On Oct 6, 2020, in response to questions in Parliament regarding cancer outcomes during COVID-19, the UK Health Secretary, Matt Hancock, stated the “best way to keep cancer services running is to suppress [coronavirus]”. We beg to differ. The notion that cancer care provision should be contingent on the success of policies to contain COVID-19 is as offensive as it is irresponsible. Cancer care cannot be put on hold; cancer care during the pandemic should not be beyond the capacity of the UK's ostensibly world-class health system; and patients with suspected or prevalent cancer must not be denied timely access to care.
The devastating effect of the first UK lockdown earlier this year on cancer screening, diagnosis, treatment, and supportive care has been widely documented. So far, an estimated 3 million people have missed cancer screenings, and between April and August, 2020, suspected cancer referrals were down 350 000 compared with the same period in 2019. Delays in diagnosis and referral will indisputably lead to excess early cancer mortality; although exact numbers are uncertain, upwards of 60 000 life-years could be lost during the next 5–10 years. Early in the pandemic, most clinical cancer trials in the UK were halted, and although these are now starting to reopen, the impact on both novel treatment development and individual patient outcomes is incalculable. Following loosening of the initial lockdown restrictions, referrals and treatment have returned to near-normal levels, but, with a second wave of COVID-19 looming, Hancock admits that the ability of the National Health Service (NHS) to see patients for reasons other than COVID-19 is now once again at risk. It is incredulous that 9 months after the first case of COVID-19 in the UK, and despite ample data regarding the effect of COVID-19 policies on cancer care services, the UK Government's solution during the impending second wave of COVID-19 over the winter, is to again reduce or pause cancer care, rather than to find answers to maintain services. This is not an impossible ask. Other countries have managed to continue with provision of cancer care despite COVID-19 and will not have the devastating legacy the UK will endure in the years to come. For example, France has successfully handled workforce issues by drawing on a voluntary reserve force of medical professionals, and several countries, including Australia and Germany, have responded to localised outbreaks by coordinating the redistribution of medical resources. Most notably, in New Zealand, cancer treatment (surgery, medical oncology, radiation oncology, and haematology) continued during the COVID-19 lockdown and is still being provided at pre-COVID-19 levels. Unfortunately, after years of austerity, the NHS entered the pandemic with fewer doctors, nurses, and capital assets than did health systems in many other high-income countries, which has severely hampered its ability to deal with the pandemic.
Fortunately, despite Matt Hancock and the UK Government's incompetence, the NHS has been working hard under its own guidance to prepare differently for the second wave of COVID-19. Several NHS hospitals will be declared COVID-free treatment hubs to ensure cancer care and other non-COVID care can continue through the autumn and winter. To ensure that this plan becomes a reality, sufficient COVID-19 testing capacity will be crucial. Cancer Research UK has set out additional recommendations for preserving high-quality cancer care, including ways to increase the workforce, harness new technologies, and other long-term ambitions for improvement. Frontline NHS staff have worked tirelessly to protect and care for their patients, and to reduce the impact of COVID-19 on health care with innovative solutions. Yet, in Parliament on Oct 15, Hancock reiterated that “unless we suppress the virus, we cannot keep non-COVID NHS services going.” It is the Government's responsibility to encourage and support NHS efforts, not undermine them with threats.
Governmental failures have contributed to a second wave of COVID-19—failures in testing and track and trace strategy and implementation, inadequate attention to the vulnerability of care homes, insufficient guidance and support for school exams and reopenings, unequal application of lockdown measures, and high-profile flouting of safety rules have eroded public trust. Yet letting these failures hinder the provision of cancer care is indefensible. Hancock, and by extension, the UK Government, have set up a false choice between COVID-19 and other life-threatening diseases; the way forward must be to find an equitable and humane way to address both. Mr Hancock, we implore you: provide patients with cancer the continuity of care they deserve. If you are unable to achieve this, you should relinquish your role immediately to someone who can.
© 2020 Peter Nicholls/Reuters