Avoiding a Cancer Care Crisis During the COVID-19 Pandemic
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The effect of COVID-19 on the British healthcare system has been seismic. The medical profession had to think on its feet responding to the demands of the pandemic. But, in doing so, every medical discipline from general practice to palliative care has taken a hit. Of particular concern is how delays to screening, diagnosis and treatment of cancer have already impacted morbidity and mortality rates, with cancer death rates looking likely to rise significantly over the coming years.
While devastating, these diagnostic and treatment delays are also compounding a pre-existing problem – a worrying lack of knowledge amongst the public of some of the least-survivable cancers and their symptoms.
Assessing cancer symptoms during the pandemic
Various predictions have been made about the impact of the pandemic on cancer deaths in the UK, with some experts warning that up to 35,000 excess deaths may occur as a result.
Many of these deaths may occur due to delays in treatment – the ripple-effect from canceled surgeries, chemotherapy and radiotherapy sessions. But modeling the effect of delays to diagnosis has been equally troubling. Predictions for breast, colorectal, lung and esophageal cancer estimate deaths rising by 7.9–9.6%, 15.3–16.6%, 4.8–5.3% and 5.8–6%, respectively, in the five years after diagnosis, compared to pre-pandemic levels.
The impact COVID-19 has had on the level of care for cancer patients is widespread and other countries, like the U.S., are experiencing delays in cancer care. Research found that 44% of breast cancer survivors had experienced a delay in care, with 79% stating that the main setback was in follow-up appointments. That said, the majority of respondents stated that their treatment had been modified instead of cancelled.
Tracing the delays in diagnosis goes further than patients having MRIs canceled and biopsies stalled. Non-urgent diagnostic work was deferred by both primary and secondary care workers during the lockdown, and even urgent 2-week-wait cancer referrals (one of the only routes to diagnosis during that time) decreased by 80%. To add to this, many patients – fearful of the virus – will not have presented at their GPs in the first place.
If people are unaware that their symptoms may indicate cancer, the urgency of having their symptoms investigated will undoubtedly be lacking.
The studyPrior to the spread of COVID-19, a survey of 2,000 British participants was conducted to understand more about the public’s understanding of general cancer symptoms and how confident people were in their knowledge. The results highlighted gaps in awareness of, and confusion over, the most common symptoms.
Respondents generally considered themselves to be knowledgeable about the most common cancers – breast, lung and prostate. But 38% of respondents confessed to having no understanding whatsoever of the six less survivable cancers – lung, pancreatic, liver, brain, esophageal and stomach.
What’s more, when probed about how confident they were in their understanding of the different cancers, the picture changed. For example, 81% of people responded that they didn’t lack knowledge about breast cancer. From the overall survey population, only 46% stated that they were confident in what they knew. That means almost 1 in 5 of the population have no understanding of this widespread disease, while over half are unsure about the information they do know.
This lack of surety played out when quizzed regarding signs and symptoms of the disease – only 12% of people were able to correctly identify the seven most common cancer symptoms. All other respondents either incorrectly identified a non-suspicious complaint or failed to select all seven symptoms.
Why it mattersAcross all cancers, the earlier it is diagnosed, the better the survival rates. The difference between an early stage diagnosis and a late one can be stark – 90% of lung cancer patients survive for at least a year after diagnosis if the disease is caught early, compared to just 15% of those diagnosed at an advanced stage.
But, however skilled the medical professional, they can only investigate symptoms that they have been made aware of. If individuals are not aware that their skin blemish, persistent cough or loose stools are a potential warning sign of cancer, they may delay visiting a doctor or medical professional. This lag in presentation can mean the difference between life and death – a delay in diagnosis of just two months can mean a curable, early-stage tumor progresses into an uncurable one.
How can we respond?When it comes to our health, knowledge is power. What the study into awareness of cancer symptoms in the general population indicates is that there is a clear lack of understanding of the gamut of cancer symptoms.
Medical professionals should, of course, never overestimate their patients’ understanding of their own bodies and health, but increased education of the public must also be a priority. While addressing this in schools is important, medical institutions should also take steps to distribute reliable information about the signs and symptoms of cancer to their patients.
What are the solutions?Navigating the waters of effective cancer and COVID-19 treatments is paramount and the landscape of cancer care must adapt to fit the current climate to ensure the safety of patients. One solution is to provide access to correct and tailored information for cancer patients regarding the virus.
This could include guidelines to help patients through diagnosis and treatment while the virus is still active in the community, resources covering frequently asked questions and an outline of best practices so they know what to expect from their medical team. All these steps will help the patient understand if they are at an increased risk of contracting the virus and will help them determine if they need to get tested for COVID-19 before treatment.
What’s been done already?Medical practitioners have had to take action quickly to ensure patient wellbeing. Precautions have been taken in cancer centers to both prevent the spread of the virus and protect those with cancer. This has included postponing or adjusting treatments – such as face-to-face consultations moving to online interactions to reduce exposure, while still providing the best oncological care possible.
As an example, hospitals such as the Clatterbridge Cancer Centre have increased the use of chemotherapy at home to limit exposure to the virus, with the number of people receiving care at home having risen by 15%. Other measures include pharmacies allowing the advanced dispensing of medication – so patients have access to three months’ supply instead of one month, dedicated helplines being set up with access to senior nurses during the working week and psychological support for patients hand-in-hand with limiting access for visitors.
As the medical community in the UK attempts to deal with the aftershocks of lockdown and the continued impact of the pandemic, providing reliable information and promoting health-seeking behavior is just one way to help encourage better cancer outcomes.