Cancer patients must not be the forgotten tragedy of this coronavirus crisis
As a prostate cancer surgeon, my life before coronavirus was pretty predictable. Each day I’d go to work and either operate on patients with prostate cancer, see patients with a new diagnosis of prostate cancer to discuss surgery, or check in with patients after I’d operated on them to monitor their recovery. Now, my working days are chaotic and unpredictable.
Some hospitals are already overloaded with coronavirus admissions. Others, like University College London Hospitals, where I work, are busy making space for the impending outbreak. At UCLH, cancellations of elective cases have given doctors more time to help Covid-19 patients. Anaesthetists have tried to hold off using respirators for these patients until absolutely necessary, preferring less invasive methods instead.
This has used fewer resources and freed up anaesthetists and intensive care nurses who would otherwise be managing incubated patients. Our strategy appears to be working, at least for now. What is less clear is how we will prevent death and disability from other non-viral conditions during the outbreak.
Though some would be forgiven for assuming coronavirus is now the only disease, the NHS still has to deal with myriad other illnesses alongside the pandemic. What will happen topatients with cancer, diabetes, heart disease and other medical conditions that still need managing?
For these patients, the knock-on effects of coronavirus could be devastating. A patient with end-stage cancer, who needs chemotherapy that could extend their life by a few months, may no longer get this treatment – as the chemotherapy could make them more susceptible to coronavirus. Oncologists have informed me that the decisions facing their patients amount to Hobson’s choice – without chemotherapy, patients will likely die more quickly from their cancer, but they will still be less likely to die than if they contracted coronavirus while undergoing chemotherapy.
And what about the cancer patients with better prospects - those who could have an operation and be “cured”? In the current viral climate, these patients are now deemed not “time critical” enough to warrant their operations. They may remain stuck in a “holding pattern”, rather like flights not yet cleared for landing. They risk their cancers progressing – possibly even to an incurable state. And while these risks may be low, it’s a lottery no patient wants to play. When this is all over, when the NHS has defeated this virus, when children are back to school, shops are reopened and cities are no longer under lockdown, what will happen to the countless people who are still waiting for treatment? How does a previously overstretched NHS cope with managing these patients, in addition to those who will present with cancer and other nonviral illnesses during the coronavirus outbreak? The NHS will face one of the steepest backlogs of cases in its history.
To stem this backlog and ensure patients get the treatment they need, we should consider redistributing current resources to create hubs where oncologists and cancer surgeons could treat their urgent patients. Rather than basing the clinical priority of these patients on NHS waiting targets, as has historically been the case, these doctors could instead triage patients according to the severity and risks of their disease.
Though much of our focus now is rightly on coronavirus deaths, we risk losing sight of another wave of tragic fatalities – those who didn’t have coronavirus, but didn’t get the treatment they needed during this urgent crisis.