We must all act urgently to stop the cancer backlog doing more damage
By Integrated Care Journal-
I never dreamed of setting up a Twitter account before March last year. I was having lunch with an oncologist friend of mine who was bragging about racking up a few hundred followers on Twitter. At that stage I thought a tweet was simply what the birds sang in the morning.
As concerns grew over the new virus and of the threat of hospitals becoming overwhelmed, I knew that it was inevitable that cancer patients would be forgotten. If I could pick up a few thousand Twitter followers and make the case for the lost cancer patients, then it would be worth doing.
What happened in March 2020 was unprecedented. The situation quickly spiralled out of control, and we were hit by the first wave. Cancer referrals dropped by 60 per cent in April 2020 compared with the previous year. Patients starting treatment following a GP referral dropped by 18 per cent. The numbers have fluctuated since and progress has been made, but almost everybody working in oncology accepts that there is an enormous backlog to deal with.
The impact of delays and disruption
A delay of a few weeks will not cause any significant issues. A few months or more, and the patient’s prognosis will rapidly deteriorate. We cannot just put cancer patients on the shelf and expect to be able to return to their treatment several months later; cancer just does not work like that.
There have been major disruptions to treatment, but the most serious bottleneck is in diagnosis. There are an estimated 45,000 “missing” cancer patients – people who would have been diagnosed in a normal year but in 2021 have cancer without knowing it. This is the increasingly deadly problem we are facing.
Pictures of intensive care units filled with Covid-19 patients on ventilators have, understandably, deterred many from going anywhere near medical facilities. This has been combined with significant disruption to the primary care sector, further hampering diagnostic capacity.
We have also seen a reluctance to become a “burden” on the NHS during its hour of need. We were told to stay at home to protect the NHS and save lives, and a countless number of seriously ill people did just that. They protected the NHS but in doing so were not given the care that they needed.
Out of the 2,000 patients we have treated or diagnosed at Rutherford Cancer Centres, more than 700 have been within the past year. Many of them presented with a later-stage cancer than we would normally expect. Those people we would usually have seen in spring last year picked up the phone in autumn instead. The cancer grew and sadly their chances of survival shrank. I hear the same from colleagues in oncology across the country; it is a tragically recurring theme.
Continuing failure to recognise the risk
One of the biggest problems with keeping the cancer crisis in the media spotlight is that the disease, while relentless, is relatively slow to develop. We have had numbers of Covid-19 cases, hospitalisations, deaths and vaccinations and other figures given in daily media bulletins, but cancer just does not work like that. Tragic individual stories unconnected to Covid have received some media focus, but nowhere near as much as the virus. When we look back in five years, the extent of the damage will be clear. Excess cancer deaths will be in their tens of thousands, many of them wholly preventable and among younger people.
If the cancer crisis had received a fraction of the attention that the pandemic has, countless lives would have been saved. I have often called for a press conference dedicated to non-Covid health issues, specifically cancer, but those requests have been ignored. These are uncomfortable truths for politicians and I doubt they want to shine a light on the adverse impacts of their own policies.
So where do we go from here? Sadly, so much damage has already been done that will be impossible to reverse. We can, however, mitigate further damage, through investment, awareness, training, staff, collaboration – we need a true national effort to get the cancer backlog under control.
Protons will play an increasing role in how we treat many different types of cancer. In June 2021 Rutherford Health released a report on proton beam therapy that shows how far behind many of our European neighbours we are in the UK, but also the progress we are making. We are training oncologists, building specialist centres and developing world-first artificial intelligence (AI) technology that can quickly distinguish the benefits of protons. In all my years in oncology, the most exciting developments are being made right now.
It is that flexible, innovative and pragmatic spirit we need on a national scale. One example of this I often give relates to using the equipment pretty much continuously. If we pay staff a fair stipend for doing so, they will work round the clock. Patients will certainly come and have a scan at 3am if it means massively expediting the whole process. It will take investment, but quite frankly, considering the money that has been spent on our Covid response, it will be a small price to pay.
The cancer crisis has often been referred to as a “ticking time bomb”. I’m sad to say that this is no longer the case. People are suffering today, and many have already unnecessarily lost their lives. Now is the time for an urgent national response to this crisis. Put politics aside and let us not just tackle the backlog properly but improve cancer services in the UK forever.
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