Despite staff working flat out, the pandemic has been devastating for NHS cancer services.
Cancer Research UK estimates that 3 million fewer people were screened for cancer between March and September last year, meaning around 9,200 fewer patients started cancer treatment as a result in England alone – a 42 per cent drop. And the charity’s latest analysis suggests that around 45,000 fewer people were diagnosed with cancer than expected last year – people undiagnosed in the community but not yet in the system.
Of course, NHS staff have been working tirelessly to protect and reconfigure cancer services, and figures from March reveal that more people are now being seen than ever before. Nevertheless, a substantial cancer backlog remains that must be urgently cleared.
But just clearing this backlog isn’t enough, we also have to boost cancer services beyond pre-pandemic levels, and renew national research capacity and infrastructure.
It will also mean “levelling up”, addressing long-standing, unacceptable, cancer inequalities across the UK, which equate to around 20,000 more cancer cases each year. Overall, these cases could be avoided if cancer rates were the same for the least deprived as they are for all other groups.
For diseases like lung cancer, which disproportionately affects more deprived groups, “levelling up” means greater investment in smoking cessation services, and in CT imaging of high-risk individuals with smoking histories. Three-thousand to 4,000 cancer deaths a year could be prevented by lung cancer CT screening programmes, beyond current lung health checks.
When it comes to diagnosing other cancers, this means easier and rapid access to diagnostic tests and investigations. Health services already have a roadmap for this, with the recent Independent Review of Diagnostic Services, chaired by Sir Mike Richards, leading to a roll-out of rapid diagnostic centres.
We also have to focus on ensuring equality of care across the country. In my speciality, the proportion of early-stage lung cancer patients having surgery to remove their tumour varies hugely across England. If patients aren’t receiving surgery that we know saves lives, something must change.
This will require substantial investment in staff and diagnostic equipment. The UK went into the pandemic with fewer specialists and fewer scanners than most comparable countries.
Since then, data from the Rapid Cancer Registration dataset collected between April and September 2020 shows that fewer people were diagnosed with lung cancer last year than expected. I worry that this will lead to more people presenting with later-stage, harder to treat disease.
In addition to these disruptions, cancer clinical trials were put on hold for the best part of a year and drug development slowed. This, in turn, will have slowed down future improvements in cancer care, which depend on the research and clinical trials of today.
In the last decade we’ve seen huge breakthroughs, for example in cancer immunotherapy – now a real hope for people with late as well as early stage cancers. We need to develop the next big “immunotherapies” of tomorrow. Such breakthroughs require investment today in discovery “blue skies” science.
Take osimertinib – an extremely effective lung cancer drug, recently approved by NHS England to prevent recurrence after surgery, in patients whose tumours contain a defective copy of a gene called EGFR.
This gene was first associated with cancer in the 1980s by Cancer Research UK scientists studying the links between viruses and cancer. The drugs developed off the back of this have transformed survival rates for certain forms of lung cancer.
We need the government to invest in the country’s discovery science infrastructure and ensure a conveyor belt of new scientific discoveries to help patients of tomorrow.
We went into Covid-19 with cancer services that needed improvement. We’re coming out with a long waiting list and many people in our communities with undiagnosed cancers. And we’re almost a year behind on life-saving cancer research.
Now is the time to build something better. It will require investment on multiple levels – workforce, equipment, primary care, diagnostic centres and the clinical research scientists who will help deliver the medical breakthroughs our patients so desperately need. And investment in our great tradition of world-renowned biomedical research, which gave the world scientists like Godfrey Hounsfield, Rosalind Franklin, Ernst Chain and Dorothy Hodgkin, and, consequently, a mastery of cancer imaging, DNA structure, penicillin and protein structures that have resulted in immeasurable benefit for patients.
With the right approach, we can emerge from this pandemic with better, world-leading, cancer outcomes. A cancer pathway that is more innovative, flexible and better equipped. All within a health system and a world-leading clinical research infrastructure that continuously strives to improve outcomes, providing patients and future generations with their best chance of survival.
Charles Swanton has been chief clinician for Cancer Research UK since 2017