26 October 2020
The COVID-19 pandemic has had a profound impact on healthcare across the UK and particularly on cancer services. The continued safe functioning of most non-surgical oncology care during the first wave of the crisis was testament to the manner in which the clinical community pulled together to support each other, our teams and our patients. As we approach the second wave with an increasingly over-stretched workforce, maintaining this collaborative, compassionate and adaptable ethos will be critical in navigating the enduring challenges we face.
From the outset of the crisis, it was clear that the ongoing safe delivery of radiotherapy and Systemic Anti-Cancer Therapies (SACT) would be challenging. Now, with an increasing wealth of data showing a heightened risk to patients with cancer from coronavirus, it is even more crucial that spaces optimally protected from COVID-19 are established and maintained so that our patients can receive care as safely as possible. Many cancer patients have also experienced heightened anxieties during the pandemic consequent to uncertainties about their treatment, social isolation and concern over the risk of COVID-19 and many will have increased psychological needs to address.
The RCR has produced guidance on recovery, restoration and reconfiguration for clinical oncology departments which offers high-level advice with respect to infection control measures, treatment decisions and modifications in the context of endemic COVID-19 as well as the provision of support for cancer patients so they feel safe and confident in accessing their oncology care. The guidance is multi-professional and draws on the good practice and innovative new ways of working developed by the community during the pandemic period which we should now aim to embed into everyday operations.
Modelling studies have shown substantial increases in the number of avoidable cancer deaths in the UK are to be expected as a result of presentational and diagnostic delays due to the COVID-19 pandemic (see references 1, 2.) As the second surge progresses, the demand for radiotherapy and SACT services may continue to increase to account for the substantial diagnostic backlog, altered referral pathways and an increase in presentation of more advanced disease. Staffing levels across departments will be reduced and will continue to fluctuate at short notice due to stress, sickness and the requirement to isolate. This will add yet more pressure on an already strained workforce. To prevent further avoidable cancer deaths, it is critical that measures are taken to maintain the safe running of all cancer services and to support and retain those working in cancer care. This should include minimising redeployment of any oncology staff unless absolutely necessary, facilitating both remote and flexible working and implementing strategies to address the negative impact of COVID-19 on staff wellbeing and morale.
The considerable drop in GP referrals for suspected cancer during the first coronavirus outbreak and the reduced availability and throughput of diagnostic and surgical oncology services, all of which form crucial parts of the integrated cancer pathway, remain an ongoing concern. Discussions across organisations providing cancer care to facilitate and highlight innovative local solutions in primary care, diagnostics and treatment delivery such that they may be more widely implemented are strongly encouraged, as is investment in national public awareness campaigns to urge those with potential cancer symptoms to seek help appropriately. Clinical trials also form an integral part of cancer services and many were paused at the onset of the pandemic. Continued liaison with local Research and Development departments is advised to re-open and maintain oncology clinical trials during the second surge in line with the National Institute for Health Research’s Restart Framework.
COVID-19 disruption to cancer pathways will be an ongoing issue until a successful vaccine or treatment is identified, and it is one whose negative impact may not be fully evident for at least 10 years. As we enter a second surge, it is imperative that we continue to work together as a community to support and take care of each other and our multi-professional teams in increasingly stressful times. Concurrently, at a national level, we continue to strongly advocate for the protection of and investment into cancer services such that we can continue to safely deliver the highest quality care for our patients during this exceptional crisis.
- Sud et al. 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 21(8):1035-44 (2020)
- Maringe et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study, Lancet Oncol 21(8):1023-34 (2020)
Read previous statements about the RCR's position on coronavirus (COVID-19) for clinical oncology
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