By Integrated Care Journal-
Since a UK wide lockdown was introduced in March, there has been a looming spectre around oncology. Screenings were suspended, routine diagnostic work deferred, and only major surgery prioritised – resulting in a mountain of elective care backlogs and unmet clinical need. The longer the pandemic continues, the further cancer outcomes will deteriorate.
There is already a growing body of ominous data to confirm these fears. #seccestitle10">A recent Lancet study compared pre-pandemic figures to those being observed now to examine the impact upon four cancer types. The study estimated a 7·9–9·6 per cent increase in breast cancer mortality up to five years after diagnosis, corresponding to between 281 and 344 additional deaths. For colorectal cancer, 1445 to 1563 additional deaths, a 15·3–16·6 per cent increase; for lung cancer, 1235 to 1372 additional deaths, a 4·8–5·3 per cent increase; and for oesophageal cancer, 330 to 342 additional deaths, 5·8–6·0 per cent increase up to five years after diagnosis. For these four tumour types, the data corresponds with 3291–3621 additional deaths across the scenarios within five years.
It is not just the long-term impact on cancer outcomes that policymakers should be concerned with. A recent study from Imperial College London compared mortality between Italy, Spain, Germany and the UK – the latter was shown to have the highest mortality rates for cancer patients with Covid-19. The study also found that continued chemotherapy and immunotherapy treatment had little impact on the severity of Covid-19 and survival rates. Further, it provided evidence for using demographic factors to identify cancer patients most at risk from Covid-19, which supported them being further shielded.
For lung cancer patients, the risk of catching Covid-19 is serious. The Memorial Sloan Kettering Cancer Center (MSKCC) studied the impact of Covid-19 on US cancer patients - 62 per cent of those who caught coronavirus were hospitalised and 25 per cent died. However, it was shown that determinants of severity are patient-specific, including smoking status and chronic obstructive pulmonary disease (COPD), rather than tumour-specific characteristics or treatments. Although severe, Covid-19 accounted for a minority of overall lung cancer deaths in the MSKCC during the pandemic (11 per cent).
The severity of Covid-19 on direct cancer outcomes, paired with the backlog the resulting lockdown produced, has created a cauldron of challenges for oncology. Fortunately, there are some positive developments in innovation and in treatment streamlining that could alleviate pressures.
‘Covid-19 friendly’ cancer treatments
Earlier this month, NHS England announced the expansion and extension of ‘Covid-friendly’ cancer treatments that have been proven safer for patients during the pandemic. There are now plans to for a £160 million initiative to pay for drugs that treat patients with minimal impacts on their immune systems and require fewer hospital visits. Some new treatments on offer enable patients to take tablets at home or receive medicines with fewer side-effects instead of undergoing hospital-based treatment that can leave them more susceptible to coronavirus and other infections.
Five Years of Innovation in Five Weeks
The funding for Covid-friendly drugs is just one of the innovations adopted by the NHS to care for patients. The introduction of ‘111 First’ has provided help and advice to millions of patients over the phone and online, ensuring those who need medical help are directed to the right services. Remote consultations have spared many more unnecessary trips to the doctor’s surgery or outpatients’ clinic, with more than 500,000 GP consultations being conducted online every week. Covid-secure cancer hubs have been set up to safely provide surgery for those who need it. Talking to The Lancet Digital Health, Richard Roope, Senior Clinical Advisor at Cancer Research UK and practising GP in Sussex, hailed the huge increase in the number of daily consultations seen thanks to the rapid uptake of telemedicine. As Richard says: “We've had five years of innovation in five weeks. ”
For clinicians, a range of innovative new e-learning programmes have been developed to enable real-time training opportunities. One such example, developed by experts at the University of Stirling, has been to educate and empower nurses to improve cancer care. The ‘Cancer Nursing Careers’ programme provides learning opportunities for nurses who provide care to people affected by the disease in non-specialist cancer settings – including in primary, secondary, and community care.
As Professor Charlie Gourley, Clinical Director at Cancer Research UK Edinburgh recently told The Scotsman, the loss of vital funding to cancer research as a result of the Covid-19 pandemic will have a devastating cost to patients. Professor Gourley made the stark warning following news that the charity is expecting a £160 million drop in income in the year ahead (30 per cent of their income) and has already been forced to cut £44m in research funding. The Chief Executive of Cancer Research UK, Michelle Mitchell has highlighted that these cuts will deal a significant blow to their ambitions to improve cancer survival to 3 in 4 by 2034 and will slow progress as they make fewer discoveries, fund fewer trials and produce fewer therapeutic and diagnostic innovations to help patients across the world. They, like many other research charities, are asking the Government to further support clinical research.
In some countries around the world, there is some good news in that clinical trial enrolment is on the increase. However, in the UK there are several concerns in respect of trial sites not reopening at the pace expected by national leaders. For those trials conducted in partnership with the NHS, there has been a significant delay as the NHS has focussed on preparing for likely successive Covid-19 waves. For the future of clinical research and improving cancer outcomes, it is imperative that trial sites resume and improve upon the volumes welcomed prior to the pandemic.
Questions to be answered
From almost every angle, Covid-19 continues to pose major challenges to oncology services across the globe. For UK oncologists, they must tackle this while already understaffed and often under-resourced. However, while serious, the challenges posed by this pandemic are not insurmountable. The flexibility and resilience, along with the skill and determination of specialists, has proven to be a major positive out of this pandemic. This newfound sense of innovation could help see the health sector through this difficult period.
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