The Forgotten ‘C’ of the #Covid Crisis

The impact the covid pandemic has had on cancer treatments has been devastating. In March 2020 when the country went into its first lockdown, other medical procedures were put on hold, including many of those for people undergoing cancer treatments.

Throughout the UK key cancer services, including diagnostic endoscopy services, were severely impacted as resources across the UK were diverted towards the pandemic response. Surveillance for patients with Barrett’s oesophagus, which in a small fraction of cases can progress to oesophageal cancer, was also suspended.

A study from Queens University looked at diagnoses of cancer of the oesophagus (foodpipe) and stomach, in addition to Barrett’s oesophagus, which is a condition that can lead to oesophageal cancer.

Dr Richard Turkington, Clinical Senior Lecturer at the Patrick G Johnston Centre for Cancer Research, and lead author on the study, explains:

“We investigated how the COVID-19 pandemic has affected the diagnosis of oesophageal and stomach cancer and Barrett’s oesophagus. Analysing data from the Northern Ireland Cancer Registry, we estimated the number of patients who had been diagnosed with these conditions across Northern Ireland between March and September 2020, and compared this with data from 2017-2019.

“We found that diagnoses of oesophageal and stomach cancer fell by 26.6%; meaning that 53 fewer patients than expected were diagnosed during the first six months of the pandemic. For Barrett’s oesophagus diagnoses fell by 59.3% which represents 236 fewer Barrett’s cases than expected.”

February is Oesophageal Cancer Awareness month and this study has highlighted the dreadful impact that disruption to endoscopy services has had on early diagnosis.

According to a report by Macmillan Cancer Support 50,000 people are now missing a cancer diagnosis who are at risk of becoming ‘the forgotten ‘C’ of the coronavirus crisis.’ It goes on to say:

Our analysis shows that even with significant extra resource (over and above pre-pandemic levels), it will take 20 months to clear the backlog in cancer diagnosis.

The report says that over 650,000 people have had their cancer treatment and care disrupted due to the measures put in place to handle the covid crisis. Back in March 2020 there was a fear that the NHS would become overwhelmed and not able to cope with the number of patients hospitals would have to deal with who had contracted Covid19. In Scotland the Louisa Jordan Hospital was set up for that purpose but due to the high compliance with lockdown the NHS was able to cope. The Louisa Jordan was then used for other procedures and now for the mass vaccination programme.

The NHS is open for business but the backlog in treatments, including cancer, is significant. In June the Scottish Government published its framework for the recovery of cancer services: Recovery and redesign: cancer services – action plan

In the Ministerial Forward to the document, Jeane Freeman says:

“Working to a horizon of March 2023 and with the provision of up to an additional £17 million of funding, subject to annual Parliamentary approval, in addition to a committed spend of £97.5 million, this plan has been produced with input from a wide range of stakeholders, all of whom will be crucial to supporting its delivery over this period.”

In Scotland the Macmillan report states that :

Between April and June 2020, at the peak of the pandemic, there was a 20% drop in the number of people starting treatment for cancer within 62 days of urgent referral compared to last year, meaning 649 fewer people began treatment. Worryingly, 1,324 fewer people were treated within the 31-day limit from decision to treat to treatment compared to last year (21% lower than last year).

And it goes on to say “These figures demonstrate the significant impact of people being too worried to seek care and investigate symptoms for fear of being exposed to Covid-19 or being a burden on the NHS.”

The Macmillan report can be found here: The Forgotten’C’

Professor Helen Coleman, Deputy Director of the Northern Ireland Cancer Registry and senior author on the Queens University study, said:

“This study is the first to show the impact of COVID-19 on the pre-cancerous condition, Barrett’s oesophagus. There will be missed opportunities for prevention of cancers due to this sharp decline in Barrett’s oesophagus diagnoses.

“Coupled with the drop in expected numbers of oesophageal and stomach cancer diagnoses, we are very concerned that patients will present later with more advanced disease and have poorer survival outcomes as a result. It is vital that we protect and reinstate our cancer diagnostic services, such as endoscopy, to help minimise the impact of the pandemic on cancer patients.”

The researchers warn that the pandemic could have a devastating impact with many cases potentially remaining undiagnosed. They highlight the need for individuals with symptoms such as difficulty swallowing, persistent heartburn or unexplained weight loss to seek medical help as soon as possible.

The study was funded by Cancer Research UK, Wellcome Trust, Cancer Focus NI and OGCancer NI and the NICR received funding for this work from Public Health Agency, Northern Ireland. It has been published in the journal Gastroenterology and presented at the American Association for Cancer Research conference.

Reporter: Fiona Grahame

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