How much have cancer referrals and treatments recovered from Covid impacts?
- Credit: Sarah Lucy Brown
Cancer referral and treatment numbers in Suffolk are nearing pre-pandemic levels following a dramatic fall in the spring caused by Covid-19, according to new data.
The two-week wait referral from GP to specialist for urgent symptoms plummeted by 74% in April 2020 compared to the same month in 2019 in West Suffolk, fell 68% at James Paget University Hospital where those in north Suffolk are catered for, and down 45% in East Suffolk and North Essex NHS Foundation Trust (ESNEFT).
For the 31-day cancer treatment target between a specialist's decision and a patient's first treatment, April 2020 figures were down 52% in West Suffolk, -38% at ESEFT and 23% lower at James Paget compared to April 2019.
However, latest data for December 2020 compared to the same period in 2019 indicated that those numbers were recovering.
For two-week wait referrals, ESNEFT was up 24%, while James Paget was down 13% and West Suffolk -7%.
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Rates for 31-day first treatment comparing December 2020 to December 2019 were up 11% in ESNEFT, down 6% at James Paget and -24% at West Suffolk.
At Wednesday's health scrutiny committee meeting for Suffolk, health chiefs urged people with concerning symptoms to make sure they get them checked out.
Sarah Miller, head of informatics for the East of England Cancer Alliance, which brings together clinical leaders, patients and the community to drive improvements in cancer care, said: "We saw a large reduction across the country, across the East of England and within Suffolk in terms of patients being seen on a two-week wait pathway.
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"The referrals have increased over many months, and fluctuated at times as well.
"[Now] we can see referrals at the back end of last year above pre-pandemic levels."
On the reasons for the fall in referrals, she added: "Less was known about the virus, it was new territory for everyone in the community but also the NHS. Primary care [services] with our GPs and also hospital staff and activity were under significant pressure from Covid. Healthcare staff were redeployed to support the pandemic response.
"There is an element of patient choice and some patients did prefer to stay at home due to the perceived risks, but also had been asked to shield potentially as well."
She added: "The message is that the doors of the NHS are open for patients who suspect they may have cancer symptoms to come forward."
The meeting heard that cervical screening services were running at broadly similar levels to those seen before the pandemic. However, bowel and breast screening are still recovering and not yet back up to normal levels.
Dr Christopher Scrase, clinical lead for cancer for Suffolk and North East Essex Integrated Care System, told the committee that at the start of the pandemic, some low risk skin and prostate cancers could wait because the risk of catching Covid-19 outweighed the benefits at that time, but "very little was paused" in terms of radiotherapy as a whole.
However, with chemotherapy they had "some very difficult conversations with some patients because the logic that made complete sense was that if you were immune-compromised and you caught Covid then there would be a very significant risk of not being able to survive Covid, so there were some cases where we advised patients either not to start chemotherapy or those started chemotherapy advised to pause".
Towards the end of 2020, more data emerged that certain cohorts of cancer patients, such as haematological and lung cancer patients, were more at risk than others, so that "a more risk strategized approach" could be taken.
Some cancer treatments like chemo were moved to other independent providers, including Nuffield Hospital in Ipswich and BMI Bury to ensure they were away from hospital settings where Covid patients were in beds. At Nuffield alone, that amounted to 300 chemo sessions per week.
For surgery treatments, some operations were delayed by up to three months where appropriate to help ease the burden, and reduce risks on patients, Dr Scrase said.