Coronavirus: Wales cancer campaign urges people seek help

Dr Sarah Gwynne works at Singleton Hospital's cancer unit in Swansea

People with possible cancer symptoms are being urged not to put off getting them checked out as part of a new campaign by the Welsh Government.

One health board said cancer referrals were down by two-thirds, which it attributed to people's fears of visiting hospitals or GPs.

Charities have also warned of a future cancer "timebomb" due to a disruption to services caused by the pandemic.

The Welsh Government said it had a strategy to "meet pressures".

Velindre Cancer Centre has remained "open for business" over the last three months

Clinical oncologist Dr Sarah Gwynne from Swansea Bay health board said: "It's a difficult time at the moment. People are very scared about possibly coming into hospital or going to see their GP.

"We can see that the number of people who would normally be referred with symptoms that are suggestive of cancer have reduced dramatically - we are only seeing a third of what we would expect.

"That makes us think there are patients out there who may possibly have cancer but are not contacting their GP."

New research by Royal College of Radiologists (RCR) suggests a shortage of cancer doctors could hamper efforts to deal with an expected surge in new cases.

The government's campaign highlights the fact that tests and treatment for cancer are still available even though services have been adapted as a result of the coronavirus outbreak, with some appointments being done remotely.

There are also worries that patients with potential symptoms are hesitant to get help due to fears of catching Covid-19.

Cancer charity Macmillan has warned Wales, like the rest of the UK, is facing a potential cancer timebomb due to the disruption to diagnosis, treatment and care caused by coronavirus.

The charity pointed to a reduction in GP referrals, the suspension of national screening programmes and delays in cancer surgery as examples of this.

The Welsh Government acknowledged services had been hit due to pandemic but it said that the number of referrals was improving.

Siobhan O'Flynn and her nine-year-old son Dylan, who was coming to the end of cancer treatment when lockdown was called

Siobhan O'Flynn's nine-year-old son Dylan Williams was coming to the end of cancer treatment when lockdown was called, although follow-up appointments had to be cancelled.

"People have stopped going in for treatment because they have been so fearful of catching coronavirus," said Siobhan, from Cardiff.

"The message has to be positive in that if professional people are saying it's OK to come back or to keep going, or that you must go to see your GP."

Dylan was diagnosed with a very rare cancer, which first showed signs when he developed a swollen cheek, not long after he first started school.

"I know if we'd been in the situation as Dylan was diagnosed, in this current climate, it could have been a different story."

Cancer screening resumes from July

On Wednesday, Public Health Wales announced plans to resume cancer screening programmes, beginning with cervical screening in July.

It will also be sending invitations and reminders to people eligible for breast and bowel cancer screening away from the main hospitals.

Meanwhile, private hospitals have been working with health boards to help continue cancer surgery.

More than 1,000 patients - the majority cancer patients - have had treatment at the Spire hospital in Cardiff since the start of the pandemic.

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However, some patients continue to face delays in surgery even though cancer staff across the NHS have been praised by health bosses for going "over and above" keeping as many services as possible going.

Health Minister Vaughan Gething said: "Tests and treatment for cancer are available and I want those who need to seek care and treatment to continue to do so.

"We have worked hard with the NHS to ensure cancer services can continue but the pandemic has had an impact on services.

"That doesn't mean the NHS isn't there for you but it does mean care and treatment has had to adapt to being delivered in a world with covid."

Vaughan Gething admitted the pandemic has had an impact on cancer services

Steve Ham, boss of Velindre University NHS Trust that includes Velindre Cancer Centre in Whitchurch, Cardiff, said it had been "open for business" over the past three months.

"We have embraced new technology as a means of maintaining patient-doctor relationships and upped our online engagement to signpost services and reassure an understandably anxious public," he said.

Richard Pugh, head of partnerships for Macmillan Cancer Support in Wales and chair of the Wales Cancer Alliance, said it was a "very anxious time for people living with cancer and those awaiting diagnosis or treatment".

"We welcome the clear message by Welsh Government that no-one should hesitate to come forward with symptoms of cancer and at Macmillan we urge people to respond to this by getting any cancer signs or symptoms checked straight away," he said.

Cancer centres 'understaffed'

Meanwhile, the Royal College of Radiologists (RCR) is warning that a shortage of specialist cancer consultants could hamper efforts to deal with the growing backlog of cases.

It fears the shortage of oncologists compounded by a predicted surge in new patients, and restricted capacity as a result of infection control measures, means patients may have less chance of successful treatment.

And it warns Wales could be particularly hard hit by shortages in the future years.

Its latest oncology census shows the UK's provision of clinical oncology consultants - the doctors who treat cancer with non-surgical means such as radiotherapy, chemotherapy and immunotherapy.

The findings show that although in Wales the consultant workforce went up by three full-time cancer consultants between 2018-19, Wales' three cancer centres were still understaffed by 21%.

The report also makes a projection about the state of the workforce within five years' time, considering factors such as the age of the current workforce.

It predicts if nothing is done to increase the number of clinical oncology experts, by 2024 Wales will have one less full-time consultant than it does now and its consultant shortfall will hit 33%, the highest predicted shortage in the UK.

The survey's staffing figures were compiled in December, before coronavirus hit.

However, the RCR argues cancer services are under even more pressure due to the knock-on impact and capacity constraints caused by the virus.

It argues although non-surgical cancer treatment has continued throughout the pandemic, patient turnaround has slowed as cancer centres have had to manage staff sickness and reduced capacity due to social distancing and cleaning requirements.

The wider cancer community is also anticipating seeing a surge of new patients whose diagnosis and treatment has been delayed because of the virus, likely to hit in the autumn.

'Added pressures of coronavirus'

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Dr Tom Roques, the RCR's clinical oncology workforce lead, said: "NHS cancer teams were working flat out before coronavirus hit and have continued to provide services during the pandemic.

"We just do not have the capacity to provide the same level of care as before, when we are faced with a new peak of cancer referrals and given the added pressures of coronavirus.

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"Delayed access to diagnosis, compounded with clinical oncologist shortages, will inevitably mean patients waiting longer to see a cancer expert, with worse outcomes and less chance of curing their cancer.

"The UK workforce needs at least another 200 more clinical oncologists to keep up with demand, but the stark reality is last year it only had an overall gain of five consultants."

Cardiff-based clinical oncologist Dr Seema Arif, chair of the RCR's Standing Welsh Committee, said: "With Welsh shortages set to become the worst in the UK because of increasing retirements and not enough trainee consultant posts, the Welsh Government desperately needs to fund more training places and we must do more to incentivise consultants to come and work here."

'Referrals below normal levels'

A Welsh Government spokesperson said: "We recognise the growing demand on cancer services in Wales and have been working with the NHS to improve capacity.

"Our workforce strategy will support NHS services to meet pressures as a result of Covid 19, including the expected rise in cancer demand during and beyond the pandemic."

The spokesperson said the Welsh Government was "aware from health board feedback that cancer referrals immediately fell by about 70% at the end of March".

"Since then it is reassuring to note that health boards are reporting that referrals are now improving but they remain considerably below the level they normally are."