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After Enduring Covid, Hospitals Brace for Cancer Onslaught

June 11, 2020, 11:42 AM

Ailsa McDonagh has struggled with cancer on and off for the past five years. When her doctors explained in January that the disease had spread, she was booked swiftly for another round of treatment. Then came the pandemic.

The chemotherapy to tackle cancer that had reached McDonagh’s diaphragm was delayed by six months until September, when the risks from Covid-19 are expected to be lower. The 39-year-old mother of two, who was initially diagnosed with bowel cancer, worries about further disruption from a potential second wave of coronavirus -- and about the impact on her health.

“Cancer only does one thing unchecked,” said McDonagh, who lives in Lancashire, in northern England. Covid has made life “even more uncertain.”

Across the world, people like McDonagh face harrowing treatment delays as hospitals try to shield the most vulnerable from contamination risks and salvage overstretched health systems. What’s more, routine screenings for breast, cervical and bowel cancer have slowed or stopped altogether, depriving some unsuspecting patients of a chance to tackle the disease early.

New figures from the U.K. on Thursday -- representing the first full month of data since the shutdown -- give an insight into how many thousands may have missed diagnosis as a result of the pandemic. Urgent hospital referrals for suspected cancer fell 60% in April, according to Cancer Research UK analysis based on National Health Service data. Around 7% of referrals are usually found to have the disease, estimates show.

Message to Patients

Patients’ fear of Covid-laden hospitals or wasting doctors’ time are among the reasons referrals may have fallen so much.

“Lives are saved if more people are referred for checks,” said Peter Johnson, the NHS’s national clinical director for cancer. “NHS staff have been working incredibly hard to ensure that essential and urgent cancer treatment has been able to go ahead safely for thousands of people. My message to anyone who has a worrying symptom is: Please help us help you.”

The U.K. isn’t alone. Routine screenings fell between 86% and 94% in the U.S. in March, depending on the type of cancer, compared with the previous three years. Spain’s screening, diagnosis and treatment numbers have also plunged, while around half the normal number of patients in France were diagnosed during the two-month lockdown, according to Axel Kahn, president of the country’s League Against Cancer.

“The diagnostic delays are what risks having the most dire consequences,” Kahn said.

Don’t ‘Stay Home’

Wealthier countries could experience a 5% to 10% decrease in cancer survival because of the disruption, according to an editorial published last month in The Lancet medical journal. That translates into hundreds of thousands of excess deaths, dwarfing those caused by Covid-19, though the data required to make accurate predictions are limited, the report said.

In Britain, “Stay Home, Protect the NHS, Save Lives” will long be remembered as the country’s Covid-19 mantra. But while that helped the health service focus on tackling the pandemic, the cancer backlog may now engulf hospitals with a second wave of a different kind.

“If this keeps going, there will be tens of thousands of patients in the system who will land at some point,” said Jodie Moffat, head of early diagnosis at Cancer Research UK. “We know that the NHS was finding it very difficult to meet the demands and the tests needed by all of those patients who were being referred with suspected cancer before Covid hit.”

Waiting Lists

The NHS waiting list for routine procedures could reach 10 million by the end of the year, possibly higher if there is a Covid-19 resurgence before an effective treatment or a vaccine, according to analysis shared with the NHS Confederation. Before the crisis, more than 4 million people were already on hold.

Bowel cancer -- the type McDonagh first had -- is curable if it’s detected early enough, but the coronavirus crisis has delayed both testing and treatment for thousands of people, according to Genevieve Edwards, who runs Bowel Cancer U.K. It’s a cancer that kills more than 40 people in Britain every day, making it the country’s second-biggest cancer killer.

“Clinicians have to make decisions about what’s the greater risk: bringing someone into hospital and they might get coronavirus, or leaving them for three weeks, three months, and what will happen in the intervening time in terms of their cancer progressing?” Edwards said. “For some, I think it’s inevitable they’ll have a worse outcome as a result, with years of life lost.”

Hospitals in Italy set up cancer hubs to try and continue therapies away from Covid patients, an approach the U.K. has also taken. Nicholas van As, medical director at cancer-specialist hospital The Royal Marsden in London, helped create these spaces, working with private hospitals to try and provide Covid-free environments. By mid-May, only one patient had contracted the virus after an operation, he said.

“We’re really actively now trying to get the message across that we’re open and cancer treatments are continuing,” he said.

Clinical Trials

The pandemic’s impact on cancer research and clinical trials is also a concern and could hinder the availability of life-saving treatments in the future. A survey conducted by America’s Cancer Research Institute and data research company IQVIA at the start of the lockdown found Covid-19 had affected enrollment in clinical trials. About 15% of AstraZeneca Plc’s 100-plus oncology trials have been impacted, according to José Baselga, Astra’s head of cancer research, although these were mostly early-stage studies.

The new coronavirus has hurt the battle against many diseases. As the virus took hold -- about 7 million people have been infected and more than 400,000 have died globally -- hospitals became a threat to all immune-suppressed patients. But managing the looming surge of cancer cases to protect the NHS and save lives is now one of the biggest concerns.

“Delay has a real and demonstrable impact,” said Bhavagaya Bakshi, a general practitioner and co-founder of C the Signs, an online tool to help doctors diagnose cancer earlier. “The full casualties of Covid and the impact it has had will not really come to light for months, and it may be years before the true ramifications are felt.”

--With assistance from Marthe Fourcade, Thomas Gualtieri, Tim Loh, Naomi Kresge, Emma Court and Michelle Fay Cortez.

To contact the reporters on this story:
Suzi Ring in London at sring5@bloomberg.net;
James Paton in London at jpaton4@bloomberg.net

To contact the editors responsible for this story:
Eric Pfanner at epfanner1@bloomberg.net

Marthe Fourcade, Anne Pollak

© 2020 Bloomberg L.P. All rights reserved. Used with permission.

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