‘It’s the worst cancer crisis in a generation’
Isla Whitcroft hears from two patients who, like 650,000 others, have had their treatment plans derailed by the pandemic
Just before Christmas last year, Dominique Lucas received the news that she had stage two breast cancer. At 39, with three young children, it was a devastating shock, especially given she was fit and healthy with no family history or obvious risk factors for cancer.
But Dominique, a police detective who lives with her family in Oxfordshire, put her full confidence in her doctors, who advised a plan of a mastectomy and reconstructive surgery, then chemotherapy followed by radiotherapy and hormone treatment for six years.
“I knew it was gold standard and I pinned all my hopes on it, believing it would give me the very best chance of being around for my family for many years to come,” says Dominique, married to Ian, a fellow police officer.
The mastectomy went ahead, but then, in March, like many other cancer patients, Dominique was told that her chemotherapy treatment had been cancelled because of fears that it might leave patients vulnerable to Covid-19. In fact, chemotherapy had been taken out of her treatment plan for the foreseeable future.
“On top of everything else we had been through it was almost too hard to bear,” she says.
“I was tormented by the thought that my cancer was spreading and I would not be around for as long as the children needed me. I hardly slept for weeks and I would ring my oncologist in tears, but it was out of her hands.”
Dominique began radiotherapy instead, which was considered a lower-risk procedure, and finally, in late June, after pleading with her oncologist, chemotherapy was reinstated into her treatment plan.
“The truth is I will never know how this has affected my chances compared with what might have been,” she says. “That is a really hard thing to get my head around.”
The decision to close many cancer services during the spring lockdown, as the NHS prioritised Covid-19 care, means Dominique’s experience has been replicated across the UK. Not only did this result in crucial treatment delays, but cancer screening schemes were halted, diagnostic procedures reduced, or stopped altogether, and vital support services removed.
In April alone, the number of people in England receiving an urgent cancer referral from their GP fell to 79,573 from 200,000 in April 2019.
The cancer charity Macmillan estimates that since the lockdown, more than 655,000 patients have received disruption to their cancer care and that there are about 50,000 “missing” diagnoses (compared with 2019 figures) and about 33,000 people who should have started treatment for cancer who have not yet done so.
Natasha Marisa, 28, from Hampshire, is another who fell into the gap. She has been scanned every three months since her breast cancer diagnosis five years ago. She was due a scan during lockdown, but it was cancelled.
“I had no idea when the next one would be. It was just horrible, not knowing how the cancer was behaving,” she says.
Four weeks later a scan showed her cancer had spread. She is now on a course of chemotherapy that is currently working, but says: “It keeps going through my head – would my cancer have spread if we had managed to have the scan on time?”
A recent study by the London School of Hygiene and Tropical Medicine justifies her concerns. It found that each four-week delay in treatment was associated with a six to eight per cent increased risk of death for all cancers.
“It is the worst cancer crisis in my professional lifetime,” says Professor Patricia Price, academic clinical oncologist at Imperial College London. “The early days of the pandemic were particularly difficult for cancer. Cancer physicians, surgeons and support staff were often moved from their highly specialist roles into backup positions in emergency and respiratory care.
“I understand why those decisions were made because no one really knew what was coming and how the virus would behave. But everyone understands that the earlier cancer is diagnosed and treated the better the outcomes, so once the situation became clearer, the mistake was not to prioritise cancer services along with the Covid-19 response. It is the failure to act with sufficient speed and urgency that has put us in such a dark place.
“The situation was then compounded by the Government telling people to stay at home, and that we must all work to reduce the burden on the NHS – all messages which are the antithesis of good cancer practice, where early diagnosis is key to good outcomes.”
Sharon Wilson, 50, from Newcastle, was one of those who followed the rules, with dreadful consequences. The gym administrator had been troubled by a new and ongoing cough since early January. A course of antibiotics failed to clear it and her GP was about to refer her for further investigation when Covid-19 struck.
“I was absolutely terrified at the prospect of catching Covid-19 and dying,” says the mother of three. “I am an anxious person anyway and all the messages about staying home, the risk of millions of people dying really scared me. Suddenly my cough didn’t seem to be so important.”
It wasn’t until four weeks into the lockdown, when Sharon coughed up blood, that she opted to visit her GP, who immediately referred her to hospital. She is currently receiving treatment for stage four lung cancer. Although heroic efforts are being made to clear the cancer backlog, Macmillan is concerned that the enormity of the task means that, without a huge concentration of resources, it could be several years before waiting lists and referral times are near to pre-pandemic levels. There is also concern over recent government claims that the two-week waiting targets are now being met.
“There are fewer patients being diagnosed due to lack of screening and routine appointments, so the treatment services currently can cope,” explains Professor Price.
“However, once the backlog starts coming through in the months and years to come, it will be a very different story. The Government and NHS England need to calculate the true backlog, rapidly get a plan for recovery based on accurate data and come up with a radical approach that boosts capacity, invests in smart technology solutions and takes a radical approach to sweeping away the bureaucracy that has held services back for so long.”
Dominique, who has finished her chemotherapy and will now have regular tests to check the treatment has been successful, is haunted by reports that the second wave is again affecting cancer treatment.
“I can’t believe this is still happening. The Government needs to get a grip on this. Covid-19 doesn’t stop people dying from cancer.”