‘NHS staff will struggle with the backlog of cancer cases’
ALEADING doctor has warned that NHS staff in Wales will struggle to cope with a huge increase in demand for cancer services.
Dr Rachel Lee, a GP at Woodlands Medical Centre in Ely, Cardiff, and a Macmillan GP adviser, said her NHS colleagues have shared an “enormous burden” during the coronavirus pandemic “for which there is no clear end”.
She now fears that a significant backlog of confirmed or suspected cases of the disease will be very difficult to manage successfully without casualties.
Cancer services were severely disrupted after the Welsh Government chose to suspend all non-urgent appointments, treatments and screenings in March.
The decision was made so resources and staff could be redeployed to the frontline of the Covid-19 crisis, which was still in its infancy in Wales.
While some of these cancer services are now finally resuming after months of uncertainty, clinicians are warning that more people could die from the disease in the near future as a result of them being put on hold for so long.
A new study found that delays to cancer treatment caused by coronavirus could lead to as many as 35,000 additional deaths across the UK.
“I think the high increase in demand will be very difficult for NHS clinicians to manage, but we will do everything we can to cope,” admitted Dr Lee.
“Colleagues and friends within the NHS have shared an enormous burden through this, for which there is no clear end.”
Dr Lee said the suspension of routine appointments and screening was “a very difficult decision” for the Welsh Government to make ahead of a predicted surge in Covid-19 cases.
“Decisions had to be made to balance the risk to patients of exposure to a potentially deadly virus if they attended for these non-urgent investigations, and the risks of missing cancers at potentially more curative early stages,” she said.
Dr Lee admitted she was “very concerned” about the huge reduction in the number of patients contacting the surgery in the initial days and weeks of the lockdown.
“This was due to a combination of patients’ fear of catching Covid-19 if coming to the practice and a wish not to burden the NHS,” she added.
“We very quickly put measures in place to make it as safe as possible for patients to contact GPs, and new technology was very quickly embraced.
“If patients needed to be seen this was done in a safe way using PPE. Patients wouldn’t wait with others in waiting-rooms and would be escorted straight to a clean room.”
She said special “hot rooms” were set up at her surgery for those with suspected Covid symptoms which were deep-cleaned after each patient.
“There was widespread concern among GPs that patients were not contacting the surgery and that serious conditions including cancer were being missed,” she admitted.
“Messages by practices were done encouraging people to contact their surgeries using short social media videos and messages on practice websites.”
At the start of the pandemic, Dr Lee said there was a “huge” reduction in the number of urgent suspected cancer referrals from primary care to secondary care.
“This was a result of the huge reduction in the numbers of patients contacting primary care,” she said.
“At the start of the pandemic referrals were reduced by 75% across Wales.
“As a Macmillan GP I worked closely with the secondary care cancer leads to adapt referral pathways to make it easier and quicker for patients to be referred to secondary care with suspected cancer symptoms using the new virtual way of consulting.”
Dr Lee said the number of suspected cancer referrals has now increased, although referrals for lung cancer are still lower than other cancers.
“This is likely to be because Covid19 symptoms can be very similar to cancer symptoms and a prolonged cough, for example, may be assumed to be related to Covid-19 infection.
“This is an area that as a Macmillan GP I will be liaising with primary care to encourage GPs to think lung cancer in people with these symptoms.”
While Dr Lee added that GP practices are starting to get busier again, she said it was unlikely that cancer services will get back to normal while Covid-19 is still prevalent.
She admitted that it will take a long time to manage the huge backlog of patients needing appointments and screening sessions.
“Cervical Screening Wales, for
example, has said that they won’t catch up with the missed smears (as well as the ones that continue to be due) until early 2021,” she added.
She said that the NHS has a “great history of collaboration and dedication” which will pull it through the crisis.
“All services have shown remarkable capacity to flex and adapt to delivering care in different ways,” she said.
“The impact on patient care has been to try and keep people safe. This has had a physical and psychological impact on the patients, but also on their relatives and those working in the NHS trying to deliver care in very challenging circumstances.
“Instead of worrying about not being able to cope in the future, we are trying to ensure that there are smooth, streamlined processes to get people on the right treatment with minimal clinical appointments – thus reducing infection risk and time saving.”
She concluded: “A lot more consultations will continue to be remote in the future and this will provide its advantages to some, such as the ability to not take time off work or to worry about travel and parking costs.
“It is important that people choose the right route for help. Not everything needs to come to a GP and a pharmacy; your practice website may have the answers people need. To continue to survive and thrive the NHS needs us all to use it wisely.”
NHS Wales chief executive Dr Andrew Goodall said yesterday that cancer services had been maintained “wherever possible” but admitted there were disruptions during the pandemic.
“Some will have been affected by the need for an enhanced infection control, reduced staff availability, reduced access to theatres and critical care and access to diagnostics,” he said.
He added that while some aspects of cancer treatment were restarting, other areas remained challenging, including endoscopy, where the risk of infection was high.
“Cervical, breast and bowel cancer screening services have all restarted and I urge everyone who has been invited to come forward.”