Urgent action needed in cancer diagnostics and treatment

The Thin End has referred to the 'hidden' health cost of the COVID pandemic in previous articles.  Clearing the decks to prevent the National Health Service being overwhelmed meant that others had their diagnosis and treatment put on hold. 

What the government should do now is to learn the lesson to build resilience into the system.  Else, we are saving the lives of those directly affected by a pandemic while allowing the health and lives of others to be lost.  This has been particularly evident in cancer services.  It is challenging to see the real ethics of that choice.  Sacrificing Peter to save Paul is not the best approach.   On the contrary, it had all the hallmarks of a panic response. 

NHS England has now prioritised cancer services, but an analysis produced this month by The Institute for Public Policy Research (IPPR) says that the UK government must now use the opportunity of restarting cancer services in the NHS to "build back better."

The new analysis by IPPR and the CF healthcare consultancy finds that survival rates for cancer could be set to drop significantly this year as a result of Covid-19.  

The report shows that five-year survival rates could drop from 16.2 per cent to 15.4 per cent for lung cancer, from 85 per cent to 83.5 per cent for breast cancer, and from 58.4 per cent to 56.1 per cent for colorectal cancer.  

The authors of the report say that these declines would represent a significant setback to progress, with outcomes equivalent to those one year, six years, and eight years earlier, respectively.  

Depending on the level of disruption in other countries, they could also leave the UK further behind in international performance tables. The survival rates implied by the modelling are equivalent to countries such as Turkey and Lithuania before the pandemic.  

The study suggests the leading cause of this decline will be late diagnosis and treatment of cancer caused by the pivot in the NHS towards prioritising Covid-19 patients. It highlights that during the pandemic: 

Screening across the UK stopped during the lockdown meaning 210,000 people per week going without; 

Urgent GP referrals for diagnostics - formally known as the two-week wait - are down by over 40 per cent; 

Diagnostic testing, including through CT and MRI scans and endoscopy, is down by between 28 and 76 per cent; 

Treatment including surgery, chemotherapy and radiotherapy is down by between 10 and 40 per cent. 

A change of approach in diagnostics

The report recognises recent initiatives by the government to restore performance across cancer services but argues that it must go “further and faster” by: 

Making diagnosis and treatment of cancer “Covid-safe’ by moving diagnostics into the community where possible and ensuring all cancer staff and patients are tested regularly. The analysis suggests this commitment alone would require up to 170,000 tests per week. 

Increasing capacity - particularly for diagnostics and treatment - as quickly as possible. The government must swiftly invest in more capacity to clear the backlog of patients - even if this means using the private sector.  

A new approach to prevention

It also argues that there is an opportunity to “build back better”, using the pandemic as an opportunity to address existing weaknesses in our health and care services for cancer by:  

Building on the prime minister’s recent obesity drive by launching a comprehensive new public health strategy to prevent illness. This should span the leading causes of cancer, such as alcohol consumption and smoking, across both adults and children. It should also include restoring the public health grant by providing at least an additional £1bn per year. 

Increasing diagnostic and treatment capacity within the NHS by committing to match OECD levels of CT and MRI machines. The report also highlights the need for more endoscopy and radiotherapy equipment. This would require the government to reach OECD levels of capital spending, as recommended by IPPR previously.  

Pre-Covid status quo insufficient

Thousands could die early as a result of lockdown.

Harry Quilter-Pinner, IPPR associate director and head of its Better Health and Care Programme, said: 

“The pandemic has been devastating, not just for families directly impacted by Covid-19 but also for those with loved ones suffering from other health conditions. Our analysis shows that thousands could die early of conditions such as cancer as a result of the lockdown in NHS services. The government must make it a top priority to restart cancer services and ensure they are resilient for a potential second wave of Covid-19. 

“But we do not have to - and should not - revert to the pre-COVID status quo which saw the UK lagging behind other advanced countries in cancer outcomes. We can use the disruption of the pandemic to design a better system. This demands bolder action on public health to prevent people from getting cancer, and also more investment in NHS diagnostics to ensure that if people do get cancer, we can catch it early.” 

The report outlines the necessary steps to recover and restore cancer services, namely creating safe diagnostic hubs for patients, increasing diagnostic capacity (CT, MRI, and endoscopy), dramatically increasing rapid testing for patients and staff, and working with GPs to better understand and address the bottlenecks.  Furthermore, it says creating COVID-secure diagnostic hubs will require:

A 131% increase in diagnostic capacity (CT, MRI and endoscopy) over a period of 3 months

124,000 to 172,000 additional COVID-19 tests per week for patients and staff to give confidence that cancer services are COVID-secure;

305,000 urgent referrals per month for a 6-month period, with the attendant encouragement of patients to present to GPs and GPs to refer to specialist cancer services.