Chemotherapy services in Scotland resumed far quicker than in other countries after the first UK lockdown and the Covid-19 pandemic has led to improved treatments for cancer patients, according to new University of Dundee research.
Russell Petty, Professor of Medical Oncology at the University’s School of Medicine, led a study examining the impact of Covid-19 on the delivery of anti-cancer treatments in Scotland.
Many chemotherapy services were paused in response to fears that the treatment would greatly increase the risk of vulnerable patients contracting the virus. Professor Petty and his colleagues have shown that this activity decreased by almost 29% initially but that chemotherapy treatments had been almost fully restored after a month following service re-design. This compares to nadir figures of 45% and 66% respectively for England and Northern Ireland.
Across the country, a variety of actions enabled the rapid recovery of chemotherapy treatment. These include developing Covid-protected clinical areas for chemotherapy administration, switching patients to alternative chemotherapies which required less hospital contact and had less side-effects, and expediting the approval of new cancer medicines.
Professor Petty says that these enforced changes might prove to be a rare positive side-effect of the bleakest period in living memory.
“Our analysis shows that NHS Scotland rapidly recovered and maintained cancer chemotherapy for patients during the first wave,” he said. “The initial decrease in activity lasted only a few weeks and, even at its nadir, far more cancer services were operating than in many other countries.
“The prospect of cancer treatments being postponed or cancelled completely has been a real fear for patients and their loved ones over the past year. There has been increasing anxiety about the indirect impact on cancer treatment so this study provides reassurance that the impact and disadvantage for cancer patients in Scotland was limited.
“New treatments that clinicians across the country had been gradually introducing to improve cancer chemotherapy were greatly accelerated as a result of the pandemic. Processes that would normally take months or even years took just weeks while the UK Coronavirus Cancer database allowed us to collect data on the safety of treatments for patients.
“Crucially all this activity was undertaken in a co-ordinated way across NHS Scotland, so the recovery was national regardless of how badly or not different regions were affected by Covid-19. These activities have placed us in the best position to sustain treatment during the second wave and, in the medium-term, chemotherapy services for patients will have actually improved.”
Professor Petty and his colleagues found that the extent to which treatment for individual cancers were affected varied considerably. Whereas breast cancer chemotherapy dropped to just 19.7% of its pre-pandemic levels and reverted to normal the quickest, treatment for colorectal cancer fell by 43.4%. This reflects the fact that endoscopy, the main method for diagnosing colorectal cancer, was almost completely paused due to concerns about the potential for this procedure to spread Covid-19.
The effect of chemotherapy on the immune system also sparked fears about the risk of patients not just contracting Covid-19 but of their vulnerability to the most severe forms of the disease. Reporting to the national database helped demonstrate that neither cancer nor chemotherapy put cancer patients at a significantly higher risk from Covid-19.
“Covid-19 is a new disease and when it emerged it wasn’t known what the effect would be on cancer patients,” continued Professor Petty. “Their immune system is already weakened, particularly in those receiving chemotherapy, so it was right that caution was exercised until we could be sure that proceeding with treatment wouldn’t endanger them more than the cancer was.
“The data was encouraging in this respect and this enabled health boards to rapidly recover chemotherapy services and offer these newer, better, more patient friendly and convenient treatments for cancer patients.
“While the short-term situation is more positive than many feared, we will not know the full impact of Covid-19 on cancer for several years. The number of people diagnosed with cancer is down significantly on previous years. Sadly this means that cancers will be diagnosed later than they normally would and this will invariably impact on survival rates and other outcomes. The effects of Covid-19 will be felt for years to come.”
The reporting method developed by Prof Petty and his colleagues is informing the creation of a national realtime dashboard for chemotherapy activity in Scotland.
Health Secretary Jeane Freeman MSP said, “We welcome these findings and appreciate the recognition it gives to the swift and effective national response during the Covid-19 pandemic which has not only enabled the continuation of treatment, but also accelerated new treatments and technologies for patients.
“We are acutely aware that this continues to be an incredibly difficult time for people affected by cancer. Diagnosing and treating cancer remain a priority, which we have supported in a new Cancer Recovery Plan with a planned investment of up to £114.5 million over the next two years.
“The NHS remains open for non-coronavirus health concerns. If you are experiencing any new signs or symptoms, GP practices want to hear from you. Also, any cancer patient worried about symptoms should call their existing cancer treatment helpline or the national cancer treatment helpline on 0800 917 7711.”
The research is published today in the British Journal of Cancer.