100s of cancers may have been missed due to coronavirus
FORGOTTEN TOLL OF COVID PANDEMIC AS CASES ARE FOUND – OFTEN TOO LATE
HUNDREDS of cancer diagnoses may have been missed due to the pandemic, says Derby and Burton’s hospital trust.
Despite having to pare back much of the typical hospital workload for the past year amid Covid19, local NHS leaders have kept a focus on cancer patients and urgent surgeries.
However, leadership at the University Hospitals of Derby and Burton NHS Foundation Trust, which oversees Royal Derby Hospital and Queen’s Hospital in Burton, says there has still been a “significant impact” on cancer patients, despite the best efforts of staff.
This includes an estimate that hundreds may have gone undiagnosed for cancer and also the known fact more patients are presenting with cancer at hospital at a later stage and with a worse likely outcome – potentially meaning less chance of survival.
This includes 40 % of prostate cancer patients presenting at stage four, nearly 66% of bladder tumour patients presenting at stage three and stage four, and 64% of head and neck cancer patients presenting at stage three or stage four.
Presenting at a later stage has also led to more patients presenting with a disease which is either inoperable and/or incurable.
It will take years to recover from the impact of the pandemic on cancer care and other waiting lists, the trust says.
A report from Sharon Martin, the trust’s chief operating officer, says that around half of all cancer diagnoses are usually found during routine hospital visits for an entirely different ailment, while the other half are direct cancer referrals.
Due to the scaling back of all but Covid, cancer care and emergency treatment, routine visits came to an end – so too, the chance to catch possible cancers.
Ms Martin estimates 335 cancer patients in the Derby and Burton hospital area may have gone undiagnosed in the past year. This is through the reduction in cancer referrals, 12.3% down (3,723 patients) compared with the previous year. Ms Martin says that figure is based on the average rate of 9% of referrals being found to have cancer.
Referrals had been expected to increase this year, not remain flat and not dip with “cancer incidence rising locally”.
She writes: “While cancer services have been prioritised during the pandemic, there has been a significant impact on outpatients, diagnostic services and the timeliness of treatment, particularly for surgery, though the impact has been mitigated to some extent by clinical prioritisation.
“Two factors have contributed to the late presentation of cases.
Firstly, a reduction in the number of patients referred by primary care with suspected cancers through the ‘two-week wait’ pathway. “Secondly, many cancers are detected ‘incidentally’ as a result of patients attending hospital for some unrelated reason. During the pandemic there have been fewer attendances to hospital and so few cancers have been discovered this way. “Despite priority given to the continuation of cancer services, the impact has been identified and audited by clinical teams, with later-stage diagnosis and worse disease prognosis in a range of tumour sites. “At UHDB, despite the best efforts of our teams to prioritise cancer care there are signs of poorer clinical outcomes for some.” Ms Martin says in the period April to September last year there was an increase in the severity at which prostate cancer diagnoses were being made, with 40% of all diagnoses presenting at hospital already at stage four – a drastic increase from 22% in the same period in 2019. Fewer patients, she said, were suitable for radiotherapy, which may have halted their condition.
During the same time in 2020, nearly 66% of bladder tumour patients were found to have invasive stage three or four tumours, up from 25% the previous year.
The number of cases judged to be inoperable, she wrote, and the number of patients found to be “incurable” both increased.
In the first six months of the pandemic (March to August), 64% of head and neck cancer patients presented with stage three or four tumours – of 41 patients seen during that time, a total of 26.
This was double the number presenting at stage three or four in the previous six months when 32% of patients presented with stage three for head and neck cancer - 12 of 39. Trust papers say the organisation is faring well when compared with local, regional and national performance with regards to cancer treatment.
Ms Martin writes: “Recovering screening backlogs, building system outpatient, diagnostic and treatment capacity and restarting routine services will all require significant and sustained effort over coming years to fully restore cancer care to pre-pandemic levels.”
The trust says there are 1,098 more urgent and cancer patients on its waiting list than before the pandemic and it would need to carry out 200 more urgent operations each month to cut this by the end of June.
This depends on capacity and being able to scale up and maintain, with the hope that Covid-19 cases do not increase again.
The hospital trust is in the midst of what is effectively the pandemic after the pandemic – the battle through its waiting list. There are now nearly 10,000 Derby and Burton patients who have been waiting longer than a year for treatment accounting for 15% of everyone on the trust’s total waiting list - as of the end of March.
Before the pandemic, this waiting list was typically at zero, with no-one waiting longer than a year. This, it is expected, may take up to three years to clear – up from an estimate of two years less than a month ago.
More than a quarter (27%) of those waiting longer than a year are trauma and orthopaedics patients – typically hip and knee surgeries –3,428 patients at the end of March.
Gavin Boyle, the trust’s chief executive, wrote in this week’s board report: “We have been keen to keep our staff and our communities aware of the scale of this challenge.
“We will need to plan our recovery in a way which allows our front-line clinical teams to recover, we expect that by June 2021 we will have restored services to close to prepandemic levels.
“However, the backlog of planned surgical cases may take two to three years to clear.”
The backlog of planned surgical cases may take two to three years to clear
Gavin Boyle, Trust CEO