Cancer care in a Covid world
For most of the population the relaxation of lockdown signals a return towards normality, but for all of us living and working in the world of cancer there is much to consider.
Cancer Research UK suggests as many as three million people across the UK have not been screened, tested or treated for cancer compared to normal as a result of the COVID-19 pandemic.
Whether it is the impact on research funding or dealing with a backlog of patients, our staff and researchers are now operating in an entirely new world.
Professor Ian Hall, Director of the Nottingham Biomedical Research Centre and Consultant in Respiratory Medicine at Nottingham University Hospitals, explains what has changed over the last four months and how we are adapting to support patients in our care.
Emergency and routine admissions
“Standard emergency work at the Queen's Medical Centre had been running at about 70% of its normal capacity during the early stages of the pandemic. There were a number of reasons for this; for example some people who were quite ill may have stayed at home and improved over time without coming to hospital. People may also have been taking more care of their health if they have a chronic condition.”
A further challenge for Ian and his colleagues has been how to ensure that what previously were routine testing procedures now become as low-risk as possible.
“Something like a colonoscopy, which is a standard routine screening test for many people over 60 - all endoscopy procedures now have to be carried out with enhanced PPE and with the minimum number of people in theatre to make sure we’re delivering the service safely for both staff and patients.
“Another example is lung function testing – this has had to stop for the period of the outbreak because it’s classed as an aerosol generating procedure. So anyone who may need an operation for lung cancer, you need to know if their lung capacity is adequate to go for surgery.
"So this illustrates how there are all manner of practical issues which could potentially result in delays in patients presenting, being diagnosed or starting treatment. This isn’t unique to Nottingham either, it is an international issue, but our staff have adapted fantastically and we are confident in our plans going forward.”
A positive impact on research
Continuing our vital research into cancer has been challenging during the course of the pandemic, but encouragingly many studies have been able to continue – and an unexpected benefit has also become apparent, which could have far-reaching effects.
“We have still managed to keep something like a quarter of our research projects running. This included prioritising cancer trials to ensure patients with cancer didn’t miss out on the opportunity to participate in trials.
“This is particularly important because it is well-established that if you have any disease and your care is managed as part of a clinical research trial your outcomes are generally better. 50% of all patients with cancer were being offered the chance to participate in trials pre-COVID and one would hope outcomes will continue to be strong because we are keeping these studies open.
"One huge positive has been the speed at which we have been given regulatory approval and access to data. Things which would ordinarily take six months to get a decision on in terms of accessing data for research or patient care suddenly became unblocked overnight.
“From a research point of view typically a study would take three months from the point of concept to being signed off and ready to go, for COVID studies it has come down to 7-10 days. There are definite lessons to be learned in streamlining approvals and these can be implemented in the long term across healthcare.”
Making use of our China connection
The University of Nottingham has had a campus at Ningbo in China since 2004 and the links established with healthcare services in the city have given staff here a unique insight into COVID-19.
“My colleague Richard Hubbard and I established the ‘Nottingham Health China’ initiative three years ago and we have close links with Ningbo First Hospital and other health care providers in the city.
"Ningbo itself hasn’t had a massive number of cases but it all happened a month to six weeks before here in the UK so we had some immensely helpful discussions. In particular, a couple of calls with the head of respiratory service here to look at the lessons they had learned allowed us to design effective care pathways for Nottingham.
"We also put them in touch with Professor Jonathan Van-Tam and Professor Chris Whitty who have been integral to the UK Government's planning and response, who I think were grateful for the insight too.”
So although the outlook may be uncertain, all our staff responsible for cancer research and care are making sure that where possible we use the pandemic as an opportunity to innovate, learn and improve our world.