Diagnosis of cancer in A & E rockets during lockdown

The number of people diagnosed with cancer after a visit to A&E has rocketed – illuminating the “devastating” impact COVID-19 has had on cancer survival in Essex.

With new data showing for the first time that those who have been diagnosed are more likely to have been diagnosed via an emergency presentation, the Government has been urged to ensure that people living with cancer get the care they need.

Data released last week shows that a proportion of people being diagnosed with cancer via an emergency presentation in mid-Essex soared by more than  half in the first wave of the pandemic, compared with the previous yearly average.

The proportion diagnosed as an emergency jumped to 30.2 per cent in April to June 2020 – up from 18.5 per cent in the last quarter of 2019- and only dropped back to 22.7 per cent in July to September.

Figures for Basildon and Brentwood CCG were even more stark. The proportion there diagnosed as an emergency  doubled from the figures seen in the last quarter of 2019 to 31.1 per cent in April to June 2020, and only dropped back to 21.4 per cent in July to September.

In Castle Point proportion there diagnosed as an emergency jumped to 28.9  in April to June 2020. West Essex saw a relatively small rise from 15.7 per cent in the last quarter of 2019 to 18.9 per cent in April to June 2020.

Overall, the data shows that cancer diagnosed via an emergency presentation in England soared by almost half in the first wave of the pandemic, compared with the previous yearly average.

The proportion diagnosed as an emergency jumped to 27.4 per cent in April to June 2020, and only dropped back to 23.8 per cent in July to September.

Prior to the latest data, figures had shown that, on average, 18.5 per cent of cancers were diagnosed via an emergency presentation.

Macmillan Cancer Support says that the data is further confirmation of the scale of ‘missing’ cancer diagnoses caused by the disruption to the NHS — in April to September 2020. There were around 35,000 fewer people admitted to hospital with cancer for the first time, compared with the same time last year.

Overall from April to September 2020, an average of 17,800 people each month were admitted to hospital for the first time, compared with an average of 23,500 per month in 20194.

In July to September 2020, the number of people diagnosed via an emergency presentation soared to the highest on record. During this time there were an average of 4,800 people each month first diagnosed via an emergency, compared with an average of 4,400 per month in 2019.

Responding to Public Health England’s emergency presentations of cancer data up to September 2020, Sara Bainbridge, head of policy at Macmillan Cancer Support, said: “These figures are yet more evidence of the devastating impact COVID-19 has had on cancer care.

“So far the Government has failed to show how it will deliver the staffing and resources needed to clear the backlog of people waiting for a diagnosis and treatment. They must urgently put this right so that people living with cancer get the care they need and do not become forgotten amidst this pandemic.”

Stage IV cancer is sometimes referred to as metastatic cancer, because it often means the cancer has spread from its origin to distant parts of the body.

Nick Hulme, CEO of East Suffolk and North Essex NHS Foundation Trust, which covers the North East Essex CCG area, added his concern at the large number of people currently missing a diagnosis or being diagnosed via A&E, where often the disease has reached a late stage and chances of survival are affected.

He told an Essex County Council health scrutiny committee last Wednesday: “We’re seeing a big increase in stage three and stage four cancer presenting through emergency departments, rather than being picked up earlier down the line and therefore having an impact on prognosis.

“A bit of flexibility in setting those priorities I think would be helpful in terms of us getting back to the new normal – we’re not let’s talk about the old normal.”

In North East Essex – the  proportion diagnosed as an emergency jumped to 27.6 per cent in April to June 2020, and only dropped back to 23 per cent in July to September.

Under normal circumstances, around 60 per cent of emergency presentations for cancer follow a visit to A&E, while 30 per cent are via an emergency referral from a GP.

Before COVID-19, people first diagnosed with cancer following an emergency presentation were significantly more likely to be diagnosed with advanced cancer than those diagnosed via other routes.

Between 2015 and 2016, more than half of people diagnosed with cancer following an emergency presentation were diagnosed with stage 4 cancer, compared with just a fifth of those diagnosed via an urgent two-week-wait referral from their GP.

Similarly, before COVID-19 people first diagnosed with cancer following an emergency presentation had, on average, significantly lower survival rates.

Between 2011 and 2015, one-year survival for those diagnosed via an emergency presentation was just 40 per cent, compared with 85 per cent of those diagnosed following an urgent two-week-wait referral from their GP.

A spokeswoman for the department of health and social care said: “Cancer diagnosis and treatment has remained a top priority throughout the pandemic.

“Despite confronting enormous pressure, the NHS has continued to treat cancer patients as a priority, with 1.86 million urgent referrals and over 477,000 people receiving cancer treatment between March 2020 and January 2021.

“We continue to urge people to come forward to their GP if they have symptoms and as part of our additional investment in the NHS, an extra £1 billion is being used to boost diagnosis and treatment across all areas of elective care in the year ahead.”

Piers Meyler

Local Democracy Reporter