Of the health crises in the mind of the general public when thinking of 2020, cancer may not be the first that comes to mind. Of course, with the pandemic accelerating even now in August 2020, the UK and several other European countries are seeing an unfavourable lean back towards the epidemiological headlines of late April. With the acute problem of a global pandemic, the virulent nature of the disease is of utmost concern to public health officials – and rightly so. In April and May, the NHS announced nationwide cancellations of routine appointments, screening and operations in response to the demand of acute healthcare for COVID related cases. Amongst these were thousands of vital cancer screening appointments and referrals which, according to Cancer Research UK, is ensuring as many as 3,000 cancer diagnoses are missed every week in the UK.
This ticking timebomb of cancer, secondary diseases, obesity and mental health paint a cloudy picture for the future of national healthcare in the UK as ministers and senior NHS officials attempt to resume normal services across trusts. The double headed issue of the reduced ability to secure a doctor’s appointment due to distance appointments and a possible change in mentality of patients across the country mean many ‘red flag symptoms’ may be being ignored by people experiencing early cancer development. This has led many scientists and oncologists to issue a stark warning: the excess deaths from cancer and related co-morbidities is going to far outweigh the death toll from COVID-19 in the UK.
Some patients are in limbo with their diagnosis, having had early treatment in March but no follow up therapy, meaning diagnostics relating to the spread and effectiveness are thus far on pause. This existential dilemma leaves patients unsure if they are in remission or if their cancer has spread further, a problem with cancers like skin cancer and secondary cancers. Early in June it was reported that a 75% drop in referrals for cancer screening was seen by GPs and providers, with the NHS pleading with patients to not neglect to use GP services or A&Es for medical emergencies. The uncomfortable situation being faced by directors and heads of cancer services is stark: we may have to treat those most needing of radiotherapy or chemotherapy and delay patients with less aggressive cancers. This news comes after a further estimate by Cancer Research UK that: 2,300 people a week are being missed with urgent referrals and 400 missed diagnoses through screening.
The news broken in this article is frank and paints a bleak analysis of the more complex chronic care in ongoing conditions which has been stifled by coronavirus. Experts expect a huge backlog of individuals requiring surgery and radiotherapy, and a double-edged sword of potentially immune-compromised patients developing secondary illnesses or even contracting COVID-19 themselves. Could this signify the beginning of the end of the national healthcare initiative? Many hospitals have begun to lean on private services and contracting services to private hospitals in the inability to cope with regular service pressures on top of the pandemic.
Many cancer charities and oncologists are calling for the government to rethink their policy on coronavirus just as the beginning of August saw many shielded individuals – some of them with cancer – being allowed to gradually begin re-integrating into society. It is unknown how the pandemic will pan out going into winter in the northern hemisphere as the NHS attempts to ramp up services for essential cancer referrals and treatment. Professionals have reassured patients that individuals with the most severe and aggressive cancers can still receive treatments and will be prioritised, but many newly diagnosed (or those with concerning symptoms) who face a long wait for consultation may be left anxious and uncertain for months. With another impending mental health crisis coming amongst unemployment and social isolation, dark and difficult times lay ahead for all sectors of society.
Despite the issues with supply and demand, the NHS remains open and health leaders – including Chris Whitty, Chief Medical Officer – are imploring the public to remain in contact with GPs and health services if they are unwell for any reason. This comes after news earlier in the year that people may have been avoiding health services for fear of contracting COVID-19. At a press conference, Whitty said, “It's not just cancers, we are very concerned that there has been a fall away in people coming to accident and emergency... with things like strokes and heart attacks. They must be going on, and one of the worries we have is people are thinking 'I can't go to the NHS because it can't deal with these emergencies' - it definitely can”. As the pandemic continues and hopefully winds down, people should continue to prioritise their health and use services as and when they need them as the NHS regains strength going into the winter.