Cancer crisis ‘replacing Covid emergency’ as 300,000 miss urgent checks

·11-min read
Experts warned that many of the 'missing' patients would be those who were never referred for checks by their GP or kept away for fear of adding to the Covid pressures on the NHS - Getty Images Europe/Hollie Adams
Experts warned that many of the 'missing' patients would be those who were never referred for checks by their GP or kept away for fear of adding to the Covid pressures on the NHS - Getty Images Europe/Hollie Adams

England is at risk of "replacing the Covid crisis with a cancer crisis", with more than 300,000 people missing urgent checks since the start of the pandemic, experts have warned.

Official statistics show that, in the 12 months ending in March, 304,555 fewer patients were given an urgent referral to hospital by their GP because of suspected cancer.

The number referred for breast cancer checks alone dropped by more than 20,000 in 2020/21, the analysis by Cancer Research UK showed.

Overall, around 38,800 fewer patients started treatment for cancer – a drop of 12 per cent, according to the data, which covers England.

In some cases, treatment was put on hold to allow hospitals to cope with an influx of Covid patients and to protect cancer patients from virus infection.

But experts warned that many of the "missing" patients would be those who were never referred for checks by their GP after struggling to access appointments or had kept away for fear of adding to pressures on the NHS.

Cancer Research UK's chief executive, Michelle Mitchell, said: "The UK faces the real possibility of the Covid-19 crisis being replaced with a cancer crisis."

The statistics show the numbers starting treatment who were referred as an urgent case dropped by more than 17,000, increasing the risk of later diagnosis when treatment is less likely to succeed.

The charity said the "devastating" figures showed Britain was at risk of walking into a cancer crisis that could set back survival for the first time in generations.

Ms Mitchell urged anyone with possible cancer symptoms to contact their GP and keep trying if they struggled to secure an appointment. She said: "Sadly, the Covid-19 pandemic has had a devastating impact on cancer services, and the lives of cancer patients, over the past year.

"It’s not only those who've had a cancer diagnosis that we’re worried about – there are thousands of missing cancer patients out there, many of whom would ordinarily have been diagnosed through an urgent referral but haven't been because of the pandemic. Finding the missing cancer patients is a priority.

"It's vitally important that anyone who has noticed an unusual change in their body gets in touch with their GP. And if it's tricky getting an appointment, do keep trying."

It comes amid growing concern that patients are being put at risk because of poor access to GP care, with some struggling to get the right help. The Telegraph was inundated with letters from readers describing how difficult it was to see a GP after reporting the case of Joy Stokes, 69, who died from cancer after months of being refused an appointment.

Listen to Joy's story, as told by her husband Nick, on the Planet Normal podcast with Allison Pearson and Liam Halligan, from 20:49 on the audio player below:

Family doctors were told to introduce a system of "total triage" during the pandemic, meaning those seeking to see their GP were being discouraged and told to have an online or phone discussion first.

The system became embedded in annual guidance which took effect last month but was abolished last week amid a growing backlash.

The NHS statistics show that, between April 2020 and March 2021, 2,078,403 patients were given an urgent referral to hospital by their GP because cancer was suspected – a fall from 2,383,958 the previous year.

The 13 per cent drop followed a Government campaign urging people to "Stay Home, Protect the NHS, Save Lives" and the introduction of "total triage".

In recent months, health chiefs have repeatedly urged those with symptoms that could mean cancer to contact their GPs amid concern that too many are staying away or struggling to get the appointments they need.

The number of women with suspected breast cancer who were given an urgent referral fell by 20,144 over the year, the NHS data shows, with around 425,147 in 2020/21 compared with 445,291 in the previous 12 months.

While the number of referrals fell dramatically during both the first and second Covid waves, there was a sharp rise this March as services struggled to catch up. The figures show 232,084 referrals in March, up from 174,624 in February.

Separate research by the Institute for Public Public Policy Research suggests survival rates have been set back by up to eight years, with an extra 4,500 avoidable deaths likely this year alone as a result of late diagnosis.

Charities said too many patients had been left struggling to get an appointment or been scared off seeing their GP for fear of being a burden on the health service or catching Covid.

Sara Bainbridge, the head of policy at Macmillan Cancer Support, said: "This data shows a devastating year of disruption, which has seen tens of thousands of people missing a diagnosis or experiencing changed and delayed treatment, while their chances of survival potentially worsen."

The charity said its own analysis showed a 15 per cent drop in new cancer diagnoses between March and December last year compared with the previous one.

Last autumn, the Care Quality Commission warned that poor access to family doctors could fuel delayed cancer diagnoses and deaths, with 26.7 million fewer appointments between March and August.

An NHS spokesman said: "While treating more than 400,000 people for Covid-19 throughout the pandemic has inevitably had an impact on care for other conditions, NHS staff have gone to great lengths to ensure cancer treatment could continue safely, with almost 300,000 people starting treatment and more than 2.2 million referred for cancer checks throughout the last year.

"The NHS is now going further and faster to ensure patients receive timely, expert care, with more people receiving potentially life-saving cancer checks in March than ever before, and our message remains the same – please come forward if you have a worrying sign or symptom so we can treat you as soon as possible."

Disruption, delays and changes to treatment

The pandemic has a devastating impact on healthcare, with thousands of patients suffering from other conditions facing delays as the pressures on the NHS grew, write Laura Donnelly and Lizzie Roberts.

Some patients who had already been diagnosed with cancer suffered disruption, delays and changes to their treatment amid attempts to reduce the numbers in hospital and the risk of infection.

Charities are particularly worried about the "missing cancer patients" – those who suffered worrying symptoms yet were never referred for tests.

The official figures show that, across the country in 2020/21, there were around 300,000 fewer urgent referrals by GPs for suspected cancer, while around 38,800 fewer patients started treatment. Each of these cases is far more than a statistic.

Jess Brady: Contacted GP more than 20 times, but diagnosis came too late

Jess Brady, 27, from Hertfordshire, had been planning travel adventures until she began feeling ill last summer.

When the satellite engineer started experiencing chronic fatigue and a cough she could not shrug off, doctors insisted it must be long Covid even though she had never been diagnosed with the virus.

Her symptoms grew increasingly debilitating, with weight loss and vomiting, and she got in touch with her GP repeatedly but to no avail. "Jess contacted her GP surgery on more than 20 occasions in five months and went to A&E," her mother, Andrea, said.

Jess Brady and her mother, Andrea, who had become increasingly concerned about her daughter's health
Jess Brady and her mother, Andrea, who had become increasingly concerned about her daughter's health

By November, Mrs Brady was increasingly concerned about the possibility of cancer as large, ugly glands appeared on her daughter's neck.

When they finally secured a face-to-face appointment with her GP, concerns were dismissed. "She was young, previously healthy and apparently there was no knowing how long a referral to a specialist would take," her mother wrote in Metro.

Such was Mrs Brady's concern that she secured a private hospital appointment for her daughter. Urgent tests followed, which identified stage four adenocarcinoma, which had spread throughout her body and was too advanced and aggressive to treat. She died on Dec 20, less than a month after being diagnosed.

"No parent should cradle their child as they enter this world and hold them as they leave it. Nothing could ever prepare us or can ever console us," her mother wrote. She is now campaigning for prevent cancer deaths, calling for an increase in face-to-face appointments and more urgent referral of suspected cases.

"Dealing with the real risk of Covid should not create a higher risk of cancer death in our younger generations. Action must be taken," she said.

Jess's parents are campaigning to improve diagnosis of cancer in young adults. To add your signature, click here.

Brian Marsden: Cancer diagnosed five months after attempts to see GP

Brian Marsden, 66, from Barnsley, South Yorkshire, first discovered an unusual mole in June last year but struggled to get a GP appointment despite repeated efforts.

After difficulties even getting through to his local surgery, he was told "we're not seeing patients" and had to push to secure an appointment.

A nurse at the practice had "a fleeting glance" at the mole and pronounced it fine, despite the fact it had been weeping and produced a scab, his daughter Clare Marsden Eastburn said.

Brian Marsden was diagnosed with an aggressive nodular melanoma in November – five months after first contacting his GP
Brian Marsden was diagnosed with an aggressive nodular melanoma in November – five months after first contacting his GP

Within a few weeks it had "aggressively grown", but again Mr Marsden could not get through to the surgery. "They resorted to sending a letter through the prescription box because they weren't even opening up, you couldn't even walk into reception to speak to someone," said Mrs Marsden Eastburn.

Eventually Mr Marsden, who owns a DIY business, was referred to hospital and diagnosed with an aggressive nodular melanoma in November – five months after first contacting his GP. Surgery to remove it only went ahead in January, when lymph nodes and nerves had to be removed because the cancer had spread.

Mr Marsden continued to worsen, suffering pain in his shoulders and arms. Scans in April established that the cancer had spread to his spine, with a further deterioration after more surgery.

Until last year, he was "really fit and healthy" and active, rising at five o clock in the morning to go flower markets and carrying around big bags of compost, his daughter said. She added: "It's like looking at an 80-year-old man now – he has just been through so much."

Michelle Bailey: Treatment disrupted as Britain entered lockdown

When Michelle Bailey, 37, was diagnosed with fast-growing and invasive breast cancer at the start of March 2020, she was told she would need a lumpectomy, chemotherapy and radiotherapy.

But as the Covid crisis took hold, the plan was changed.

"I was told 'there's been disruption to your treatment plan,'" said the mother of one from Stockport, Greater Manchester. "Instead, I would need a single mastectomy. It was a lot to take in. I'd prepared myself and talked to my son about it. To go back and be told 'we can't do that now' was a shock. But I had no choice.

Michelle Bailey was told there had been 'disruption to your treatment plan' as the Covid crisis took hold
Michelle Bailey was told there had been 'disruption to your treatment plan' as the Covid crisis took hold

Since the operation at Wythenshawe Hospital more than a year ago, there has been little follow-up. She has yet to see the surgeon for a post-operative appointment or to have a fitting for a prosthesis.

When the site of the mastectomy became sore, her GP attempted to examine her remotely.

Ms Bailey said: "My GP did a FaceTime call with me to look at the site because I was concerned about a build-up of fluid there as it was so sore. There was no physiotherapy afterwards, no support other than from charities."

Manchester University NHS Foundation Trust said it was sorry to hear about the concerns and had continued to provide cancer care throughout the pandemic.

Sherwin Hall: Suffered long delays before fatal tumours found

Sherwin Hall, 27, from Leeds, West Yorkshire, went to hospital suffering from leg pain on March 23 last year, just as Britain locked down. Despite repeated visits and begging for a scan, he was only given a course of antibiotics for a misdiagnosis of prostatitis.

After 13 hospital visits in four weeks, Mr Hall was finally given an MRI on May 26 which revealed a 14cm malignant tumour in his pelvis and 30 small tumours on his lungs. He died in December.

Sherwin Hall went to hospital suffering from leg pain on March 23 last year, just as Britain locked down
Sherwin Hall went to hospital suffering from leg pain on March 23 last year, just as Britain locked down

He had said: "I kept begging them in April and May to give me an MRI scan, but no-one would listen. Both my GP and my consultant told me that I couldn't get one because scanning services were slowed down because of the coronavirus."

His widow, LaTroya Hall, being supported by the Catch Up With Cancer Campaign, said: "I am devastated. I have lost the love of my life."

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