Lockdown negatively impacted on cancer outcomes

DUNDEE: Scottish patients diagnosed with one of the least survivable cancers were 13% less likely to receive potentially curative treatment in the post-lockdown period, according to new University of Dundee research.

The study, published in the British Journal of Surgery, is one of the first to examine the survival impacts of the Covid-19 pandemic on cancer patients.

Russell Petty, Professor of Medical Oncology at the University’s School of Medicine, and his colleagues carried out a Scotland-wide analysis of 958 consecutively diagnosed gastric and oesophageal cancer patients. They looked at the clinical pathway for diagnosis, treatment, and outcomes in the six months prior to and immediately following lockdown.

Post lockdown, patients were said to present in poorer condition, were more likely to do so in an emergency, had more advanced stage cancers, and were less likely to be suitable for treatment. As a result, more patients received palliative rather than curative treatment and a poorer post-lockdown survival rate was recorded. The study showed that, on average, post-lockdown patients survived three months less than the pre-lockdown cohort. For a less survivable cancer this is very significant.

No post-lockdown issues were identified in the diagnostic and treatment pathway after patients were referred. Professor Petty says this suggests that the delays came in the initial presentation at patients’ GPs, but that this was not specifically investigated and is the subject of ongoing research.

“In many respects the pandemic allowed us to undertake an investigation we would never have wanted to do, namely asking what the impact of delaying cancer presentation is,” he said. “We now have a clearer understanding of the importance of prompt diagnosis and the strongest evidence I have seen to date of the importance of ensuring timely cancer diagnosis and treatment.

“Our work starts to explain that delayed presentation of cancer patients to GPs as a key issue. This is topical given the current primary healthcare issues and cancer waiting times.

“Recent reports picked up on the fact that the absolute number of cancer deaths decreased in 2022 to suggest that the impact of the pandemic on cancer was perhaps less than might be imagined. This was a misrepresentation and for many cancer types it is too early to know the impact on survival in 2022.

“What our work shows is that with the less survivable cancer types like oesophageal and gastric cancer, where the impact would be expected to be seen quicker due to the natural course of the disease, then they are acting as an early warning signal. A true picture of how the pandemic impacted in more survivable cancer types will not be formed for some years yet.”

More than 9,000 new cases of oesophageal cancer are recorded in the UK each year, with 1 in 50 males and 1 in 96 females in the country diagnosed with the disease in their lifetime. The five-year UK survival rate in just 12% for men and 15% for women. Around 60% of people die within a year of being diagnosed with oesophageal cancer.

Kate Cunningham, Campaign Director of OCHRE: the oesophageal cancer charity said, “This is an important and timely report and reflects our experience of what patients and their families are experiencing post pandemic.

“It is devastating to see that so many sufferers of this less survivable cancer have lost the chance to have life extending treatment. Indeed many have been diagnosed so late that palliation is their only option. For these people, their families and their loved ones, this is an absolute tragedy.

“While hard to read, we hope that this report will bring about better awareness of symptoms and will encourage people to come forward in time for potentially curative treatment. Change is the least we can do for people diagnosed with this cancer of poor outcomes.”