75 per cent drop in urgent lung cancer referrals during lockdown say experts

The number of people urgently referred to a lung cancer specialist dropped by 75 percent during the first wave of the Covid-19 pandemic, says a new report published today (21st October 2020) by the UK Lung Cancer Coalition (UKLCC).¹

“Fear of engaging with health services, halting the national programme of lung cancer screening pilots, and restricted access to diagnostic tests have all contributed to a drop in urgent two-week wait GP referrals in England,” says Professor Mick Peake OBE, chair of the UKLCC’s Clinical Advisory Group.

According to NHS England, there were 62,461 two-week wait lung cancer referrals in 2019-20.²

“Government guidance to stay at home with a cough, a key symptom of lung cancer, has also caused further confusion,” says Professor Peake.

The report states that the reduction in referrals will lead to a backlog in outpatient appointments, surge in late-stage presentations and potentially hundreds of additional lung cancer deaths – reversing the progress achieved in lung cancer survival over the last 10 to 15 years.¹  Between 2005 and 2015, five-year lung cancer survival almost doubled in England from 9 per cent to 16 per cent.³

Other key findings from the report, Covid-19 Matters (compiled from a meeting and interviews with 45 of the UK’s leading lung cancer clinicians and key patient groups) include:

• It is estimated that at least one third of lung cancer patients have already died since the beginning of the pandemic – some deaths may have been labelled as Covid-19
• During first wave of pandemic, the risk of a patient dying after lung cancer surgery because they contracted Covid-19 around the time of surgery, increased from around 2per cent^4,5 to up to 40-50 per cent^1,6

Other key findings from the report, Covid-19 Matters (compiled from a meeting and interviews with 45 of the UK’s leading lung cancer clinicians and key patient groups) include:

• It is estimated that at least one third of lung cancer patients have already died since the beginning of the pandemic – some deaths may have been labelled as Covid-19
• During first wave of pandemic, the risk of a patient dying after lung cancer surgery because they contracted Covid-19 around the time of surgery, increased from around 2per cent^4,5 to up to 40-50 per cent^1,6
• Over half (55%) of lung cancer nurse specialist nurses or their team member were re-deployed or unable to work as a result of Covid-19^1,7

As a result, the report makes a series of key recommendations, which include calling on Government and the new National Institute for Health Protection to:

• Rapidly launch a ‘Be Clear on Lung Cancer and Covid-19’ campaign to increase awareness of lung cancer symptoms and the public’s confidence in engaging with healthcare services early
• Quickly resume those local lung cancer screening pilot programmes that were already operational
• Urgently review isolation and visiting restrictions in hospital and palliative care settings to enable critically ill patients to see their families during the final phase of their lives
• Provide necessary funding to establish Community Diagnostic Hubs to reduce the risk of COVID-19 transmission and accelerate diagnostic turnaround time for lung cancer patients.¹

Provide necessary funding to establish Community Diagnostic Hubs to reduce the risk of COVID-19 transmission and accelerate diagnostic turnaround time for lung cancer patients.¹

Lung cancer is the UK’s biggest cancer killer with 35,300 people dying each year.⁸  It accounts for more than a fifth of all UK cancer deaths (21%)⁸ – and lung cancer in never smokers is the 8th most common cause of cancer-related death in the UK.⁹ However, lung cancer can be cured if diagnosed early enough.

“The survival and quality of life of lung cancer patients will have been seriously and adversely affected as a result of Covid-19,” says Mr Martin Grange, chair of the UKLCC.  “Therefore, we urge everyone in the lung cancer community, be they clinicians, nurses, managers or policy makers to work together to help us recover the previous momentum in improving quality of care for people with lung cancer and continue to save lives.”

-ends-

About the report

Entitled Covid-19 Matters, a review of the impact of COVID-19 on the lung cancer pathway and opportunities for innovation emerging from the health system response to the pandemic, the report based on the outputs of the UKLCC’s Clinical Advisory Group on 26th June 2020 plus a series of interviews with lung cancer experts including patient groups. It was also informed by comprehensive desk research and a literature review of key statements and publications, including written stakeholder submissions to the Health Select Committee inquiry on Delivering Core NHS and Care Services during the Pandemic and Beyond.

About urgent two-week wait referrals

In England, GPs are requested to send patients for an urgent chest x-ray within two-weeks if they show suspected lung cancer symptoms. They should refer to a specialist if the x-ray shows anything abnormal.

About the UKLCC

The UK Lung Cancer Coalition (UKLCC) is the UK’s largest multi-interest group in lung cancer. It was set up in 2005 with the founding ambition to tackle poor lung cancer survival outcomes and, specifically, to double five-year survival by 2015, which was effectively achieved. The UKLCC has published numerous milestone reports including ‘25 by 25 – a ten-year strategy to improve lung cancer survival rates’ – calling for a re-doubling of five-year lung cancer survival rates to 25 per cent by 2025. The UKLCC’s membership includes leading lung cancer experts, senior NHS professionals, charities and healthcare companies with an interest in fighting lung cancer. For more information about our work and members, visit:  www.uklcc.org.uk

References:

1. UK Lung Cancer Coalition.  October 2020. Accessible from 21st October here: www.uklcc.org.uk/our-reports
2. NHS England Waiting Times for Suspected and Diagnosed Cancer Patients 2019-20 Annual Report. Accessed October 2020 here:   https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/07/Cancer-Waiting-Times-Annual-Report-201920-Final.pdf
3. Walters S, Benitez-Majano S, Muller P, et al., ‘Is England closing the international gap in cancer survival?’ Br J Cancer, 4 S 2016, doi: 10.1038/bjc.2015.265 Accessed October 2020 at: https://www.nature.com/articles/bjc2015265
4. The Society for Cardiothoracic Surgery in Great Britain & Ireland. Accessed here:  https://scts.org/wp-content/uploads/2019/03/Thoracic-Blue-Book-2018-FINAL.pdf
5. Glasbey et al.  J Clin Oncol. October 2020. Accessed at:  https://ascopubs.org/doi/10.1200/JCO.20.01933
6. Mortality and Pulmonary Complications in patients undergoing surgery with peri-operative SARS-CoV-2 Infection– An international cohort study. The Lancet 2020: 396;27-38. COVID SURG Collaboration Accessed here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31182-X/fulltext
7. The impact of COVID-19 on lung cancer care: views from lung cancer specialist nurses. Lung Cancer Nursing UK. October 2020. Accessed here: https://www.lcnuk.org/news/impact-covid-19-lung-cancer-care-views-lung-cancer-specialist-nurses
8. Figures from Cancer Research UK, accessed Aug 2020 and available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality
9. Peake M et al. Accessed August 2020 at: https://journals.sagepub.com/doi/full/10.1177/0141076819843654