In March 2020, a national lockdown was announced as a government strategy to curb the rapid spread of COVID-19. With this came a pause on non-essential health services including cancer screening. This meant that routine diagnostic work was deferred, and only urgent and symptomatic cases were treated.
This move, together with our individual responses to COVID-19, has had a huge impact on our cancer services and will continue to do so for years to come.
The population was instructed to stay at home and many vulnerable individuals were advised to shield, meaning that even when cancer screening re-opened, many people would not seek the help or advice they needed out of fear of contracting COVID-19.
This has been evident in our own practice: patients have not come in for face-to-face appointments and have instead deferred their cancer screenings until the end of the lockdown period.
According to Cancer Research UK, 3 million fewer people have been screened from March to Sep 2020 and 9,300 fewer people started cancer treatment (April 2020-Jan 2021) compared to the same time the previous year.
Urgent suspected cancer referral dropped by 16%, with 400,000 fewer people being referred (March 2020- Jan 2021). There has been a huge impact on key diagnostics tests, as aerosol-generating procedures were halted due to the risk of COVID-19 transmission and procedure time would take longer with infection control precautions in place.
Endoscopies in particular have been affected with 6-9 times more patients on waiting lists and some patients waiting over 6 weeks for urgent referrals.
Studies are now researching the impact of COVID-19 on cancer screening, diagnosis and management. These studies have included the most prevalent cancer types in the population, but we must remember that all cancer services have been affected by this pandemic and it may take years for the full impact to be realised.
Elizabeth Gourd published an article in The Lancet on how lung cancer control has been hit by COVID-19. Lung cancer is the leading cancer in the UK, killing 35,000 people each year.
It is thought to be the illness worst affected by the COVID-19 pandemic due to the overlap in respiratory symptoms of ongoing cough and shortness of breath, combined with the fact that people have been told to stay home and not to seek medical advice unless it is urgent.
A large proportion of consultations are occurring over the phone or via virtual consultations, and GPs may therefore misdiagnose the symptoms of lung cancer as being those of COVID-19.
There has now been a substantial increase in late-stage presentations of lung cancer, and experts predict that an additional estimated 1,372 lung cancer deaths will occur 5 years after diagnosis following the COVID-19 pandemic.
Another study conducted by Prof Eva Morris and her team investigated the impact of COVID-19 on the detection and management of colorectal cancer. There has been a reduction in endoscopy activity during the COVID-19 pandemic.
This study shows real data from January 2019 to October 2020. The results have shown a sustained reduction in the number of people referred, diagnosed and treated for colorectal cancer during the COVID-19 pandemic. This is likely to have a significant impact on the disease prognosis.
Camille Maringe’s study looking at an increase in cancer deaths following a delay in diagnostics tests during the COVID-19 pandemic has estimated that an increase in deaths for breast, colorectal, oesophageal and lung cancer, and highlights the need for urgent policy intervention to manage this backlog.
This highlights the magnitude of missed cancer diagnoses and the importance of early cancer detection and treatment. As the lockdown lifts and services open up over the next few weeks and months, we can all play our part by ensuring that we remain up to date with our cancer screenings and speak to GPs about any ongoing symptoms or concerns.
We should also encourage friends and family to see their GP if they have concerns. We know for a fact that early cancer detection and intervention saves lives.
Dr Jane Benjamin, General Practice and Health Screening, HCA Primary Care (Roodlane & Blossoms)
