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The Pandemic's Hidden Death Toll

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IV drip/Chemo The incredible demands placed upon the NHS from the COVID pandemic have left huge waits for the treatment of other conditions, including cancer

As the UK enters its third lockdown, the COVID-19 pandemic is at the forefront of the minds of the UK. However, recent data shows that we should be especially concerned by the knock-on effects of the pandemic on treatments for conditions such as cancer.

The pressure placed on the NHS is clear from Health Foundation data, which found that 162,888 patients waiting for routine hospital treatment have now waited longer than 52 weeks, compared to just 1,321 this time last year, as the number of people starting treatment is 25% lower than the same month in 2019. Although visits to A&E departments in November were 31% below the same month last year, 16.2% of patients waited longer than the four-hour target and there was an increase in the number who waited over four hours for a bed to become available.

‘Routine hospital services have been steadily returning to pre-pandemic levels, but today’s figures suggest this progress may have stalled in the face of the rise in patients hospitalised with COVID-19 during the second wave,’ said Tim Gardner, Senior Policy Fellow at the Health Foundation.

In London NHS leaders are expected to cancel urgent surgery in a move that could mean cancer patients waiting months for potentially lifesaving operations. With more than 71,000 excess deaths (a temporary increase in the number of deaths) in England and Wales since the COVID-19 pandemic began, this bottleneck of cancer treatments could cause this number to skyrocket. If current trends continue, the total excess death toll for 2020 could exceed 80,000 very likely leading to a significant fall in life expectancy in 2020.

‘Cancer care is at a crossroads and services cannot be shut down this winter. Because of the pandemic, we estimate that an additional 50,000 people are missing a cancer diagnosis and others are having their appointments disrupted once again. It is simply unacceptable if they face unbearable and unprecedented delays which could affect their chances of survival,’ said Lynda Thomas, Chief Executive at Macmillan Cancer Support.

As many as 50,000 people in the UK could have cancer which has not yet been detected because of the disruption caused by COVID-19, according to Macmillan Cancer Support. It warns that the pandemic has created a backlog of undiagnosed cancer which could take a further 18 months just to tackle in England alone.

‘These figures show encouraging improvements in the number of people being referred for cancer diagnosis and starting treatment during September. However, in some areas the numbers are still down on 2019 levels and, generally, people are waiting longer to see a specialist for suspected cancer than they were last month. Rising Coronavirus rates now risk making this worse, in the face of an already significant backlog,’ said Steven McIntosh, Director of Policy, Campaigns and Influence at Macmillan Cancer Support.

‘Tens of thousands of people are missing a cancer diagnosis because of COVID-19, and we know that delays to diagnosis and care can cause untold worry and affect chances of survival. Anyone with any cancer symptoms should contact their GP as an absolute priority. But we also need Government action to protect cancer services this winter and to ensure no one is waiting too long for tests and treatment. We cannot risk cancer becoming the “forgotten C” in this second wave.’

‘While the NHS is rightly focused on the urgent task of fighting COVID-19, there is meanwhile a rising tide of unmet need which will have a significant impact on people’s health if a sustainable solution is not found,’ said Mr Gardner.

The number could double by this time next year if cancer referrals and screening do not catch up. This would leave 100,000 people at risk of being diagnosed late and having a lower chance of survival. ‘The NHS made significant progress towards fully reopening services after the first peak of the pandemic, but there is still a potentially huge hidden backlog, as the health service is undertaking far fewer routine procedures compared to last year. While the NHS is working hard to address the backlog, radical interventions will nonetheless be needed to avoid prolonged delays for those currently waiting for things like hip, knee and cataract surgery, as well as those not yet on any waiting list’.

The factors behind the backlog are not just a lack of capacity in the NHS. Many patients are hesitant to access services as a result of the pandemic. Research by NHS England into cancer appointments found that, 48% of the public would delay or not seek medical help at all if they noticed a sign or symptom that they would otherwise have checked. A further 22% would not want to be a burden on the health service while a similar number said that fear of getting coronavirus or passing it onto others was a major reason for not getting help. More than four in ten people would leave it longer to get health advice than they normally would have before the coronavirus outbreak, however delaying can have serious consequences for some cancers.

‘We all know the pressures in hospitals are meaning reduced referrals from primary care and the very understandable concerns of patients. It is important, though, that patients know we are open so please contact us if you are unwell or have symptoms that you are worried about. We are here to help you,’ said Heather Randle, RCN Professional Lead for General Practice Nursing

‘While the number of COVID-19 infections continues to grow so will the number of people in hospital. So we would also urge people to continue to follow the rules and play their part in bringing down the number of cases. Things will be challenging for many but please remember practice nurses are still there for you but they too are under increased pressures.’

The NHS has launched the Help Us Help You campaign to urge people to speak to their GP if they are worried about a symptom that could be cancer, particularly if they are hesitant to leave the home due to COVID-19.

‘It is hugely concerning, but completely understandable, that the number of people coming forward to seek help for symptoms that may be cancer has fallen since the start of the COVID-19 pandemic,’ said Jane Lyons, CEO of Cancer52, an alliance of nearly 100 organisations working to address this inequality and improve outcomes for patients.

Additionally, ‘COVID-friendly’ cancer treatments that are safer for patients during the pandemic are being expanded through a £160 million initiative from NHS England. Analysis shows that these less risky (these include drugs that treat patients without having such a big impact on their immune system or offer other benefits such as fewer hospital visits).

However, effective cancer therapies have been given to almost 2000 people during the first few months of the COVID-19 pandemic, allowing their treatment to go ahead when it might otherwise have been delayed indefinitely.

These include a rapid new test to help decide whether to go ahead with treatment which may compromise health opt for a lower dose or use a different method of tackling tumours. While most patients undergoing chemotherapy do not suffer severe side effects a small number taking certain drugs called fluoropyrimidines (5-FU and capecitabine) can suffer nausea, vomiting, diarrhoea, breathlessness and severe skin reactions and, in rare cases, the reaction can be fatal.

‘Since the first case of COVID in England, NHS staff have fast tracked new, innovative ways of working so that other services, including A&E, cancer and maternity could continue safely for patients and it is thanks to these incredible efforts that 65,000 people could start treatment for cancer during the pandemic,’ said NHS chief executive Simon Stevens.

‘We are now adopting new, kinder treatment options which are not only effective but safer for use during the COVID-19 pandemic and more convenient for thousands of patients, who can take medication at home or be given medicines with less harmful effects on their immune system.’

The Macmillan report also warns there are an estimated 33,000 people in the UK who should have started treatment for cancer but have not yet done so because of the disruption from COVID-19. The number of people in England being seen by a specialist for suspected cancer following an urgent referral by their GP was 199,801 in September 2020. This number of people who have seen a specialist for suspected cancer between March and September 2020 is still almost 340,000 lower (a drop of 24%) than across the same time period last year.

‘Cancer doesn’t stop for COVID-19 and neither can our health services,’ said Ms Thomas. ‘Macmillan is doing whatever it takes to support people with cancer and our exhausted NHS staff, but we need more. Governments need to promise every person with cancer that they won’t be forgotten and ensure cancer services are protected, come what may.’

With COVID-19 still raging across the UK, it seems that the NHS will have to adapt to this new normal, and make strides towards regaining the standards of cancer care that the pandemic has affected.

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