The Impact of COVID-19 on Cancer Diagnosis & Treatment

On World Lung Cancer Day, a day dedicated to raising awareness about lung cancer and its impact throughout the world, we wanted to spotlight the impact the COVID-19 pandemic has had on cancer diagnosis, treatment and potentially survival. To contribute our piece, we thought we’d open a conversation on the importance of radiology in diagnosing, treating and overcoming cancer.

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Current statistics show that 1 in 2 people will sadly develop cancer at some point in their lives (Cancer Research UK), with lung cancer being the most common cause of cancer death in 2020 according to the World Health Organisation.

Fortunately, cure rates can be improved with earlier detection. In the UK, there are 3 national screening programmes for bowel, breast and cervical cancer along with the Targeted Lung Health Checks (TLHC) programme currently underway in England.

All of these programmes aim to increase the opportunity for early diagnosis and as result survival rates for those with cancer.

The pandemic has had a huge impact on healthcare; increasing patient waiting times, creating backlogs in elective care, cancer care and radiology.

This was further exacerbated by a shortage of MRI radiographers, attempts to mitigate the risk of spreading the virus through extra cleaning procedures and staff being reallocated to care for COVID-19 patients

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Waiting longer for imaging and results can massively hamper patient outcome and consequently, a delay in cancer treatment can directly impact mortality rates

A research paper published in late 2020 found that “A four-week delay in treatment is associated with an increase in mortality across all common forms of cancer treatment, with long delays being increasingly detrimental.“ (Hanna et al., 2020)

National Health Service England (NHSE) statistics show that diagnostic test activity and waiting times have been severely impacted by COVID-19.

“At the end of August 2020, there were a total of 472,100 patients waiting six weeks or more from referral for one of the 15 key diagnostic tests. Compared with August 2019, the number of patients waiting six weeks or more increased by 429,000.”

Such massive increases illustrate the dramatic knock-on effect of having to halt non-emergency imaging during the peaks of the pandemic.

Further NHSE insights are equally concerning. In January 2020, 4.3% of patients were waiting 6 weeks or more for an MRI whereas, in January 2021, this figure rose to 25.8%.

Waiting times for CT and non-obstetric ultrasounds also jumped by around 20% over the same period.

A modelling study in August 2020 found “During the COVID-19 lockdown, referrals via the 2-week-wait urgent pathway for suspected cancer in England, UK are reported to have decreased by 84%”.

Hexarad Teleradiology patients waiting for one of the 15 diagnostic tests
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An article published in 2020 by The Lancet examined data for breast, colorectal, oesophageal and lung cancer.

Worryingly, 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 of diagnosis, this being a conservative estimate.

Urgent policy intervention is necessary to manage the backlog within routine diagnostic services to mitigate the foreseeable impact of the pandemic on cancer patients.

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.

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.

Following the budget announcement in March 2021, the Royal College of Radiologists (RCR) President, Dr Jeanette Dickson said, “Imaging and cancer teams are working through recent backlogs but demand only goes in one direction.

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Even before the immense pressures of COVID-19, the UK radiologist workforce was understaffed by 33 per cent, and the clinical oncology workforce by 19 per cent. There is only so much our stretched medical specialities can do without more resources. Treatment waiting lists are now at a record high, and millions of those patients waiting will need some form of radiological diagnosis or treatment.”

In order to be able to meet these increased demands she adds, “we must have a fully-costed, sustainable funding package from the UK government that deliberately addresses the equipment, IT, and crucially workforce needs across NHS radiology and oncology.”

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 track cancer diagnosis and, compounded with the pandemic backlog, the issue of workforce needs to be urgently addressed.

As the Lancet article states, “Urgent policy interventions are necessary to mitigate the indirect effects of the COVID-19 pandemic on patients with cancer.

These interventions should focus on increasing routine diagnostic capacity through which up to 40% of patients with cancer are diagnosed.”

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World Lung Cancer Day serves as a poignant reminder to not only support those impacted by lung cancer but also magnify the ways in which we can work together to try to lessen that impact for future
patients through earlier detection.

References:

Hanna T P, King W D, Thibodeau S, Jalink M, Paulin G A, Harvey-Jones E et al. (2020) Mortality due to cancer treatment delay: systematic review and meta-analysis BMJ 2020; 371 :m4087 doi:10.1136/bmj.m4087

https://www.england.nhs.uk/contact-us/privacy-notice/how-we-use-your- information/our-services/evaluation-of-the-targeted-lung-health-check- programme/

https://www.rcr.ac.uk/posts/rcr-responds-spring-budget

Maringe, C et al. (2020) The Impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population- based, modelling study. The Lancet Oncology, Volume 21, Issue 8, 1023-1034

https://doi.org/10.1016/S1470-2045(20)30388-0

Sud A, et al. (2020) Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. Lancet Oncol. 2020 Aug;21(8):1035-1044. doi: 10.1016/S1470- 2045(20)30392-2. Epub 2020 Jul 20. PMID: 32702311; PMCID: PMC7116538.