Cancer treatment has become a postcode lottery with many patients not receiving vital care as a result of the coronavirus outbreak, doctors have warned.
Leading oncologists have said that even those patients in category one and two priority, the highest for continuing treatment, are not receiving chemotherapy.
The NHS said non-urgent operations would have to be put on hold so hospitals could focus on battling the Covid-19 pandemic, and NHS England guidance states that cancer services should continue to deliver care. However, it also calls for “local solutions to continue the proper management of these cancer services while protecting resources for the response to coronavirus”.
Prof Karol Sikora, the chief medical officer at Rutherford Health, which runs oncology centres, said the advice provided by NHS England around cancer was sensible but was being “implemented inconsistently” around the country.
“That is always the trouble – it becomes inconsistent, so people getting chemotherapy have now had it stopped even though they are category one and two patients, the highest priority. Also some hospitals have put blanket bans on cancer treatment for two to three weeks … Not everyone needs to rush ahead with cancer treatment but others need to continue despite this to get the best long-term cure,” he said.
Sikora said: “The important thing here is people with curable cancer still get treatment. The private sector is in talks with NHS England and providers to provide increased capacity for NHS patients.”
The doctor said one of his close friends who worked in gastroenterology had got an email from a nurse saying “not to bother coming in” and that his treatment would be “stopped for the duration of the crisis”. “The emotion is very difficult for our patients … everything is uncertain,” he said.
“It is a hard decision regarding how much you transfer care to coronavirus and how much say ‘we have to keep going with vital non-urgent but critical services’. The same is true of cardiac care.”
He said that there was the “looming threat” that cancer centres would close and all staff would go to the new Nightingale hospitals, built to take coronavirus patients from overstretched NHS facilities. “I don’t think that will happen. But there is concern that they will abandon all cancer patients. It would be sad if that happened.”
Angus George Dalgleish, a professor of oncology at St George’s, University of London, said: “It’s difficult. Coronavirus is having a devastating impact on how we deliver ordinary care – everything is out on hold or delayed.”
Asked whether this could mean more indirect deaths because of patients not getting care, Dalgleish said that “we won’t know until it is all over”.
“But we are already seeing the effects of patients who are not going to get treatment. I heard today St George’s is going to have nine wards full of coronavirus patients. They cannot do that without seriously impacting care of everyone else.”
Laura Lee, the chief executive of the cancer charity Maggie’s, said anxieties among patients were being exacerbated by the current situation. She said: “The government needs to be more articulate about the issue, in the same way it has explored the effects of Covid on, for example, businesses and employment. In a sense, the plight of Covid isn’t just with those who are going through Covid.”
She said that people had heard about the plight of those losing their jobs, but not about those with health conditions who would be affected by the virus, adding: “The unintended consequences or the non-choice consequences are coming.”
Dr Rosie Loftus, the joint chief medical officer at Macmillan Cancer Support, said that more than a quarter of calls to the charity’s support line in the past week were from cancer patients concerned about Covid-19. “We’re hearing from people who are feeling upset and scared, fretful about their future and even lonelier as a result of having to self-isolate,” she said.
“We recognise that these are exceptional circumstances for the NHS. It is vital that, across the UK, the NHS is assessing the impact of coronavirus on cancer treatment and care, and putting in place urgent plans to ensure that vital cancer services can still be delivered safely. Even in a time of crisis, decisions for cancer patients must be made according to an individual assessment of their need for critical care and treatment and their vulnerability to coronavirus.”
NHS England said in a letter issued to hospitals: “Essential and urgent cancer treatments must continue. Cancer specialists should discuss with their patients whether it is riskier for them to undergo or to delay treatment at this time.” It said that it had secured the use of almost all independent hospitals across England and their capacity should be used for cancer diagnosis and treatment.
