Covid-19 – The Impact on Pancreatic Cancer
Covid-19 has been dominating the news and the way that we live our lives for months now. The disease has impacted all elements of the health care system and lead to rapid changes into the way that services are organised and delivered. We know that pancreatic cancer patients have been particularly affected along every stage of their journey, from diagnosis to treatment, recovery, and palliative care. However, we are now starting to see some published data which reflects the scale of the challenges ahead.
Recently published data from NHS England reveals that at the height of the pandemic, two week wait referrals for upper GI cancers, including pancreatic, fell by almost two thirds from around 5000 a week to just above 1500. Referrals have since recovered to around 75% of pre-pandemic levels for upper GI cancers, but there is still a long way to go to encourage everyone with pancreatic cancer symptoms back to their GPs.
Pancreatic cancer can present with vague and nonspecific symptoms such as abdominal and/or back pain, nausea, indigestion, weight loss or change in bowel habit. These symptoms do not always prompt people to think cancer and the Covid-19 outbreak has created more barriers to visiting the GP and being referred for pancreatic cancer then ever before.
Once patients have been referred, access to diagnostics has been dramatically affected by the pandemic. Average waiting time for diagnostics has risen from just over 3 weeks to 6.5 weeks. Pancreatic cancer patients are often diagnosed via endoscopy, the average wait time in this area has risen to 7 weeks and the waiting list has increased during the pandemic. Endoscopy has been the hardest hit form of diagnostic during the pandemic. The procedure involves a high risk of transmitting Covid-19, therefore, to protect patients and staff, the number of endoscopies carried out in April fell by around 90%.
Recovering these services will require regular Covid-19 testing for patients and staff and the ability to keep areas free of Covid-19 through rigorous cleaning and use of PPE (gloves, masks, visors, gowns etc). The time taken to carry out these necessary precautions could reduce the time available to carry out endoscopy procedures by a third and working through the backlog of cases is going to be challenging. Guidance has now been produced on the safe restoration of endoscopy services that aims to help prioritise people who may have cancer and diagnose them as quickly as possible.
After diagnosis, cancer patients continue to face challenges. Access to surgery and treatments such as chemotherapy has reduced during the pandemic. Pancreatic cancer has been particularly affected due to the specialist level of surgery, high intensive care need and infection risk. Surgeries for these patients at the peak of the pandemic reduced to almost zero.
Covid-19 free space or “cancer hubs” are now established across the country to deliver surgery and treatment and guidance has been produced for patient testing and keeping safe spaces. Treatment is being increasingly restored and more and more patients being seen, however we await the longer-term results of the impact of delay on patients.
The temporary suspension of clinical trials also affected pancreatic cancer patients, especially those for whom a trial represented a final treatment option. Trials are slowly beginning to recruit again across the UK and patients are beginning to receive personalised medicines again.
The Covid-19 outbreak has highlighted the importance of health inequality in treating disease. Anyone can get Covid-19, in the same way that anyone can get pancreatic cancer. However, evidence suggests that some of the inequality that affects the chances of catching or dying from Covid-19 also affects pancreatic cancer, including age, ethnicity and long-term conditions such as diabetes and obesity. These statistics wont change without addressing underlying socioeconomic inequality and creating long term sustainable change for affected populations.
What needs to happen next?
As we learn to live with and provide cancer services alongside Covid-19, we are looking for a focus on Covid-19 free rapid diagnostic centres during the restoration of diagnostics. Patients with pancreatic cancer must be prioritised for surgery and other treatments to prevent their disease spreading. Furthermore, patients with advanced stage disease must receive personalised care that balances Covid-19 risk and quality of life.
It is clear that moving forward we need to address the health inequalities that have created increased Covid-19 mortality in some ethnic groups compared to others. But also, that many of these challenges are applicable to pancreatic cancer. We need to address the inequality that means some peoples pancreatic cancer risk and outcomes are worse than others. We need to target those who fear the disease and show that early diagnosis is the key to survival. We need to spread the message about pancreatic cancer where it hasn’t reached before and while the system faces so many challenges, find more efficient ways of getting patients referred, diagnosed and treated.
Advocating for patients
Pancreatic Cancer Action is working with the NHS, government groups, other charities and organisations across the UK to advocate for patients and our voices are being heard.
We called for greater data transparency and to be able to provide advocacy where decisions affected how patients were treated. The result of this has been access to more referral data than ever before to help us identify areas of improvement. We have fed into NICE guidance for treatments during the pandemic and seen new guidance for restoring services.
We have collaborated with NHS England and other organisations resulting in the introduction of a campaign encouraging people to come forward with cancer symptoms. Cancers, including pancreatic, and the risks posed to patients during Covid-19 have been highlighted across media outlets.
The pandemic has only heightened our determination to fight for every single person diagnosed with pancreatic cancer and will always work towards our vision; a day where everyone diagnosed with pancreatic cancer will survive the disease.