World Cancer Day will take place on 4 February 2021. Organised by the Union for International Cancer Control, the day is marked across the world through fundraising and awareness campaigns.

Cancer survival rates

Cancer is among the leading causes of death worldwide. In 2018, cancer was the second leading cause of death globally, responsible for an estimated 1 in 6 deaths around the world. Only cardiovascular diseases claimed more lives.

Survival rates in the UK vary significantly between different cancer types. Cancer Research UK has calculated

that, when combined, overall cancer survival rates have doubled in the last 40 years. This rate continues to improve. However, survival rates for some cancers, including pancreatic, lung and brain, remain very low.

Highest survival rates over 5 years Lowest survival rates over 5 years
Testis (95.3%, men only) Mesothelioma (6.5%)
Melanoma of skin (91.3%) Pancreas (7.3%)
Thyroid (87.4%) Brain (12.2%)
Prostate (86.6%, men only) Liver (12.7%)
Breast (85%, women only) Lung (16.2%)

Source: The Nuffield Trust

Impact of the Covid-19 pandemic

Many health organisations and charities have expressed concern that the Covid-19 pandemic is having, and will continue to have, a detrimental effect on cancer survival rates in the UK. Reasons for this include:

  • increased waiting time for cancer screening appointments due to strain on the NHS caused by Covid-19;
  • cancellation of cancer related surgery; and
  • weakened immune systems of cancer patients potentially leaving them more vulnerable to serious Covid-19 symptoms.

Screening and early diagnosis

Research has shown that delay of screening and diagnosis carries high risk. A study published in the British Medical Journal found that:

People whose treatment for cancer is delayed by even one month have in many cases a 6 to 13% higher risk of dying, a risk that keeps rising the longer their treatment does not begin.

Concern has been raised about the declining number of face-to-face GP appointments during the pandemic. This is likely to have negatively impacted the chances of early cancer diagnosis. An overlap of symptoms between lung cancer and Covid-19 is one reason for late or no presentation. This has been echoed by the UK Lung Cancer Coalition (UKLCC), who state:

There is a specific problem for lung cancer, which is the overlap of symptoms with Covid-19. Some patients may develop cough symptoms and be told to stay at home until their symptoms get worse. This has resulted in an increase in late stage presentations.

The UKLCC states that patients should seek medical treatment if they have had a persistent cough for longer than three weeks.

Cancer surgery

Urgent, non-elective cancer surgery has largely been able to continue during the pandemic. However, there have been a small number of reported instances of cancellations. In most cases, the trusts involved cited concern over a lack of intensive care beds available to patients post-surgery as the reason.

In late October 2020, Nottingham University Hospitals Trust cancelled urgent surgery for four cancer patients. A senior doctor from the trust stated:

We’ve had to make the extremely difficult decision to postpone operations for four of our cancer/pre-cancer patients this week due to pressure on our intensive care units from both Covid-19 and non-Covid related emergencies.

Over the weekend of 3 and 4 January 2021, King’s College Hospital in London cancelled urgent, ‘priority two’ cancer operations. Priority two patients require surgery within 28 days to save their life or stop their disease progressing “beyond operability”. King’s College Hospital stated:

A small number of cancer patients due to be operated on this week have had their surgery postponed, with patients being kept under close review by senior doctors.

While many hospitals in the UK have cancelled elective, non-urgent surgery since the start of the pandemic, the majority have been able to continue with non-elective, urgent cancer surgery.

Covid-19 in cancer patients

According to Cancer Research UK, cancer patients are at higher risk from Covid-19 than the healthy population. This is due to the negative impact cancer and cancer treatment has on a patient’s immune system, leaving them more vulnerable to serious complications from Covid infections. Some cancers, such as cancers of the blood, leave patients particularly vulnerable.

At the start of the first national lockdown in March 2020, many specific cancer patient groups were placed in the clinically extremely vulnerable group and asked to shield. These included:

  • patients having chemotherapy;
  • patients having radical radiotherapy for lung cancer;
  • patients with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma; and
  • patients having immunotherapy or other continuing antibody treatments for cancer.

The exact relationship between Covid-19 and cancer related damage to a patient’s immune system is still unclear. Trials are ongoing, including a major study run by Cancer Research UK.

The NHS Cancer Recovery Taskforce is leading a programme to manage cancer services during the pandemic. Currently in phase 3, the taskforce aims to restore cancer screening and urgent cancer referrals at least to pre-pandemic levels. A plan for delivery was published in December 2020. Its aims include:

  • reduce the number of patients waiting more than 62 days for treatment after urgent referral to at least pre-pandemic levels;
  • expansion of Covid-19 protected surgical hub arrangements; and
  • to ensure cancer treatment services support flexible working innovations, such as remote reporting and seven-day working.

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Cover image by the Union for International Cancer Control (UICC).