By Holly Giles
“It’s not a great time for having cancer at the moment” was the message of Professor Pat Price in Monday night’s Panorama Britain’s Cancer Crisis. Many may question what a good time to have cancer looks like, but with treatments postponed and diagnoses missed, it is definitely not in the middle of a global pandemic.
The show focused on the effects of the COVID-19 pandemic on cancer patients both undergoing treatment and those waiting to be diagnosed. This is a topic close to my own heart as my mum was diagnosed with breast cancer in January. During lockdown, she has had six rounds of chemotherapy and underwent surgery last week.
We have been so fortunate for her treatment to have carried on, except minor changes including no visitors and a lot of PPE, but I am aware this is not the case for so many other cancer patients. My mum explained feeling similarly to the documentary’s narrator who said she felt guilty that she has been given her treatment when so many others haven’t; it is hard to see the reason for these vast discrepancies.
Many cancer patients have had their chemotherapy service “put on pause” for a minimum of twelve weeks, a move put down to a lack of staff and resources during the pandemic. This break from treatment has changed the life expectancy of many patients with one patient saying “I would not be in this position without COVID… I don’t want to die”. It is a reality faced by cancer patients and has been dubbed “grossly unfair” by many.
This is not just a problem for current cancer patients, but for those yet to be diagnosed. Recent figures estimate that 2 million screening appointments have been missed during the pandemic, with screening services being completely stopped in Wales, Scotland and Northern Ireland and greatly reduced in England. These services identify thousands of cancers which will now have been missed.
Another important detection of cancer is through GP referrals. One GP in London said that their referrals have gone down by two thirds during the pandemic due to the public not wanting to bother their local GP while they are busy or not wanting to visit the doctor out of fear of catching COVID-19. The message of “stay home, protect our NHS” may have gone too far with fears of what these missed diagnoses will mean for the future.
Normally, 3000 people each week hear the heart-stopping news that they have cancer, but now in lockdown, this figure has dropped to 700, meaning 2300 cases are being missed.
The importance of the drop in diagnosis number was highlighted by narrator Deborah James, founder of the podcast “You, Me and The Big C”, who reminded viewers that early diagnoses are key to cancer survival.
Deborah James is living with bowel cancer and has shared her story regularly on instagram with the account @bowel_babe. She explained that catching bowel disease early has a 90% survival rate, whereas a stage 4 cancer only has 10% survival. This trend is echoed across all types of cancers and calls into question the number of lives which will be lost because of this delay. A value estimated by Mark Lawler, Science Director for DATA-CAN, as an excess 35,000 deaths.
The man behind these decisions is Professor Peter Johnson, National Clinical Director for Cancer. He spoke to James in the documentary and said, “the services [have been] under huge pressure… all we can do is our best”.
Johnson explained the decision making as being a careful balance between the risk of catching the virus through treatment and the risk of the cancer getting worse which is “logistically very complicated”. When questioned on the future deaths from missed services, Johnson said “it was impossible to say”.
Since the statement, it has been widely accepted by statisticians that 7,000 extra deaths is a best case scenario and 35,000 is the worst case scenario for the British fallout from COVID-19 and cancer.
A good initiative used by the NHS during the pandemic has been teaming up with local private hospitals to create COVID free cancer hubs. One of these hubs was the location of my mum’s operation where extra precautions had been taken to minimise infection, meaning she could be operated on without contracting the virus.
The schemes have helped thousands of people continue treatment, but many worry they have not been used enough. Johnson explained it takes time to adjust to this new system but the “number is going up steadily” which brings hope that treatment numbers may now be on the rise.
A key type of treatment, experienced by half of all cancer patients, is radiotherapy. This non-invasive procedure involves the patient lying down while a machine sends targeted waves into the site of the cancer.
Professor Pat Price is the Chair of Action Radiography and believes radiotherapy should have been picked up where chemotherapy left off. It is a rapid procedure involving minimal hospital time and has been proven to have no effect on the immune system, yet Price was directly told not to treat which she described as a “high risk strategy” in the case of cancer patients.
The reality is that cancer services have had to reduce, and in many places stop, due to COVID-19 – but cancer doesn’t stop.
Cancers will still be growing in the patients that have not been diagnosed. Cancers will still be spreading in the patients that have had a pause in treatment – and cancer will still be claiming lives from the corona pandemic for years to come. It is a harsh reality but one that makes me so grateful for the experience I have had with my mum’s treatment.
From what I have seen, I honestly believe the NHS are doing “the best they can” as Johnson described.
For more information on the details given please see Panorama – Britain’s Cancer Crisis.