Beating bowel cancer together

New research shows the devastating impact of coronavirus on bowel cancer treatment and care in England

The number of people referred, diagnosed and treated for bowel cancer has gone down significantly because of the COVID-19 pandemic, new research has found. Urgent action is needed to address the growing cases of bowel cancer that are going undetected and untreated in England, says the latest study from Oxford University.

Professor Eva Morris, one of our research grant holders and a member of our Medical Advisory Board, has published the first study to investigate the true impact of the COVID-19 pandemic on bowel cancer, which has revealed some heart breaking results.

This study investigated the impacts of COVID-19 on bowel cancer care from 1 January 2019 to 31 October 2020.

What does the research say?

1. The number of people referred to hospital for suspected bowel cancer fell sharply during the first lockdown.

In 2019, over 36,000 people were referred to the 'two week pathway' every month. In April 2020, this dropped to around 13, 500 people. This is around two thirds less than the monthly average in 2019.

The two week pathway is when someone who shows possible symptoms of bowel cancer has an appointment with a colorectal specialist at a hospital within two weeks. This is the national target. Although there was a gradual recovery over the following months, the numbers had not recovered by September 2020.

Possible reasons for these changes to bowel cancer referral are because fewer people were contacting their GP with symptoms. This could be because people were concerned about bothering their GP during the pandemic, or because they experienced difficulties accessing the services due to the COVID restrictions. GPs were also advised by the NHS to limit the number of referrals to try and protect hospitals from being overwhelmed. More research needs to be done to fully understand why these changes happened.

2. The number of colonoscopies performed to diagnose bowel cancer dropped by over 90% in April 2020.

Normally around 46,000 colonoscopies are performed in England every month. In April 2020, only around 3,400 colonoscopies were carried out. Although there was a gradual recovery in the following months, by September 2020, the numbers still hadn't returned to normal.

Colonoscopies are the main test for diagnosing bowel cancer. This means there are potentially thousands of cases of bowel cancer that haven't been detected and diagnosed. This combined with fewer hospital referrals means that around 3,500 fewer people have started treatment since April 2020 (as at 31 October) and if this trend continues, this number will keep rising.

Bowel cancer is treatable and curable if found early. Nearly everyone diagnosed at the earliest stage will survive bowel cancer for at least five years. When diagnosed at the latest stage, only one in 10 people will survive.

Delays in diagnosis allow tumours to grow. The lack of colonoscopies performed in 2020 is likely to have a profoundly detrimental impact on bowel cancer survival in England.

3. The number of bowel cancer operations performed monthly in England dropped by a third at the start of the first lockdown.

The number of operations being carried out did start to increase during the following months but by September, surgeons were still performing fewer bowel cancer operations than the monthly average in 2019.

On top of this, surgical practice was adapted and changed significantly to minimise the risk of coronavirus. These changes may have helped protect patients from the virus, but they were different from the standard treatments for bowel cancer care.

For example, more people were having open surgery rather than keyhole surgery. This could be because, as part of the COVID-19 response, professional bodies such as the NHS initially recommended open surgery. This is because keyhole surgery can cause airborne particles (aerosols) to be released, which could help spread coronavirus. But keyhole surgery tends to have faster recovery times and reduced hospital stays, so changes to open surgery could have impacted recovery times for patients.

The number of operations that result in a stoma increased. During a bowel operation, the section of the bowel that contains the tumour is removed and the two healthy ends of the bowel can be joined together. In some patients, the newly joined ends of the bowel don’t heal properly, causing a leak. This can be a serious complication for bowel cancer patients and sometimes another operation is needed. To reduce the number of additional operations during the pandemic, surgeons were advised to consider forming a stoma, which doesn’t have this risk.

The impact of these changes is still uncertain, but could have a detrimental impact to the long term quality of life of people affected by bowel cancer.

These issues need to be addressed urgently

This study is the first to look in detail at what actually happened to bowel cancer services during the first wave of the pandemic. It provides the most up-to-date information available, using data from NHS Digital covering waiting times, diagnostic services and secondary care services. We need to continue monitoring bowel cancer services to make sure that these challenges are addressed rapidly and to understand the full impact on people with bowel cancer.

The numbers of undetected and untreated bowel cancer cases will continue to grow until services are fully restored and the backlog of patients has been addressed. This is particularly vital as the number of coronavirus cases rise rapidly again and we go through the third national lockdown.  

Given how quickly circumstances can change, it is important that research such as this continues. Although the long-term impact of missed and late diagnosis on bowel cancer may not be known for a number of years.

What are we doing?

1. As a member of the Cancer Recovery Taskforce, we're working with the NHS to help develop plans to ensure cancer services recover to at least pre-pandemic levels as soon as possible. This includes making sure the backlog of thousands waiting for further investigations is effectively addressed.

2. We support innovation. Healthcare services have been placed under lots of pressure, which has forced them to find innovative ways of working to tackle the backlog of patients waiting for tests. The NHS has had to be adaptive, reconfigure services and embrace technology. We’re making sure that the NHS, working with local health leaders, hospitals and clinicians, are supported to scale up innovations that have worked well to ensure a lasting impact.

3. We continue to fund vital bowel cancer research. We are committed to working towards addressing the recommendations that were made in our landmark 'Critical Gaps in Colorectal Cancer Research' initiative that saw scientists, clinicians and patients prioritising the areas of research, which if addressed, could have the greatest impact on people affected by bowel cancer. We will do this both through funding high-quality research ourselves and through facilitating and supporting larger research projects in priority research areas.

If you have symptoms of bowel cancer, or if things just don't feel right, contact your GP. GP surgeries and hospitals have adapted how they work to make it safe for you to seek medical advice during the pandemic – they will want to hear from you.



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