The NHS in the time of Covid-19: challenges for cancer diagnoses

Posted: 22/04/2020

After several years of work to raise awareness of cancer symptoms and increase the number of patients visiting their doctor at an early stage to check whether they may have cancer, the growth in cancer diagnostic referrals seen in recent years has been brought to a halt by the coronavirus pandemic. As the NHS’s creditable response to the crisis continues, referrals in England under the two week wait system — in which urgent GP referrals for suspected cancers are seen within two weeks and are key to reducing cancer mortality rates — are thought to have fallen last month by 50 - 70%.

It is accepted that some treatments for cancer, such as those which lower the immune system or surgery that can safely be carried out at a later date, have been postponed – however, this should not deter patients who find and are worried by new and suspicious symptoms that may indicate the presence of early cancer. The Health Secretary Matt Hancock has told MPs of his “concern” that “far fewer people are coming forward” with cancer symptoms, as well as suggesting that all those who think they may have symptoms of the disease should phone their GPs to get the treatment and management that is needed.

The concerns that patients are not presenting new symptoms have been echoed by the medical profession. In an open letter published in The Daily Telegraph, three consultants said: “We must not ignore the unintended consequences of effectively closing down the National Health Service.” A senior health service leader warned that the NHS would face a “massive backlog” of work that had been postponed because of the pandemic and that many patients will “suffer and die prematurely”. Carrie MacEwen, chairwoman of the Academy of Medical Royal Colleges, said: “It’s vitally important that people don’t find reasons to put off seeking medical help, especially if they are concerned that they may have a serious illness. We are asking people to continue to be vigilant about the recognised symptoms of early cancer so that they can be treated and prevent a longer-term build-up of patients with perhaps more advanced cancer after the Covid crisis is over.”

Arran Macleod, a solicitor in the clinical negligence team at Penningtons Manches Cooper, said: “Whilst one commends the NHS’s response to Covid-19, there are fears that patients are reluctant to seek medical help for potentially serious conditions other than the coronavirus. It is thought that this may be because either they do not know that NHS services remain open for them, they assume that doctors may be reluctant to refer them to hospitals where outpatient clinics have been cancelled and units turned over to fighting Covid-19, or that they are too afraid to go to hospitals or GP surgeries in case they catch the virus. The reluctance of patients to attend their doctor now could have tragic consequences if it means that patients with cancer are diagnosed later; in some cases, this could result in the chance of a cure being lost or higher mortality rates. There is also a fear that this reluctance to go to hospital could cause problems if the NHS becomes over-burdened with cancer referrals when the current crisis is over, which will likely bring with it further challenges. Indeed, we welcome the impending Public Health England campaign which is expected in the next week or so to spread the message that “the NHS is still open for business” as the public need to be reassured that general healthcare services are continuing as normal and that they should contact their GP if they are concerned about any suspicious symptoms."

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