27 August 2020

Government must act now to avert a Covid cancer catastrophe

By Professor Pat Price

We are facing the very real possibility that 2020 will be remembered as the year of not one health crisis, but two. The loss and heartache caused by coronavirus itself is well known. But what is still dawning on many is the growing, catastrophic cancer crisis that the virus has precipitated – and may well end up killing more cancer patients unnecessarily than we will lose to the virus itself.

As the pandemic swept in, cancer screening services across the country were halted; scans, surgery and outpatient appointments were cancelled or delayed in the rush to make capacity for Covid; people were told to ‘stay at home, protect the NHS’ and became frightened to come into hospital, while some GPs started redirecting patients to call NHS 111. All this has led to delays in treatment, with a quarter of a million people who would normally have been urgently referred by their GP to a cancer specialist ‘missing from the diagnostic pipeline’ – and delays in diagnosing cancer can mean treatment comes too late to save lives. One estimate puts the cost of the cancer care backlog at 30,000 lives.

This is certainly the greatest crisis in cancer care in my 30-year career. What I find utterly frustrating is that it simply doesn’t have to be this way. There is time, just, to put in place solutions to avoid this cancer catastrophe – but only if the Government and senior NHS leaders act now. And when they act, it needs to be with same speed, energy and will that they mustered to tackle the virus itself. Slowly getting cancer treatments ‘back to normal’ won’t cut it. Addressing the problem will require a significant boost to services to tackle it and will require the healthcare establishment to make best use of advanced and innovative techniques. Be in no doubt, if this crisis isn’t dealt with it will be a horrendous policy failure – made all the more difficult to bear as we and others have been ringing the alarm bell now for months, since April! This is a crisis that the authorities know is coming. There will be nowhere to hide if it isn’t addressed.

Chief amongst those advanced technology solutions should be a transformational boost to radiotherapy services. Why? Because it is a treatment option that is particularly well suited for use when surgery and chemotherapy are riskier than normal due to possible Covid infection risks. And although radiotherapy already plays a significant role in 50% of cancer patients’ treatment – and is now seen as a safe substitute for surgery in many cases – years of under investment have held it back from reaching its full potential.

Radiotherapy is quick and incredibly cost effective. Typically, a cancer patient for whom radiotherapy is clinically appropriate can be cured for around £6,000. That is up to 40 times more cost effective than some chemotherapy treatments. What’s more, it is safe and already plays a part in 40% of cancer cures. Startling advances in the last decade mean that it is now possible to treat a lung cancer patient in one single 20-minute outpatient session. With all this going for it, you might think that policy makers would be beating a path to the sector’s door in an effort to find out how government can do more for more patients. Sadly, that is not the case.

For a variety of reasons radiotherapy has been treated as something of a Cinderella Service. In the UK, just 5% of the overall cancer budget is spent on radiotherapy. In Australia it’s 9%, and in many European countries it’s around 11%. But the problems are organisational too. The responsibility for radiotherapy in England is spread across 3 ministerial briefs and multiple NHS agencies. This lack of a co-ordinated approach has inevitably led to sub optimal commissioning.

The problems arising from this lack of investment and the lack of coherent commissioning are many and varied. For example, we simply don’t have enough radiotherapy centres and machines. Recent analysis estimates that 3.5 million people in England live further away than the recommended 45-minute travel time to their nearest centre. Added to the shortage of machines is their age. 50% of Trusts are using machines over their recommended 10-year life with all the associated risks to treatment schedules from breakdowns and increased maintenance. But most shockingly, the internal tariff used to remunerate Trusts for delivering radiotherapy incentivises Trusts to treat patients with less effective sessions, meaning patients are treated more times over a longer period than otherwise necessary. That is simply crazy, and a damning indictment of the dead-hand of bureaucracy that is holding this sector back.

The only good news in this worrying scenario is that the crisis can be averted. The All Party Parliamentary Group (APPG) for Radiotherapy has worked long and hard on this issue. With the help of the charity Action Radiotherapy as their secretariat, the APPG has produced a comprehensive 6-point plan to transform the radiotherapy sector and set the 5,000 dedicated professionals delivering it free to treat even more patients, even more quickly. Costing £280 million per annum over 3 years, a modest figure relative to other treatment options, this plan will help tackle both the Covid induced backlog and leave the UK with the world class radiotherapy sector that it deserves.

The Covid cancer clock is ticking. The solutions are at hand. Pounds spent on radiotherapy are amongst the most cost effective ‘health pounds’ the Chancellor could ever spend and we will be making that case in the run up to his Comprehensive Spending Review. It’s simple: curing cancer with radiotherapy saves the UK money. Before Covid the UK sat at the bottom of the cancer league of high-income countries. Now, with the delays due to Covid, it’s estimated that cancer survival has been set back 15 years. We can change this at the stroke of a pen by investing in radiotherapy.

My closing plea to the Prime Minister, the Chancellor, the DH&SC and the NHS is this: none of us involved in cancer care and cure want to be by the bedside of a patient telling them the worst news of all, knowing that they could have, and should have, been saved – so act now, not only to #CatchUpWithCancer, but boost radiotherapy. Let’s beat this crisis.

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Professor Pat Price is a visiting professor at Imperial College London, advisor to the APPG for radiotherapy, Chair of the charity Action Radiotherapy and founder of the Radiotherapy4Life and #CatchUpWithCancer campaigns

Columns are the author's own opinion and do not necessarily reflect the views of CapX.