Covid has had a huge impact on healthcare; creating backlogs in elective care, cancer care and radiology.
Following the budget announcement in March 2021, RCR President Dr Jeanette Dickson made the following statement;
“Following the autumn spending review – which did grant some welcome funding for parts of the health service – today’s budget understandably centred on ongoing economic safeguards and stimuli. However, the long-term needs of the NHS cannot be ignored forever. The backlogs and delivery challenges caused by coronavirus continue to impact hospital patients and the services that treat them. “
“Imaging and cancer teams are working through recent backlogs but demand only goes in one direction. Even before the immense pressures of COVID-19, the UK radiologist workforce was understaffed by 33 per cent1, and the clinical oncology workforce by 19 per cent2. There is only so much our stretched medical specialties can do without more resources.
“Treatment waiting lists are now at a record high3, and millions of those patients waiting will need some form of radiological diagnosis or treatment.
“At the end of last year more than 72,000 patients in England were waiting six weeks or more for a CT or MRI scan4, and the most recent COVID-19 winter surge will be hitting waits further.
“Tens of thousands of cancer cases potentially went undiagnosed last year5 and front line cancer teams across the UK are telling us that they are seeing more patients presenting with later stage, often less curable cancers.”
As we know, 1 in 3 people will develop cancer at some point in their lives but cure rates are now increasing with earlier detection. In the UK, there are 3 national screening programs for bowel, breast, and cervical cancer.
Diagnostic Radiology is an essential part of grappling with the cancer epidemic.
Future innovations aim to improve the detection threshold and the quality of cancer staging. Some of these include opting for PET radiotracers instead of SPECT ones, which would mean using fluorine-18, a positron emitting radioisotope to give better contrast and spatial resolution.
Secondly, given how magnificently MRI can map soft tissue, there are hopes to improve its sensitivity to exogenous contrast agents. So-called hyperpolarization MRI techniques could vastly enhance the detectability of tumour cells.
Despite all the complex ways we can harness radiology for cancer treatment, there are several hurdles facing us. Sadly, waiting times are getting unacceptably high. In fact, latest figures have shown that around 330,000 patients waited more than a month for x ray results.
As more Doctors request imaging for less urgent conditions and there remains a push for the ‘two week wait’ pathway of cancer referral, the pressure on radiologists will grow exponentially.
NHSE’s latest statistics show that diagnostic test activity and waiting times have been severely impacted by COVID-19. At the end of January 2021, there were 377,700 patients waiting six weeks or more from referral for one of the 15 key diagnostic tests. This formed a third of the total number of patients waiting at the end of the month.
Compared to January 2020, the total number of patients waiting six weeks or more increased by 331,500 patients, while the proportion of patients waiting six weeks or more increased by around 29%.
Further insights are equally concerning. In January 2020, 4.3% of patients waiting 6 weeks or more for an MRI whereas in January 2021, this rose to 25.8%.
Waiting times for CT and non-obstetric ultrasounds also jumped by around 20% over the same period.
Such massive increases illustrate the dramatic knock-on effect of having to halt non-emergency imaging during the peaks of the pandemic.
Waiting longer for imaging and results can hamper patient outcome massively. Likewise, cancer treatment delay can impact mortality. Even a four-week delay of cancer treatment is associated with increased mortality across systemic treatment and radiotherapy indications for seven cancers.
An article published by The Lancet examined data for breast, colorectal, oesophageal and lung cancer. It outlines how a substantial increase in the number of avoidable cancer deaths are to be expected due to the diagnostic delays caused by the pandemic.
For these four tumour types, the data corresponds with 3291–3621 additional deaths across the scenarios within 5 years. Urgent policy intervention is necessary to manage the backlog within routine diagnostic services to mitigate the foreseeable impact of the pandemic on patients with cancer.
Fortunately, the dilemma is receiving rising scrutiny. Reports highlight a chronic shortfall in equipment and staffing which stresses the need for expanding the specialist workforce. The RCR has warned that a shortage of radiologists could hamper NHS England plans to fast tracked cancer diagnosis and compounded with the pandemic backlog the issue of workforce needs urgent addressing.
Notably, cancer treatment delay is a problem in health systems worldwide. Modelling the impact of this widespread delay is the first step to bettering cancer treatment and improving population level survival outcomes, but we also need sustainable funding, improved IT systems and to address the workforce crisis in Radiology and oncology.