Long waits for diagnosis and missed important treatment goals – how colon cancer patients face “potentially serious consequences” from a strained system, despite Bowel Babe bringing attention to the disease to Dame Deborah James
The 40-year-old mother of two has so far raised a whopping £6.6million for colon cancer research after revealing earlier this month she was receiving end-of-life care after being diagnosed with the disease in 2016.
But the renewed focus has come at a time when the NHS cancer care system is creaking at the seams in the wake of the Covid pandemic and one charity is warning patients of “potentially serious consequences”.
An analysis by NationalWorld can now shed light on long backlogs in colorectal cancer diagnosis and treatment, continued failure to meet key waiting time goals, and an increase in people being diagnosed with stage three and four cancers.
But the problems faced by the NHS and its staff have been ‘exacerbated’ by Covid, not ’caused by it’, said charity Cancer Research UK, with ‘far too many people facing unacceptable pre-pandemic waiting times’.
Fewer cases of colorectal cancer recorded
The pandemic and initial lockdown in 2020 had a seismic impact on cancer care, with screening programs suspended and treatment for some patients interrupted.
According to our analysis of figures from NHS Digital, the number of people diagnosed with bowel cancer in England in 2020 is down by 3,600 from a year earlier – suggesting cases have been missed.
In 2020, 32,875 cases of colorectal cancer were diagnosed in England, a 10% decrease from the 36,505 in 2019.
The trend reversed in 2021, with 40,126 people diagnosed – a four-year high.
The number of lower GI patients who started treatment also decreased sharply, with only 826 in May 2020 compared to 1,086 in April 2020 and 1,445 in March 2020.
dr Lisa Wilde, director of research and external affairs at Bowel Cancer UK, said colorectal cancer remains the second biggest cancer killer in the UK, but that should not be the case as colorectal cancer is “treatable and curable, especially when diagnosed early”.
She said “almost everyone who is diagnosed in the earliest stages will survive colon cancer,” but this “falls off significantly” as the disease develops.
Long waiting times for treatment
Performance on key cancer waits has deteriorated during the pandemic.
Already, around half of colorectal cancer patients have to wait more than two months to start treatment – well below NHS standards.
Under NHS rules, at least 85% of patients should start treatment within a maximum of 62 days of an urgent referral for suspected cancer.
Performance against this 62-day standard of care – already poor – has deteriorated massively during the pandemic and has not recovered.
Data from NHS England in March 2020 shows that 70% of patients with lower gastrointestinal cancer who started treatment were treated within 62 days.
But by May 2020, it had dropped to 42%. Since then it has been around 50%.
In the past two years, nearly 17,000 patients have had to wait more than two months after referral before starting treatment for lower gastrointestinal cancer.
Lower gastrointestinal cancer includes all types of colon cancer (anus, rectum and colon) and all but one type of small bowel cancer.
NHS rules also state that at least 75% of patients should receive a diagnosis or the all-clear within 28 days of an urgent referral for suspected cancer.
This goal was only introduced last year and has never been achieved for colorectal cancer patients.
In total, 219,000 patients (49%) had to wait longer than 28 days to be told if they had colorectal cancer in 2021/22. About every tenth patient (11%) waited longer than two months.
Patients across England faced a postcode lottery.
North Middlesex University Hospital NHS Trust met the 28-day target for just 9% of patients. The East Sussex Healthcare Trust now complied 81% of the time.
Performance for lower gastrointestinal cancers across England was also much worse than the average for all cancers, with 73% of patients receiving their diagnosis within 28 days.
The waiting list for important diagnostic tests has grown and grown
NHS waiting lists for key diagnostic tests to diagnose bowel cancer have skyrocketed since the pandemic began.
According to NHS England monthly diagnostic data, 91,482 people were waiting for either a colonoscopy, flexi-sigmoidoscopy or barium enema in March 2022 – 30,167 more than in March 2020.
Of them, 35% had waited six or more weeks, compared to 21% in March 2020, and 20% had waited 13 or more weeks, compared to 5% in March 2020.
Lynn Dunne, chief executive officer of Bowel Research UK, said the Covid lockdowns had caused “serious disruption” with both colorectal cancer screening programs put on hold and diagnostic services postponed to support the NHS’s response to the pandemic.
She said doctors are unable to perform normal procedures such as colonoscopies and endoscopies and that patients are “reluctant” to go to hospitals and visit clinics because they are “afraid of catching Covid”.
Although the NHS is trying its best to clear backlogs, Ms Dunne said it is still catching up on these procedures.
“Unfortunately, delays have potentially serious consequences for anyone who may already have colorectal cancer, as early diagnosis of the disease offers the best chance of a full cure,” she added.
“Delays risk more dangerous and potentially lengthy emergency procedures for people with advanced illness.”
However, Jodie Moffat, Head of Screening at Cancer Research UK, said while the full impact of Covid on cancer is not yet known, the NHS’s problems have been “exacerbated by Covid-19, not caused by it”.
Ms Moffat said “far too many people were struggling with unacceptable wait times prior to the pandemic” and that there has “long been a serious shortage of staff and facilities to provide the vital endoscopy tests needed to diagnose colorectal cancer”.
She hopes the government’s forthcoming 10-year plan will produce “a cancer plan for all, which must include more staff and diagnostic equipment – so that cancer patients receive the care they deserve”.
More people diagnosed with late-stage cancer during the pandemic
There has also been a marked deterioration in the proportion of English colorectal cancer patients diagnosed at stages three and four in the first year of the Covid pandemic, according to data from NHS Digital and the National Disease Registration Service.
In the 12 months to January 2021, 54% of people were diagnosed with stages three and four and 21% with stage four.
This was higher than in the 12 months ended January 2019 when 52% were diagnosed at stage three and four (20% at stage four) and in the 12 months ended January 2020 when 52% were diagnosed at stage three or four ( 19% at level four).
A similar deterioration occurred during the pandemic for cancer overall.
The NHS Digital and National Disease Registration Service said the proportion of colorectal cancer diagnosed at an early stage in April 2020 had “particularly decreased”, which it said “probably reflects the initial impact of the pandemic on colorectal cancer”. screening program”.
dr Wilde urged people who notice signs of colon cancer or “if things just don’t feel right for you” to see their GP.
She added, “It’s really important that people seek advice as soon as possible – regardless of their age – if they have a concern.”
NHS England was contacted for comment.
https://www.nationalworld.com/health/bowel-cancer-waiting-times-2022-how-big-is-nhs-backlog-for-tests-screenings-and-treatments-3712458 NHS under pressure as bowel cancer patients face long waits