Don’t let COVID-19 distract from the Big C

Can­cer is a big enough foe on its own, but the pan­dem­ic has pitched its malig­nan­cy onto unmapped ter­ri­to­ry where even enter­ing a hos­pi­tal or clin­ic has become fraught with dan­ger.

Deliv­er­ing can­cer care, when resources are stretched and coro­n­avirus infec­tion stalks con­tacts and pro­ce­dures, has stretched health­care providers’ abil­i­ty to cope with heavy work­loads and com­plex logis­tics.

Around 2.5 mil­lion peo­ple in the UK are liv­ing with a diag­no­sis, but staff short­ages, delays caused by height­ened safe­ty pro­to­cols and the need to dis­tance can­cer patients from COVID-19 wards has caused wide­spread dis­rup­tion across can­cer care.

A study pub­lished dur­ing the sum­mer fore­cast the UK could expe­ri­ence an extra 350,000 can­cer deaths over the next year from post­poned oper­a­tions, delayed treat­ments and patients ignor­ing symp­toms or delay­ing diag­nos­tic appoint­ments for fear of expos­ing them­selves to infec­tion risks in the health sys­tem.

Although the arm wres­tle with resources and pub­lic con­fi­dence will con­tin­ue for some time, health­care providers have adapt­ed swift­ly to ensure patients receive can­cer care and emo­tion­al sup­port no mat­ter where they are on the treat­ment spec­trum.

Pri­vate hos­pi­tals, free from COVID-19 patients, were brought on stream, 19 region­al can­cer hubs were estab­lished to deliv­er urgent surgery, phys­i­cal appoint­ments were switched to dig­i­tal plat­forms, med­ica­tion regimes were deliv­ered to patients’ homes and mobile wards were deployed to meet local needs.

The NHS intro­duced drug “swaps” to pro­vide alter­na­tives that could be tak­en at home, rather than in hos­pi­tal set­tings, with a reduced impact on patients’ immune sys­tems to min­imise the risk of infec­tions.

NHS response to cancer care risks

“The pan­dem­ic has had a fair­ly dev­as­tat­ing impact on can­cer ser­vices and peo­ple with can­cer,” says Sara Bain­bridge, head of pol­i­cy at Macmil­lan Can­cer Sup­port, which offers high-impact sup­port to 1.9 mil­lion peo­ple annu­al­ly. “But we have seen an incred­i­ble response from staff and sup­port ser­vices.”

Dr Lay­la McCay, direc­tor at the NHS Con­fed­er­a­tion, which rep­re­sents NHS organ­i­sa­tions and its lead­ers, adds: “The pres­sure has been intense. It is not that peo­ple have stopped get­ting can­cer, but the impact has been at every stage from diag­nos­tics through to care. Staff have been work­ing amaz­ing­ly hard, but that inten­si­ty is not sus­tain­able.”

The work­force strain – health­care staff also have to con­tend with a height­ened risk of con­tract­ing COVID-19 – is play­ing out across an NHS staff short­age of 84,000 with the gov­ern­ment-pledged cohort of 50,000 extra nurs­es still some dis­tance away from the front­line.

But the response has been full of inge­nu­ity that ranges from nation­al alliance with pri­vate health­care providers to run and staff the can­cer hubs, to using mobile “can­cer bus­es” that have been used as safe spaces to deliv­er chemother­a­py to four patients at a time, achiev­ing 60 ses­sions a day safe­ly.

Home care has been ramped up at Clat­ter­bridge Can­cer Cen­tre, on Mersey­side, as the num­ber of peo­ple receiv­ing care at home from spe­cial­ist chemother­a­py nurs­es has increased by 15 per cent dur­ing the out­break, with 285 patients in the area hav­ing oral chemother­a­py deliv­ered to their door by local vol­un­teers.

COVID-19 blueprint for second surge

Bris­tol Haema­tol­ogy and Oncol­o­gy Cen­tre believes it has devel­oped a blue­print to cope with COVID-19 dur­ing the sec­ond surge. It switched from face-to-face out­pa­tient clin­ic appoint­ments to an almost entire­ly tele­phone-based out­pa­tient ser­vice, increased the pre­scrip­tion length for some oral med­ica­tions, and sent some treat­ments to patients’ homes to avoid com­pro­mis­ing shield­ing, while patients estab­lished on immunother­a­py were changed to longer reg­i­mens.

“It has been flu­id and has heav­i­ly relied on the ded­i­ca­tion and good­will of staff who have sac­ri­ficed hol­i­days or time with their fam­i­lies and put them­selves on the front­line to not only treat patients with coro­n­avirus, but also to ensure oncol­o­gy ser­vices have been able to con­tin­ue,” accord­ing to a report from the cen­tre.

An NHS Con­fed­er­a­tion sur­vey revealed that 50 per cent of NHS lead­ers were not con­fi­dent that can­cer care ser­vices could recov­er swift­ly. “Can­cer ser­vices, like all oth­er ser­vices, need to learn the lessons from COVID-19,” says McCay. “Dig­i­tal inno­va­tion and new, inte­grat­ed ways of work­ing will have raised new oppor­tu­ni­ties to improve the effi­cien­cy and the effec­tive­ness of diag­no­sis and treat­ment. But, with a sec­ond surge com­ing, it is vital that we have the invest­ment to ensure it has the work­force and the phys­i­cal capac­i­ty it needs.

“We also need to think cre­ative­ly about how we can make the very most of what we have to give patients the best ser­vice. We need to be prac­ti­cal in under­stand­ing what can be achieved across what timescales to restore these ser­vices because it’s not just a mat­ter of turn­ing a switch and every­thing’s back to nor­mal.

“This is very com­plex stuff and COVID-19 has real­ly shone a light on inequal­i­ties with data show­ing that peo­ple who are poor or from BAME [Black, Asian and minor­i­ty eth­nic] com­mu­ni­ties have been dis­pro­por­tion­ate­ly affect­ed.”

Clear com­mu­ni­ca­tion about changes to treat­ment plans or loca­tions has been one of the most impor­tant ele­ments of can­cer care dur­ing the pan­dem­ic, Macmil­lan Can­cer Support’s Bain­bridge adds, and although vir­tu­al con­sul­ta­tions are effec­tive, they may not be appro­pri­ate for sen­si­tive con­ver­sa­tions.

The char­i­ty has launched The For­got­ten C cam­paign to ensure the gov­ern­ment tack­les back­logs in diag­no­sis, treat­ment and care, and that future ser­vices will be based on per­son­alised needs.

“At the start of the pan­dem­ic, the NHS was promised what it needs and it still needs that com­mit­ment because the chal­lenge for can­cer cer­tain­ly isn’t fin­ished. We need to make sure that progress made on can­cer over the last few decades is not lost,” Bain­bridge con­cludes.