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Covid and cancer services – the lasting impact of the pandemic

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Almost all NHS services have been badly affected by the Covid-19 pandemic. Referrals have declined, elective operations have been postponed and clinics cancelled. Cancer services were not spared and while they do seem to be recovering in some areas more quickly than other specialties, the statistics none the less paint a grim picture.

Data for April to June shows that NHS performance against the two-week waiting target from the point of referral for suspected cancer is slightly higher than it was for the same period last year, rising from 90% to 92%. This is perhaps not surprising, considering the drop in overall cancer referrals of 57% or 244, 325 for the three-month period. Does this mean there are a quarter of a million people out there with symptoms who have yet to approach their GP?

Perhaps not, but the figures for waiting times for known cancers are equally worrying. April to June 2019 saw 76,610 patients begin treatment for cancer, 96% of them within 31 days of diagnosis. The same period in 2020 saw just 55, 685 patients commence treatment, with 95% beginning within 31 days. That is a 27% activity reduction which represents 20, 295 fewer patients being treated.

Fewer patients being referred and fewer being treated. If we assume that there has been no dramatic change in the incidence of cancer within the UK population, it becomes fairly obvious that we are faced with a sizeable unmet need. It is difficult to be exact about the scale of the problem, as always the stats can be interpreted in a number of ways:

Do we have almost 21, 000 people with cancer still waiting for treatment?

Do we assume that the same percentage of people referred for suspected cancer go on to start treatment as in 2019 (13%)? If so, what of the reduction in referrals since the start of the pandemic? The drop in referrals would then imply over 30, 000 potential cases.

Whatever the true numbers, it is clear that this backlog must be addressed. Resuming services and getting the NHS back up to previous capacity will not be sufficient. We know that delays in cancer diagnosis and treatment lead to poor outcomes for patents and future planning needs to take account this.

We have seen an increase in non-coronavirus related mortality, but know we need to concentrate on a potential second spike in covid-19 infections over the winter. Without increasing capacity and building resilience into cancer services, we risk not a second spike in excess mortality, but yet another unwelcome ‘new-normal.’