The coronavirus pandemic, a global fight we have not seen since the previous century, undoubtedly has resulted in disastrous effects on the UK and global economy. On 12th August, the UK economy declared an official recession for the first time in 11 years as the economy shrank by 20.4%, the biggest reduction ever seen. This is the trend predicted globally as the World Bank forecasts a 5.2% reduction, the deepest recession since WWII.
What does this mean in cancer care? For a disease in which survival is time dependent and care is reliant on funding, a global pandemic and recession does not bode well.
Impact of economic crises on cancer care
In the past, economic recession and high unemployment have been associated with a lower rate of cancer detection and treatment. Data from 1973 to 2007 shows across all cancers for every 1% increase in unemployment there was a 2.7% decrease in cancer diagnosis. This was significantly higher in cancers that are considered ‘treatable’ such as breast cancer, reaching a 7.4% reduction.
Treatment has also been reduced in previous economic crises. Data from 1973 to 2007 indicates that across all cancers for every 1% of unemployment the use of radiotherapy decreased by 8.7% and the use of surgery by 12.2%. Breast cancer again shows a greater impact with a 16.8% decline in radiotherapy and a 23.9% reduction in breast cancer surgery. Adherence to treatment regimens also drops, suggesting, in countries without universal healthcare, the uncertainty around being able to afford the continuation of treatment is significant.
Furthermore, the 2008-10 economic crisis was associated with 260,000 excess cancer deaths, predominantly among cancers considered ‘treatable’, in Organisation for Economic Co-Operation and Development (OECD) countries which include the US, UK, France and Germany. During this time reduced public healthcare spending was highly associated with cancer mortality. This is attributed to a reduction in access to expensive treatments as well as less funding for drug discovery and support for cancer patients.
Low and middle income countries are also vulnerable due to precarious job markets and weak social protection systems. During the Brazilian major economic crisis between 2014-16 there were 30,000 excess deaths, in which cancer was a main contributor. The causes for the decline in healthcare were delays in medical staff payment, medicine shortages and clinic closures. This incidence in Brazil highlighted the need for robust social protection systems to protect those most vulnerable to economic crises.
Cancer research and COVID-19
In the UK, cancer support programmes and research are highly dependent on charitable funding; 50% of cancer research in the UK is funded by the charity Cancer Research UK. Cancer Research UK announced they will lose £120m over the next year in donated income and Macmillan Cancer Support reported a loss half of their fundraising income totalling £100m. Subsequently, Cancer Research UK have reported the lack of funds has resulted in postponing new research projects to at least the end of 2020. The government’s £750m bailout fund will not be enough. Cancer Research UK admit that the reduction in finances and research will directly impact their goal to see 3 in 4 survive cancer by 2034. The consequence of reduced cancer research funding is not only short term but long term. The evolution of cancer trials will be slower and the time for study completion longer, resulting in a slump in cancer research progression.
The future of cancer care
The future of cancer services and cancer research will rely heavily on the recovery of the economy and the management of the pandemic. If hospitals can control virus spread through increased testing and safety precautions, then diagnostic screening and treatment can be re-established. However, poor COVID management will only exacerbate the current problems in cancer care as well as extend economic downfall.
The worst ever recorded pandemic was the Black Death. A pandemic which killed half of Europe and lasted several years resulted in long-lasting transformation for its survivors and society. The peasants which where once under rule of the noblemen now had a new social standing and living standard. As was the creation of the middle class and the beginnings of the Industrial Revolution, the technological boom during COVID might bring a revolution to the future of health and cancer care.
In the health sector, this change highlighted the efficiency of telephone and video consultations with 9 out of 10 GPs indicating they want to continue remote consultations after the pandemic. The use of clinical AI in aiding doctors in the pandemic and cancer services has also been shown considerable interest. In services that are overworked and understaffed, clinical AI can provide support in decision-making while performing administrative tasks to ease the workload and pressure on medical professionals. If these technological advancements are utilised, then historic decline in cancer care globally can be avoided.
About the authors
Emily Toyn is a Neuroscience postgraduate student and medical writing intern at YouDiagnose Ltd.
Dr Aswini Misro is a gastroenterology surgeon with special interest in breast cancer and vascular surgery. He is also a Fellow of American College of Surgeons (FACS) and has worked in the NHS for more than 10 years as a general surgeon.
Mr Selva Theivacumar is a consultant endovascular surgeon at Northwick Park NHS Trust.
There is no competing interest