The COVID-19 pandemic has placed unprecedented demand on the healthcare service. In the early stages of the pandemic health services were asked to prioritise care and review services, including cancer screening and some non-urgent assessments or treatments for cancer. This may have led to some delays for people with less concerning symptoms, or for people where their risk from contracting COVID-19 was considered greater than the potential benefit from hospital attendance. Some people may have also delayed seeing a doctor due to concerns around picking up the coronavirus at health facilities. Separate areas in hospitals were quickly designated for those with symptoms.

In the UK, fewer people have been referred under urgent cancer referral guidelines. Additionally, some non-urgent cases may have been appropriately deferred until services were able to resume as normal. Research indicating delayed referrals will result in increased cancer deaths is so far based on mathematical modelling, and it is too soon to say what the true impact has been on cancer outcomes.

Referral numbers and appointments are now picking up, and some cancer screening has resumed. However, there are fears that delays in cancer diagnosis and treatment may lead to excess cancer deaths. It will be some time before we know the true impact of COVID-19 upon cancer mortality. Importantly, anyone with concerning symptoms should see a doctor promptly.

 

Where did the story come from?

During the course of the pandemic, there have been frequent media reports highlighting concerns around reduced cancer services and screening.  Most recently, the Mail Online published a piece based mainly on the opinions of an unnamed nurse, who considered that the NHS should have continued with more of their usual services during the pandemic. The Mail article also referenced a study by the Institute of Cancer Research on the possible effect of reduced cancer referrals.

 

What is the basis for the claim?

The ICR study, published in the peer-reviewed journal Lancet Oncology, modelled the effect that reductions in urgent referrals for suspected cancer could have on survival.

The researchers looked at recent NHS data on 10-year cancer survival rates for different cancers, by patient age and stage at diagnosis. They also looked at the number of diagnoses made via the urgent, two-week-wait pathway. They assumed that a three-month lockdown would have delayed diagnosis by around two months.

In England during 2013-16, a total of 6281 people were diagnosed with potentially curable stage 1-3 cancers (excluding advanced cancers that had already spread to the rest of the body) via two-week referrals. Around one quarter of them (1691) would be predicted to die within 10 years.

The ICR estimates that delaying cancer diagnosis by two months could cause:

  • 181 extra deaths if there was a 25% drop in urgent referrals during lockdown
  • 361 extra deaths for a 50% drop in referrals
  • 542 extra deaths for a 75% drop in referrals

However, these estimates rely on many assumptions. We don’t know what the effect of delayed diagnosis might be in individual cases or have final data on the effect of COVID-19 on cancer referrals. For example, according to figures given to the UK’s health and social care select committee in May, urgent cancer referrals dropped from 40,000 to 10,000 a week in April (a worst-case scenario 75% reduction) but then rose back to 20,000 a week.

As the ICR says, how long it takes to clear the backlog will also have an impact. They primarily modelled on the basis of the backlog being cleared within one month, but subsequent delays could potentially lead to additional lives lost. This highlights the need for continued measures to protect healthcare resources and capacity.

 

What do trusted sources say?

Cancer Research UK published a blog about the possible impact of delayed screening, diagnosis and treatment. Jon Shelton, Cancer Research UK’s senior intelligence manager, explained that the impact of delays will depend on the cancer type and stage. He added: “Accurately estimating excess deaths is virtually impossible right now, but [estimates] show what could happen if certain scenarios play out. These all strongly emphasise the importance of getting cancer services back on track as soon and as safely as possible, to minimise any further negative impact for people with cancer.”

The CRUK website has extensive information on cancer in relation to COVID-19. They highlight that any person with possible cancer symptoms should seek medical advice as soon as possible.

 

Citation

  1. Sud A et al. Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. Lancet Oncol 2020; https://doi.org/10.1016/ S1470-2045(20)30392-2 https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30392-2/fulltext (Accessed 27 July 2020).

 

Reading list

  1. Cancer Research UK. Why it’s difficult to estimate the number of extra cancer deaths caused by service disruption during COVID-19. https://scienceblog.cancerresearchuk.org/2020/07/21/why-its-difficult-to-estimate-the-number-of-extra-cancer-deaths-caused-by-service-disruption-during-covid-19/ (Accessed 29 July 2020).
  2. Cancer Research UK. Coronavirus (COVID-19). https://www.cancerresearchuk.org/about-cancer/cancer-in-general/coronavirus?_ga=2.232607967.155089102.1595950605-933261076.1587728128 (Accessed 29 July 2020).