end of January. End of February I had a lumpectomy but because the margins were not clear and the DCIS covers the whole half of my breast, I was booked for a mastectomy and implant reconstruction, because I’m slim and I will never be able to have a breast at a later stage, for end of march. My operation got cancelled due to covid. Apparently, I’m not urgent and reconstructions have been stopped. I was put on Tamoxifen and I have no idea when they will operate me. I work as a midwife at the same Trust that I was going to have my operation. I’m off work for 2 months already and waiting for my surgery. This is outrageous and totally unsafe.
Patricia Matthewman April 26, 2020
My son was diagnosed with cancer on the 17th March. He was told he needed chemo asap. 2 weeks later he was informed that his treatment had been postponed until further notice. How are we supposed to live with this. He is 47 years old with a wife and 2 children. I am terrified.
ELAINE MCDONALD April 26, 2020
I have terminal secondary breast cancer and am literally being left to die. I’ve had a call from my gp making sure that I have an advanced dnr and all appointments with my oncologist cancelled until further notice.
Stuart Fraser April 25, 2020
I have recently been diagnosed with metastatic prostate cancer and am now on hormone therapy. I was due to start chemo this month but I have been told that due to Covid19 I cannot attend hospital (too dangerous) therefore treatment delayed. There is a drug Abiraterone which is available privately for newly diagnosed patients at £4K per month (approved by NICE) but currently only prescribed by NHS for men who become resistant to hormone therapy. If this drug were to be made available on the NHS it could benefit prostate cancer patients greatly (and relieve pressure on the NHS, both now and in the future).
Anne Fraser April 25, 2020
My husband has recently been diagnosed with advanced prostate cancer. He cannot have chemotherapy because it is too dangerous. His consultant at the Royal Marsden has said that he would benefit greatly from abiraterone as an alternative. As this is already approved for use after other treatments have stopped working, I would think this would be workable and effective in saving lives.
Obviously we are concerned that in the long long tsrm his trratment will have been compromised.
AnnecFraser April 25, 2020
My husband hasrecently been diagnosed with metastatic prostate cancer and is now on hormone therapy. He was due to start chemo this month but has been told that due to Covid19 he cannot attend hospital andctreatment would be dangerous. Therefore treatment delayed. There is a drug Abiraterone which is available privately for newly diagnosed patients at £4K per month (approved by NICE) but currently only prescribed by NHS for men who become resistant to hormone therapy. If this drug were to be made available on the NHS for yhese situations it could benefit prostate cancer patients greatly (and relieve pressure on the NHS, both now and in the future).
Stuart Fraser April 25, 2020
I have recently been diagnosed with metastatic prostate cancer and am now on hormone therapy. I was due to start chemo this month but I have been told that due to Covid19 I cannot attend hospital (treatment would be dangerous) therefore treatment delayed. There is a drug Abiraterone which is available privately for newly diagnosed patients at £4K per month (approved by NICE) but currently only prescribed by NHS for men who become resistant to hormone therapy. If this drug were to be made available on the NHS it could benefit prostate cancer patients greatly (and relieve pressure on the NHS, both now and in the future).