Experts are warning that the UK could experience up to 35,000 additional cancer deaths after the coronavirus lockdown – but why has it taken three months for the figures to come to light?
A report on the BBC’s Panorama programme suggests that delays in cancer treatment due to the coronavirus lockdown could cause up to 35,000 extra UK cancer deaths – but the warning was first given three months ago on April 29th in a paper from the DATA-CAN centre.
DATA-CAN, the Health Data Research Hub for Cancer in the UK, published on April 29th a study claiming ‘Deaths in people with cancer could rise by at least 20 percent’.
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Cancer deaths
The analysis was the first to focus on the impact of the emergency on cancer deaths and uses data from the health records of over 3.5 million patients in England.
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The study estimates that pre-COVID-19, about 31,354 newly diagnosed cancer patients would die within a year in England. As a result of the emergency, there could be at least 6,270 additional cancer deaths in newly diagnosed cancer patients alone. This number could rise to an estimated 17,915 additional deaths if all people currently living with cancer are considered.
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The researchers analysed weekly data from major cancer centres in the UK and found a 76 percent decrease in urgent referrals from GPs for people with suspected cancers and a 60 percent decrease in chemotherapy appointments for cancer patients compared to pre-COVID-19 levels.
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The paper also models publicly available US data and shows an additional 33,890 cancer deaths in the US in newly diagnosed cancer patients over the next year. The study estimates that pre-COVID-19, about 169,433 newly diagnosed cancer patients would die within a year in the US.
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Treatment protocols
Senior author Professor Harry Hemingway, (Director, UCL Institute of Health Informatics), said: “The overall impact of the COVID-19 emergency on deaths in cancer patients could be substantial. There are many factors operating here including rapid changes to diagnosis and treatment protocols, social distancing measures, changes in people’s behaviour in seeking medical attention and the economic impact of COVID-19, as well as deaths due to COVID-19 infection.”
Professor Mark Lawler (Queen’s University Belfast and Scientific Lead DATA-CAN) said: “We applied our model to new cancers in the UK and the US, using publicly available data. The results are concerning. We believe countries need to rapidly understand how the emergency is affecting cancer outcomes, otherwise we risk adding cancer and other underlying health conditions to the escalating death toll of the COVID-19 pandemic.”
This research provides a comprehensive picture of how people living with a range of different cancers are affected by other often treatable long-term conditions including cardiovascular disease, hypertension, obesity and diabetes. Nearly eight out of ten of the additional cancer deaths are estimated to occur in people with one or more of these long-term conditions.
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Unintended consequences
Lead author, Dr Alvina Lai (UCL Institute of Health Informatics) said: “Our findings demonstrate the serious potential for unintended consequences of the response to the COVID-19 pandemic, which may negatively impact on patients with cancer and other underlying health conditions. It is vital that these patients are recognised as being vulnerable and that their care is managed appropriately”.
Dr Charlie Davie (DATA-CAN Hub Director), said: “Our study highlights the value of bringing together data from multiple sources to enable researchers, health systems and policy makers to improve cancer management for our patients, both during and after this pandemic.”
Pete Wheatstone, a patient and a member of the Public and Patient Involvement and Engagement group of DATA-CAN added: “This research demonstrates the value to cancer patients, the wider public and decision-makers when trusted professionals use our patient data to help decide the best course of action. It also highlights the urgent need to be able to analyse these data quickly and accurately to inform and influence current events”
The researchers say it is crucial for weekly national data on cancer deaths and services to be made available urgently, to enable better understanding of which disease combinations pose the greatest risk to life and inform how health services should be prioritised, both now and in the near future, in order to give patients the best possible life chances.
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Very worrying
Prof Mark Lawler, Scientific Lead of DATA-CAN, told BBC Panorama: “Initial data that we got was very worrying to us.
“Obviously scientists like to be right in terms of their analysis, but I hope I’m wrong in relation to that.”
Peter Johnson, the National Clinical Director for Cancer NHS England, told Panorama: “We’re working as fast as we can to put the services back together again, to restore the capacity and indeed to build more, so that we can deal with the people that have not been diagnosed during the time when the services have been running below 100 percent.”
And NHS GP Dr Gary Marlowe said: “There is a significant cohort of people who are very worried about coming anywhere near the NHS, because coming near the NHS means ‘I’m going to get COVID, and therefore I’m going to get very, very ill'”.
Clinical oncologist Professor Pat Price told Panorama: “The guidelines for radiotherapy and Covid-19 advised people to delay and avoid radiotherapy in some circumstances. I think it was a very high risk strategy.”
Right balance
With radiotherapy machines lying idle during the COVID-19 lockdown, Professor Price said: “It has been safe to give radiotherapy during Covid-19, we know that now”, but Peter Johnson explained “What we were concerned to do, when the virus was increasing very rapidly in the population, was to make sure that we could get the right balance between the risk of catching the virus, and the risk of having people’s cancer get worse.
“And in particular, the risks and benefits of things like chemotherapy where, if the chemotherapy isn’t absolutely crucial but it might be dangerous in terms of increasing your risk of coronavirus.
“This wasn’t a kind of attempt to police who should have treatment and who shouldn’t, it was more an attempt to try and help people think very clearly.”
Coronavirus lockdown
The BBC Panorama programme ‘Britain’s Cancer Crisis’ is broadcast on Monday 6th July at 7:30pm on BBC One, and is available afterwards on BBC iPlayer.
For more information on why experts are warning that the UK could experience up to 35,000 additional cancer deaths after the coronavirus lockdown, and why has it taken three months for the figures to come to light, you can read the DATA-CAN report here.
