Patients waiting more than a month for urgent cancer checks amid COVID-19 crisis

Patients referred over a month ago on the two-week cancer pathway have yet to be offered hospital appointments, GPs have warned - as NHS England urged patients 'not to hesitate to get checked'.

BMA GP committee chair Dr Richard Vautrey (Photo: BMA)
BMA GP committee chair Dr Richard Vautrey (Photo: BMA)

On 17 March NHS England modified existing cancer waiting times guidance - but warned that although service provision 'may need to flex', it remained important that 'during the response to the COVID-19 pandemic, appropriate clinical priority is given in the diagnosis and treatment of cancer'.

However, BMA GP committee chair Dr Richard Vautrey told GPonline that he was concerned patients with 'serious risk' including cancer were currently unable to access hospital support - with GPs unable to refer for diagnostic checks and some patients referred on the urgent two-week cancer pathway waiting for more than a month to be offered a hospital appointment.

The warning comes as NHS clinical director for cancer Professor Peter Johnson urged patients with possible cancer symptoms not to delay seeking help - amid evidence that referrals on the two-week pathway have dropped by more than 70% during the coronavirus pandemic and that cancer deaths could rise by 50% - equivalent to around 17,900 extra deaths - over the next 12 months.

Cancer referrals

Dr Vautrey said: 'I do have concerns that we have patients with serious risks, not least patients with potential cancer or other conditions we would normally have expected to be seen rapidly within hospital settings who are currently not able to access those services.

'We know of patients who have been referred on the two-week wait pathway who are still waiting for important diagnostic services, who would normally have been triaged within a matter of days to endoscopy or hysteroscopy and they still have not received appointments for those procedures.'

These waits had been going on since the start of the COVID-19 pandemic, the Leeds GP confirmed - meaning some patients have been waiting more than a month to be offered an appointment. Patients have a legal right to be seen within two weeks if they are referred for suspected cancer - and although guidance has been amended during the pandemic, hospitals have been told not to downgrade referrals without consent from the referring GP.

Dr Vautrey said the delays were likely to be 'quite widespread' because few hospitals are performing investigations such as gastroscopy, colonoscopy or hysteroscopy that would normally operate as part of the two-week referral pathway.

Two-week pathway

According to a University College London (UCL)/DATA-CAN study published today, the COVID-19 pandemic could lead to a more than 50% increase in cancer deaths over the coming 12 months. Data from major cancer centres in the UK assessed by the researchers revealed a 76% decrease in urgent referrals from GPs for people with suspected cancers and a 60% decrease in chemotherapy appointments for cancer patients compared to pre-COVID-19 levels.

The UCL researchers said the drop in urgent cancer referrals 'may be caused by patients struggling to secure appointments', or 'deciding not to seek care due to perceived risk of COVID-19 infection'.

Dr Vautrey added that while fewer patients were presenting, the reduction was also being driven by practices knowing that 'referrals would not be accepted'.

He said it was 'imperative' now that many hospitals were managing to cope with pressure from COVID-19 patients that they began to open up more services for patients with serious symptoms that need investigation - and warned of a 'real risk' to patients if services were not restored rapidly.

COVID-19 pandemic

NHS cancer lead Professor Johnson urged patients to seek help 'as they normally would' - as polling carried out for the health service found that almost half of the public have concerns about coming forward for medical care during the pandemic.

The poll found that one in 10 people 'would not contact their GP even if they had a lump or a new mole which did not go away after a week'.

Professor Johnson said: 'NHS staff have made huge efforts to deal with coronavirus but they are also working hard to ensure that patients can safely access essential services such as cancer checks and urgent surgery.

'From online consultations to the roll-out of cancer treatment hubs we are doing all we can to make sure patients receive the life-saving care that they need.'

The NHS launched a public information campaign last week to encourage people to contact their GP or 111 if they have urgent care needs and to attend hospital if they are told they should.

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