Victoria worked at the The Christie NHS Foundation Trust in Manchester during the pandemic.
For the latest overview of how coronavirus is impacting cancer services, please visit our February 2021 cancer services article.
COVID-19 has placed a huge strain on cancer services in the UK.
It’s been felt in all areas of cancer care – from screening and diagnosis through to cancer treatment, as we’ve blogged about before. And new figures have revealed the sheer scale of this disruption – estimating that over 2 million people in the UK are waiting for screening, tests and treatments since lockdown began 10 weeks ago.
Our chief clinician, Professor Charles Swanton, has seen first–hand the devastating impact this pandemic is having on patients. “Delays to diagnosis and treatment could mean that some cancers will become inoperable. Patients shouldn’t need to wait for this to be over before getting the treatment they need.”
“We can create a safe environment for both staff and cancer patients if testing efforts ramp up quickly.”
Screening and diagnosis
When you break down the figures, delays to cancer screening is responsible for the bulk of the backlog, with around 2.1 million people waiting for breast, bowel or cervical screening.
Screening services have been formally ‘paused in Scotland, Wales and Northern Ireland due to COVID-19 and are effectively paused in England – with invitations not being sent out from screening hubs.
For every week that’s screening is paused, 7,000 people aren’t being referred for further tests and 380 cancers aren’t being diagnosed through screening programmes.
But while the screening backlog is big, potentially the biggest impact on survival is being felt in cancer diagnosis and treatment.
There’s been a significant drop in the number of urgent referrals for cancer, often reported as ‘two-week wait figures’, with 290,000 fewer people being referred for further tests than normal.
This drop is largely because fewer people are going to their GP with symptoms that might be cancer, but we’ve heard that some GPs are also reluctant to risk sending their patient to hospital for further tests, and some diagnostic services – such as endoscopies – have been put on hold due to the risk of spreading COVID-19.
Urgent referrals dropped to around 25% of usual levels in England at the start of the pandemic but have since started to rebound, with figures at around 50% of usual levels in recent weeks. But for each week referrals stay below 100%, the number of cancer cases that are going undiagnosed will continue to stack up.
The cancer community has been working hard to get the message out there that the NHS is still open for business and that people should contact their doctor if they are worried about symptoms – and this must continue.
But patients also need to be confident that they are safe if they do go to the doctor, so ensuring that hospitals have ‘COVID-protected’ safe spaces to carry out cancer tests will be vital to getting urgent and non-urgent referrals back on track.
Despite national guidelines stating that urgent and essential cancer treatments must continue, the impact of COVID-19 has been felt in cancer wards across the country, with surgery worst hit.
Around 12,750 people are waiting for cancer surgery across the UK, as the number of operations has fallen to around 60% of expected levels. Chemotherapy has also taken a hit, with 6,000 fewer people than expected receiving chemotherapy since lockdown began.
Radiotherapy services have experienced the least disruption, with appointments falling by 10% during the pandemic. But the real impact to the service might be masked by the fact that some people have had radiotherapy instead of other treatments like surgery. It’s estimated that 2,800 fewer people have received radiotherapy because of COVID-19.
While some of this is due to the pressures faced by an overstretched NHS and a lack of recovery or ICU beds, some treatment was delayed because it could make people more vulnerable to severe illness with coronavirus.
“There have been some difficult discussions with patients about their safety and ability to continue treatment during this time,” says Michelle Mitchell, our chief executive. “But we’re over the peak of the pandemic now, and cancer care is starting to get up and running.”
We’re seeing cancer services across the UK adapting to COVID-19, with COVID-protected safe spaces being set up to allow cancer treatment to be delivered safely.
But for this to work, it requires regular testing for COVID-19 in all patients and staff working in these places, whether they have COVID-19 symptoms or not.
The road ahead – more COVID-19 testing
The Government has committed to reach 200,000 tests a day in the UK. But we’ve heard from Trusts that not everyone who needs to get a test are able to access it, and test results are taking too long to come back.
We’ve estimated that between 21,000 and 37,000 COVID-19 tests must be done each day to ensure COVID-protected safe spaces for cancer diagnosis and treatment. This assumes that staff are tested weekly and patients are tested before they come into hospital and potentially when they are there for treatment – but more regular testing will be needed.
While testing is vital, this must also be supported by staff having enough PPE and embedding infection control measures consistently.
Securing safe spaces for cancer services is an urgent the first step that must be taken to support the recovery for cancer services. It is critical that testing is ramped up as quickly as possible.
“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 free of COVID-19 where patients can be treated safely,” says Swanton.
Vanda June 4, 2020
Hi, i’ve secondary bc which has been stable for 8 years but in Dec 2019 routine ct scan showed cancer in lymphnodes in my neck. ct scans are back logged and review appointments are by phone. My concern is i went for 15mths(a few years ago) without being seen, i don’t want to slip through their net again. Cancer patients still need their routine scans, reviews etc
Helen Head June 4, 2020
Absolutely right. As a cancer patient, I stopped Chemo because it put me in hospital twice! However I have only just got another cancer drug after 8 months and injections have been stopped by oncology for 3 months. I was told although bone cancer is incurable, you can live a long time with treatment. What does this tell me? My body tells me I am ceasing up!… Why couldnt general hospital be used for co-vid and private hospitals for cancer heart and other non co-vid patients?
Georgina Brooks June 4, 2020
We need the safe spaces for people to be able to come and be screened/tested for peace of mind as much as anything else. The sooner this is up and running on full throttle again, the better!
Karen snell June 4, 2020
I agree such an important cause. I had breast cancer three years ago and my annual check up due 9/6 is going to be by telephone. I would prefer a face to face check up to make sure things are still ok. Keep up the fight
Christine Morgan June 4, 2020
Cancer treatment should be a priority otherwise more there will be a number of unnecessary deaths
David Dennett June 4, 2020
I could not agree more with all these views. Keep up the pressure & the good work
Lynne Painter June 4, 2020
Cancer patients need their
Anthony Bartlett June 4, 2020
Hi I think you do a superb job and save countless lives me being one of them , I do feel the covid virus has created mayhem for cancer victims as you know some people need to be seen straight away especially if at stage 4 ,and from my experience you will all achieve your remarkable life saving work on track again , thanks to all of you for being brilliant
Mrs Dawn Asplen June 4, 2020
I have sent this email to my mp because i myself have breast cancer and we must be able to see our oncologist, breast surgeon, and people definitely need on going appointments, plus treatments and operations im having a telephone appointment today with my oncologist this isn’t same as an hands on or face to face as how can she examine me to see if everything is ok we definitely do need somewhere safe to carry on with cancer patients, new and old
Janet Perry June 3, 2020
Cancer is the biggest killer ,and I don’t understand with treatment so important has to stop because of covid extra people will die
Christine Snowball June 3, 2020
I think it’s disgusting that the rest of the world stands still because of this virus.
Cancer treatments should be sorted now with the same vigour that this thing has been done. Cancer treatments should NOT take a back seat.
Cathy June 3, 2020
My treat.e t was stopped until last month and has just restarted again just hoping there is no further spread . I feel they could have continued in the cancer centres it is separate to main hospital and is where it’s now happening for a few people not all are lucky like mine was restarted because my blood test showed I urgently needed it to be restarted
Pete Shapter June 3, 2020
I had bowel cancer diagnosed last year and had successful surgery to remove it. I am now waiting for a stoma reversal to complete my treatment. So while not a life threatening operation it would complete my recovery from cancel in my mind
Mr D K Tanser June 3, 2020
Thankyou for the information I have just received an appointment for C T scan so hopefully in a fortnight’s time my mind will be at rest
Karen June 3, 2020
A friends cancer treatment was stopped due to the corona virus, now his symptoms have fared up again : (.
I hope treatment for cancer sufferers start getting the urgent treatment they need ASAP.
Katia Demirtzoglou June 3, 2020
Hello, great point and I would be glad to support; the wording though is slightly misleading is not COVID 19 that has done. The government has prioritised certain areas vs others. This happened to show for example testing for COVID 19 was in line with what promised, so cancer testing was cancelled as it didn’t fulfil the narrative. We need to direct the errors to the owners and help them to improve to make sure it doesn’t happen again. In Italy cancer services were never paused and my father in law received his full course of treatment during covid 19 times successfully. Yes they took protective measures, yes they separated the cancer units, yes they used PPE, yes they tested more patients. Here you couldn’t even get regular screening done. This is down to peoples decision and we can correct those by learning from errors, we cannot correct that Covid exists, so let focus on improving the decision making.
Rwade June 3, 2020
The text I received from cruk linking this article stated the article is related to steps going forward for cancer treatments. This article talks more about the problem than the actual solutions for steps going forward. Misleading and uninformative.
Marion June 1, 2020
While my cancer treatment finished at the end of February, my follow up appointments were cancelled. My GP has been great and the requested blood tests have been done there. I know I am in a better position than most and can wait to see thyroid consultant and oncologist later but definitely have missed being able to see or speak to someone after treatment finished.