Over the course of the Covid-19 outbreak we have seen significant disruption to daily life, people are now restricted to living in-doors, a necessary step to reduce the strain placed on healthcare services by this novel virus. It appears that these radical measures have helped the UK to move past its initial peak infection with new daily cases dropping below the 7-day average(1), however, there is now growing concern among research organisations and healthcare professionals that the quarantine could have serious long-term impacts on patients.

The number of diagnoses for cancers in the UK has dropped rapidly in the last few months it is suspected that the drop is the result of reduced patient visits to GPs (Not wanting to add stress to the healthcare system) and reluctance to send elderly patients for diagnostic tests (increased Covid-19 risk factors). According to cancer research UK the total number of urgent 2 week wait referrals has dropped to 25%(2) of pre pandemic levels, they estimate that for every week the lock down continues 2,300 cases of cancer go undiagnosed through urgent referrals(2). Currently the lockdown is set to last until the 7th of May(3), if there are no further extensions, the  expected number of patients receiving delayed diagnosis as a result of reduced urgent referrals over the course of the lockdown would be ~14,800, even after the lockdown ends there may be delays in testing returning to pre lockdown levels. These are patients who are symptomatic, the NHS would typically hope begin treatment within a maximum of 2 months (62 days)(4) from the time of their referral. Given that the lockdown started on the 23rd March(3), patients whose diagnosis has been delayed could have been waiting as many as 45 days before some level of normality resumes. Clearly this represents significant lost time in the battle with an acute condition, where early diagnosis and intervention can save lives(5).

The NHS has recently published guidance advising that all patients in the UK in need of urgent cancer care should continue with their treatment(6). While this advice will ensure continuation of critical therapies, physicians still face tough choices concerning whether to delay treatment. Due to the nature of cancer therapy and the demographic profile of cancer patients, physicians are currently having to make difficult decisions on whether to make referrals and recommend treatment to potentially at risk patients with very little information on how Covid-19 is likely to impact these patients(7). Better outcomes data is required to help drive these decisions however at the moment caution prevails as physicians don’t want to risk putting patients in harms way(7). Patients with early stage cancers are less likely to receive surgery now as they may not be deemed urgent cases, which could lead to further complications downline.

Society currently faces massive challenges, reopening and returning to “business as usual” (if one exists anymore), could cause a second peak which would be truly catastrophic to both people and the economy. However, the impact of closure of healthcare services on patient outcomes is becoming clearer. Delays to treatment and inability to identify de novo patients early will likely have significant impacts on clinical outcomes as more patients are diagnosed in later stages or with metastatic disease where curative therapy is very unlikely. Without solid data on Covid-19s impact on cancer patients or good options to treat the pandemic, physicians are likely to continue with the cautious approach which could have severe impacts in the long term.

Written by Henry Barling – Senior Analyst, Oncology.

References:

  1. https://www.evaluate.com/covid-19-daily-update – Evaluate Covid-19 Update - (Accessed 24/04/2020)
  2. https://scienceblog.cancerresearchuk.org/2020/04/21/how-coronavirus-is-impacting-cancer-services-in-the-uk/ - How Coronavirus is impacting cancer services in the UK
  3. https://www.independent.co.uk/life-style/health-and-families/coronavirus-lockdown-uk-remove-end-review-schools-when-government-a9453246.html - Coronavirus: When Might The UK Lockdown Come To An End?
  4. https://www.england.nhs.uk/wp-content/uploads/2015/03/delivering-cancer-wait-times.pdf - Delivering Cancer Waiting Times: A Good Practice Guide
  5. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/cancersurvivalinengland/nationalestimatesforpatientsfollowedupto2017 – Office of National Statistics, Cancer patients survival in England: National Estimates for patients followed up in 2017
  6. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0119-_Maintaining-cancer-services-_-letter-to-trusts.pdf - Advice on maintaining cancer treatment during the COVID-19 response
  7. https://ecancer.org/en/video/8882-cancer-treatment-in-the-age-of-covid-19-and-the-current-worldwide-impact – Prof Richard Sullivan, Cancer treatment in the age of Covid-19 and the current worldwide impact, E-Cancer, 09-13 April