cancer

NHS Backlog for Missed Cancer Diagnoses May Hit 50,000

According to MacMillan Cancer Support, there have been close to 50,000 missed cancer diagnoses since the time of the first lockdown, with the charity warning that the number could increase drastically over the coming months due to winter pressures placed on the NHS. The charity have also commented that there is currently a shortage of qualified cancer nurses to assist in tackling the backlog, exacerbating the initial problem. The Express has the story.

The NHS is struggling to work its way through the number of people waiting for treatment which spiked during Government-imposed lockdowns, when citizens were told to avoid using health services where possible. And figures suggest that the situation will get much worse before it starts to get better, with upcoming cancer checks likely to add significantly to the patient waiting list.

Macmillan Cancer Support has estimated that more than 47,000 people in the UK have missed a cancer diagnosis since the first lockdown.

Amid warnings of new Covid variants and further disruption to the NHS this winter, the charity added that the number of missed diagnoses could increase further still.

Steven McIntosh, Executive Director of Advocacy and Communications at the charity, said: “Nearly two years into the pandemic, there is still a mountain of almost 50,000 people who are missing a cancer diagnosis.

“Thousands more are already facing delays and disruption as they go through treatment.”

In order to catch up with the number of people who should have started treatment since March last year, Macmillan Cancer Support estimated that NHS England would have to work at a staggering 110% capacity for 13 consecutive months.

McIntosh added: “While hard-working healthcare professionals continue to do all they can to diagnose and treat patients on time, they are fighting an uphill battle.

“Cancer patients are stuck, waiting in a system that doesn’t have the capacity to treat them fast enough, let alone deal with the backlog of thousands who have yet to come forward.”

The charity warned that a primary issue faced by the NHS in its challenge to work through the cancer backlog was a lack of cancer nurses.

Worth reading in full.

12,000 Women Living with Undiagnosed Breast Cancer after a Year of Lockdowns

New analysis by Breast Cancer Now suggests that close to 12,000 women in the U.K. were living with undiagnosed breast cancer at the end of May, following more than a year of lockdowns – and, to make matters worse, screening for the disease is still below pre-lockdown levels. The Times has the story.

The charity Breast Cancer Now said that since screening resumed in the summer of last year about half a million fewer women had been seen than in the same months of 2018 and 2019.

Separate research from the University of Exeter warned that six out of ten patients showing common “alarm” symptoms for cancer were not referred on for urgent investigation.

In September last year Breast Cancer Now warned that a million women had missed out on breast cancer screening because of the pandemic.

Any woman registered with a GP is invited for NHS breast screening every three years between the ages of 50 and 71, although services were paused last year to create capacity in the health service for coronavirus treatment and to reduce the spread of infection. They have restarted but are still subject to infection control measures that often mean that not as many patients can be seen during each session.

Baroness Morgan of Drefelin, Chief Executive of Breast Cancer Now, said: “Unfortunately, despite our hardworking NHS staff, screening services running at reduced capacity means that now 1.5 million fewer women have been screened: a staggering 50% increase since services restarted.

“Women with breast cancer are continuing to pay the price due to the impact of the pandemic and in the worst cases delayed diagnoses could mean that some women die of this devastating disease.” Based on NHS referral, treatment and screening data, the charity estimated that as of May this year 10,162 people in England, 1,067 in Scotland, 620 in Wales and 30 in Northern Ireland could be living with undiagnosed breast cancer.

The charity, along with the Royal College of Radiologists, is calling for more funding and a long-term strategy to ensure that NHS imaging and diagnostic services have enough staff to see and treat patients promptly.

NHS England has said that it would spend £50 million on breast screening to meet national standards and recover backlogs by March next year.

Worth reading in full.

NHS Cancer Patient Backlog Could Take Over a Decade to Clear

Almost every day brings more bad news on the cancer patient backlog in the NHS, caused in large part by the “stay at home, protect the NHS” drive. New research suggests that the waiting list could take more than a decade to clear, and backs up a study released earlier this week showing that thousands more will die along the way because of delayed treatment. The Telegraph has the story.

The analysis of NHS statistics by the Institute of Public Policy Research (IPPR) estimates that around 20,000 cancer diagnoses have been missed during the pandemic.

Waiting lists have reached a record high of 5.5 million, with fears they could reach 13 million, as patients come forward after struggling to access services, or from fear of being a burden on the NHS during the pandemic.

It comes amid growing concern about access to face-to-face appointments with GPs.

The Prime Minister said on Wednesday that patients were entitled to see their doctor in person, raising concerns that without the option, deadly symptoms could be missed. 

Before the pandemic, around 80% of consultations took place in a doctor’s surgery – but in July the figure was just 57%.

The new study by the IPPR and CF, a data analytics consultancy, says it could take until 2033 to clear the backlog – and come too late for many of those whose diagnosis was missed or delayed. 

Even this timetable would require a 5% increase in cancer care activity levels above pre-pandemic levels, it says.

However, boosting this to 15%, with a major expansion in diagnostics and staffing, could clear the backlog by next year, the analysis suggests. …

The research shows that in the year following the first lockdown, 369,000 fewer people than expected were referred to a specialist with suspected cancer. …

Concerns about the spread of Covid, and efforts to free hospitals for patients with the virus, resulted in a major reduction in access to diagnostic tests. …

The report said: “Behind these statistics are thousands of people for whom it will now be too late to cure their cancer.”

Worth reading in full.

Extra 10,000 Brits Likely to Die of Cancer Due to Drop in Emergency Referrals during Lockdown, According to New Study

A drop in emergency referrals for cancer over the past year of lockdowns is likely to result in an extra 10,000 deaths from the disease, according to a new study. In particular, the “stay at home, protect the NHS” message is believed to have put people off coming forward and ‘burdening’ the health service for check-ups, meaning their symptoms were not investigated. MailOnline has the story.

University College London researchers said a drop in emergency referrals from GPs last year across the U.K. resulted in around 40,000 late diagnoses of the disease.

These delays and longer waits for NHS treatment – fuelled by the pandemic – mean thousands will die “significantly earlier” from the disease than would have been the case pre-pandemic.

The study of more than 2,000 adults found nearly two thirds of people worried about bothering family doctors with “minor health problems” because of Covid.

And during the first lockdown last year, the NHS moved GP appointments to online and telephone to limit face-to-face consultations. Number 10’s “stay at home, protect the NHS, save lives” messaging put people off coming forward, meaning their symptoms were never investigated. …

Just 57% of GP appointments are now in person compared with 80% before the pandemic. 

A senior coroner in Manchester earlier this month concluded a lack of face-to-face care contributed to at least five deaths in the area during the pandemic. …

23 million appointments, whether face-to-face or otherwise, were also “lost” during the pandemic.

Out of the 2,000 people polled by UCL, those above 65 – the group who require the most healthcare – were the least likely to want to see their doctor remotely.

Some 56% in that age group opposed having more telephone and online consultations, while 24% were in favour of them.

And only 46% of people aged 18 to 24 wanted more remote appointments, with more than a quarter (28%) against them.

Worth reading in full.

Why Are There Still No Cures For Chronic Disease?

We’re publishing an original piece today by Dr. Rachel Nicoll, a post-doc medical researcher, about the enduring problem of chronic disease. These are diseases for which there is no cure, condemning sufferers to live with them for the rest of their lives. Examples of chronic conditions include Type 2 diabetes, obesity, cardiovascular disease, autoimmune conditions, dementia, lung disease and cancer. Here is an extract:

Why is there still no cure for chronic diseases? By ‘cure’, I am not referring to medical management through drugs that have to be taken for the remainder of life, I mean a complete reversal of the disease, so that the patient can say, for example, that they no longer have Alzheimer’s disease or diabetes. With the trillions poured into medical research over the last several decades, we can be forgiven for asking what scientists have been doing all this time, as there seems to be very little to show for it in terms of reducing chronic disease. Furthermore, part of the definition of chronic disease includes the damning fact that it has no cure. So according to the current medical model, we apparently cannot prevent chronic disease and nor can we cure it; instead we must take ever-increasing numbers of drugs for the rest of our lives. In 2021, after decades of highly funded research, this is truly shocking. Not only is conventional medicine failing to cure chronic disease but the incidence of all chronic diseases is increasing dramatically.

Worth reading in full.

10,000 Fewer Patients in England Started Treatment for Breast Cancer in Past Year

Progress in reducing deaths from breast cancer has been put at risk because of lockdown and the prioritisation of Covid above all other diseases (as well as the reluctance of people to “burden” the NHS thanks, in part, to Government messaging), with more than 10,000 fewer patients in England alone having started treatment in the past year compared to the year before. The Guardian has the story.

According to an analysis of NHS England figures by Cancer Research U.K. (CRUK), about 38,000 fewer cancer patients began treatment between April 2020 and March 2021, compared with the same period a year earlier. Just under 28% of these were breast cancer patients, equating to about 10,600 people.

With CRUK noting that 2018 figures suggest about 15% of new cancers are breast cancer, it seems the disease has been disproportionately affected by the Covid pandemic, with the charity saying the majority of those who have missed out on breast cancer treatment are likely to be people who have yet to be diagnosed, with the vast majority in an early stage of the disease.

Cancer that is detected early is generally more treatable.

The charity said the cancers may not have been picked up in part because of the pause in breast cancer screening during the early part of the coronavirus pandemic.

According to another charity, Breast Cancer Now, almost one million British women, including about 838,000 in England, missed a breast cancer screening appointment during the height of the first wave of coronavirus.

However, CRUK said other factors behind the drop may include the reluctance of some to seek help for symptoms when the Covid waves were at their peaks, either because of concerns about burdening the NHS or because they were afraid of catching Covid.

The charity said the figures suggested progress in reducing breast cancer deaths could be at risk: while the disease is the fourth most common cause of cancer death in the U.K., mortality rates have dropped almost 40% since the 1970s.

Dr Ajay Aggarwal, a Consultant Clinical Oncologist at Guy’s and St Thomas’s NHS trust, whose own work has suggested diagnosis delays caused by the pandemic may lead to 3,500 deaths in England from four main cancers in the next five years, said the latest figures confirmed what was feared at the beginning of the Covid outbreak when cancer services were significantly disrupted.

“This also confirms work recently undertaken in south-east London, where during the first wave of the pandemic, across a region of 1.7 million people, there were 30% fewer diagnoses of breast cancer,” he said. “This is likely to worsen when considering the cumulative impact of the second wave.”

He said similar trends were being seen across a range of other cancers. “For those eventually presenting, the data suggests – and clinical experience – that patients are presenting with more advanced, complex disease, which is either incurable or associated with worse prognosis compared to if they had been diagnosed earlier.”

Worth reading in full.

Restrictions Resulted in “a Consistent Global Drop In Access to Cancer Care”, According to New Review of 69 Studies

A review of 69 studies from across the world has found that there was “a consistent global drop in access to cancer care” – both for adults and for children – during the first wave of Covid due to the restrictive measures introduced by governments. The review, led by Carl Heneghan, Jon Brassey, and Tom Jefferson for Collateral Global, highlights that late-stage cancer presentations (which are linked to decreased survival rates for certain cancers) increased because of delays to screenings, diagnoses, waiting lists and treatments during lockdowns, as well as after restrictions were lifted.

In an editorial based on their review, Carl Heneghan (Professor of Evidence-Based Medicine at Oxford) and Tom Jefferson (an epidemiologist and expert on respiratory diseases) present the findings from various studies on changes to cancer services due to government-imposed restrictions.

From mid-March until the end of April 2020, a cervical cancer screening unit in Cameroon saw screening numbers drop by nearly 80%. This is troubling because late-stage presentations are linked to decreased cervical cancer survival. The five-year survival rate for U.S. women diagnosed with advanced cervical cancer is 15% compared with 93% for those presenting much earlier with localised disease. A similar outcome is seen in low-income countries. In India, for example, the five-year survival is 9% for advanced disease compared with 78% when the cancer is diagnosed at stage one when it is localised to the cervix.

Several studies in our review reported that when routine services resumed after restrictions were lifted, there was still a shift to later-stage disease presentations, even in countries that were relatively unaffected by the pandemic.

In a Japanese regional treatment centre, no significant changes were seen in the number of patients undergoing surgery. However, the number of patients undergoing surgery with advanced disease increased compared with before the emergency. In three university-affiliated hospitals in Korea, the number of cancers diagnosed remained the same; however, the proportion of patients with stage three-four non-small-cell lung cancer (NSCLC) increased to 75% compared to an average of 63% in the three previous years.

Not all cancers have the same prognosis but presenting late with lung cancer is bad news. In those with early disease, more than 55 out of 100 people will survive for five years or more after diagnosis. But in later stage four disease – which has spread beyond the lungs – only five out of 100 survive for five years or more.

In low resource settings, delays had lethal effects. Among Indian patients presenting to a tertiary care hospital with oral cancers, 39% were deemed inoperable in the early three months of the Covid pandemic – double the number compared with the pre-Covid era.

These delays in care were not restricted to adults as children were affected in a variety of countries. In Turkey, a major Paediatric Oncology Department reported reductions in children undergoing chemotherapy, radiotherapy, surgery, and imaging studies during the Covid period. In Italy, presentations to the National Pediatric Oncology Unit in Milan during the lockdown phase were half of what would normally be expected. And in a U.S. tertiary referral centre, 75% of new leukaemia/lymphoma diagnoses required intensive care in April 2020 compared with a monthly average of 12% in 2018–2019.

Patients with cancer often delay seeking medical advice. The early phase of the COVID-19 pandemic substantially exacerbated these delays. The true extent of the impact of these delays may never be known. However, a substantial body of evidence reports that delays lead to later-stage cancer, which translates into more severe disease and subsequently reduces life expectancy. Low and middle-income countries are disproportionately affected by cancer, where more than two-thirds of all global deaths occur.

Worth reading in full.

The full review can be found here.

Britain’s Looming Cancer Crisis

Professor Karol Sikora has warned that Britain faces “the biggest cancer crisis” he has ever encountered. The Government’s focus on suppressing Covid has “sucked the oxygen away from other pressing health issues” which now require urgent attention, he says in the Spectator.

Cancer, cardiac and countless other patients are crying out for help – but are ministers listening? 

Over the last year, politicians have been adopting untried and untested policies, the consequences of which none of us can yet fully grasp. The main aim, of course, of these extraordinary lockdown measures has been to suppress Covid in order to reduce pressure on our hospitals. That has been the metric on which Government approval has been judged.

Whether or not you agree with every restriction, it is clear that this focus has sucked the oxygen away from other pressing health issues. Covid required a response unlike anything we have seen in modern times. But was it right that this happen at the expense of so many other illnesses which have torn apart millions of families? 

Too often it has been framed as Covid or cancer; it does not need to be like this. We turned the country on its head to deal with this virus; we now need to tackle the non-Covid health crisis with the same vigour.

I’ve been a consultant oncologist for 40 years. I thought I had seen everything but make no mistake: this is the biggest cancer crisis I have ever encountered. While daily updates on Covid case numbers and deaths give a picture of the grim toll of the pandemic, cancer just doesn’t work like that. A delayed diagnosis can turn a 80% survival rate into 20% and that is over a matter of months, not years. At Rutherford, my cancer centre network, we are now seeing far more patients than usual presenting with later-stage cancers. Lives have already been lost and the insidious, relentless nature of cancer will mean that will continue for some time.

Professor Sikora notes that the biggest issue which needs to be overcome if the crisis is to be dealt with is awareness. He suggests a Downing Street press conference dealing with non-Covid health issues as a starting point.

The PM needs to outline the urgency of the situation and stress that help is there for those that need it. It won’t solve everything, but it will at least start a conversation. It would do a lot more good than some of the current scripted attempts.

In a recent pice for Lockdown Sceptics, Dr Ann Bradshaw, a retired senior lecturer in adult nursing at Oxford Brookes, wrote that the Government’s mixed messages about the safety of the NHS could be putting people off using it.

And what of the mammogram? Will I be socially distanced in the waiting room? Will the radiographer have clean hands? Will the equipment carry Covid specks? The Government warnings ring again, loudly in my ears. Hospitals are breeding grounds. How many secret Covid spreaders will I encounter? To put my mind at rest I Googled “mammogram” and “Covid”. Oh no – apparently, mammograms after Covid vaccinations can give false positives. So that’s out. Easy decision this time. Or is it? What if I have a hidden lump?

Professor Sikora’s article is worth reading in full.

Urgent Lung Cancer Referrals Fall by a Third

The “stay at home” message is behind a major fall in urgent lung cancer referrals, according to Cancer Research UK’s GP adviser. Lung cancer is the deadliest type and only 3% of sufferers survive for five years or more if diagnosed at the latest stage. People with symptoms are now being urged to contact their GP, but for many, it is already too late. The Telegraph has the story.

Urgent lung cancer referrals have fallen by a third, as a consultant blames the “stay at home” message.

Some 20,300 fewer people were referred for treatment in England between March 2020 and January 2021 compared with the previous year, according to an analysis by Cancer Research UK. This is a 34% fall in patients.

The charity has now warned that multiple lockdowns have resulted in damaging delays in life-saving treatment, as people are either ignoring symptoms altogether or putting off seeking help in order to comply with Covid rules.

Dr Neil Smith, Cancer Research UK’s GP adviser, said: “It’s incredibly worrying that fewer lung cancer patients have started treatment since the beginning of the pandemic.

“While initial advice to stay at home and isolate if people had a new, continuous cough, could mean some people understandably delayed seeking help, we know delays to potentially life-saving treatment may mean lung cancer could progress.

“Covid has created a perfect storm of problems, but the tide is turning as cases drop and vaccines are rolled out.” …

Lung cancer is the most deadly type but if it is diagnosed early when it is more treatable 57% of people will survive for five years or more. This compares with 3% of people diagnosed at the latest stage.

Some of the main symptoms include a cough which doesn’t go away after two or three weeks, coughing up blood, persistent breathlessness, loss of appetite and unexplained weight loss.

Cancer Deaths Likely to Rise for First Time in Decades Due to Covid Backlog, Charities Warn

A coalition of 47 cancer charities has warned the Government that cancer deaths will rise for the first time in decades unless the Covid backlog is addressed. MailOnline has the story.

Cancer deaths will rise for the first time in decades unless urgent action is taken to tackle the Covid backlog, the Government was warned today.  

One Cancer Voice, a coalition of 47 cancer charities, argued more money and staff are desperately needed to address problems stemming from the pandemic.

The charities – speaking collectively for the first time – also asked for the NHS to be given greater access to private facilities.

They said almost 45,000 UK patients “living with cancer without knowing it” should have started treatment in 2020 but did not due to delays caused by coronavirus.

Cancer experts today praised the charities for raising awareness of “the biggest crisis in oncology” seen in more than 50 years.

Official data released last week showed cancer waiting times have spiked during the pandemic because hospital staff and surgeries have been preoccupied with coronavirus patients.

The proportion of suspected patients seen by a specialist within the two-week target hit a record-low of 83% in January, NHS England said. 

It means nearly 30,000 people with suspected cancer waited more than a fortnight to find out whether or not they had the disease in January. Early treatment and diagnosis is crucial in preventing the disease spreading and becoming deadly. 

And the pandemic has led to an increase in the proportion of patients waiting more than a month to start crucial cancer treatment after their diagnosis.

Figures from NHS England last week revealed that cancer is not the only disease to have been neglected because of the focus on Covid. Altogether, some 4.59 million people were waiting to begin treatment at the end of January – the highest since records began in August 2007.

Worth reading in full.