What actions are needed now to get cancer services back on track?
Keeping cancer services going during the covid-19 pandemic has been an enormous challenge. The impact of this disruption to cancer services, for more than a year, is now becoming more clearly visible.
Recent analysis by QualityWatch shows the disruption to activity across all aspects of cancer pathways, with 37,000 fewer patients being treated for cancer in the past year. Some tumour pathways have also been much worse hit than others. Treatment activity for lung cancer, for example, was down by 73% in December, compared to the same period the previous year.
Service recovery efforts must focus on the right things. They need to ensure that patients with signs of possible cancer come forward, they need to reduce backlogs on urgent referral and screening pathways, and strong partnerships with patients and the public need to be built.
Some of that is happening already, through high-profile public campaigns such as “Help us, Help you,” and better use of independent sector capacity to support cancer surgery.
In the past year we’ve also seen a rapid acceleration of innovation, and a willingness to do things differently. One standout example of this is the cancer hub model, incorporating a regional cancer surgery network together with “covid light” clinical capacity; a prioritisation framework based on both outcome and urgency-based criteria; and the coordination of specialist oncology workforce across regions, with deployment through network arrangements.
As part of this shift in thinking, we are seeing a greater focus on community-based service innovation to help diagnose patients faster. Rapid adoption of new technologies such as Colon capsule endoscopy could accelerate some of these positive changes—supported by a £150 million investment in diagnostics—and help deliver on the Long Term Plan’s ambition to diagnose 75% of cancers at an early stage.
One area still in need of more progress is the prioritisation and good management of patients on waiting lists, as well as those stalled in different parts of cancer service pathways. A more transparent process for prioritisation is needed, which should be implemented in the same way in different places, using consistent criteria nationally within each cancer group, and with a focus on fairness in both the process and the results of prioritisation. This should address known variations in the thresholds for referrals to specialists, and make better use of technology to help identify patients with worsening symptoms.
We can’t expect a single silver bullet solution to get cancer services back on track. Instead what’s needed is more rapid evaluation of different initiatives across screening, diagnostics, triage, referrals, and stage shift. This can quickly inform recovery efforts by identifying what works and for whom.
The last part of this—what works for whom—is important to get right, given evidence that service recovery has been much slower for certain types of cancer, including lung, urological and some head and neck cancers. We also need to pay attention to data showing that patients in more deprived areas, as well as ethnic minority groups, have been slower to see the benefits from cancer services recovery.
Some estimates suggest that we can’t expect cancer services to be back on track before March 2022, which will have a huge impact on cancer patients currently stuck on waiting lists.
Even for those who have made it through diagnosis and onto treatment pathways over the past year, many have experienced significant disruption to their care.  According to Blood Cancer UK, 47% of blood cancer patients have had their treatment changed due to the pandemic. The impact on patients with incurable cancer has been especially profound and needs more attention. 
Research by National Voices on the experience of waiting for care reveals a picture of large-scale delays and cancellations. What’s needed now is a strong policy focus on implementing recommendations to better support patients waiting for care. This includes investing in patient-centred information and communication—an issue the Health and Social Care Select Committee has highlighted as deserving of much greater attention.
At the same time, we need to ensure that care for all patients meets expected standards of access to treatment, which includes confidence that there will be no unnecessary delays in making treatments available.
We must remember that the impact of disruption to cancer services is felt first and foremost by people who have cancer.  Plans for service recovery and reconfiguration need to be built in partnership with patients and the wider public, with stronger collaboration from policy-makers and a focus on developing new inclusive and equitable policies.
Charlotte Paddison, senior fellow at the Nuffield Trust.
Competing interests: none declared.
- Macmillan Cancer Support, The Forgotten “C”? The impact of covid-19 on cancer care. October 2020.
- Macmillan Cancer Support, Cancer and covid: the story so far. March 2020 – February 2021.