When the human costs of coronavirus are tallied, seriously-ill cancer sufferers are unlikely to be counted in the official statistics.
The headlines may focus on the tolls directly affected by COVID-19, but what about those who miss out on other vital treatments during the crisis?
Like many countries, the UK’s national health service (NHS) has been forced to pool much of its resources into the coronavirus response, meaning other areas of the system have needed to make sacrifices.
There are also concerns that patients with suppressed immune systems – due to illness or from treatments such as chemotherapy – could be at a higher risk of adverse effects of the virus than others.
For those with cancer, the NHS has encouraged “essential and urgent” treatments for some patients to continue and has created specific “COVID-free” hubs for surgeries – but many of these people will still miss out.
“With some patients, a delay might not matter too much, while for other patients it might be important,” professor Karol Sikora, an oncologist and former director of the World Health Organization’s cancer programme, told Euronews.
“But if it goes on beyond a couple of months – two months at most – we have a problem.”
The UK is currently coming to the end of a three-week lockdown on Easter Monday, but is expected to extend this.
France, Spain and Italy are also all poised to extend their respective lockdowns to bring the spread of COVID-19 under control.
Patients could ‘die sooner than they would have’
Last week, the Twitter account of a British nurse went viral after she recalled telling three newly-diagnosed cancer patients they would not be considered for treatment due to COVID-19.
She said: “All will die sooner than they would have. These are the figures that are not recorded.”
Her tweet later prompted replies from other nurses and cancer patients themselves who said they could relate after having similar experiences.
Vicki Meredew, from north west England, was due to undergo a round of adjuvant chemotherapy for terminal brain cancer, when she was told her treatment would be postponed.
Speaking to Euronews, the 40-year-old said she was “a little worried” about how it would eventually continue as her hospital had been “very stretched” even before the pandemic.
She added: “It was my neuro-oncology nurse who contacted me because my consultation with my oncologist (even via telephone) was cancelled.
“To be honest, at the time she said it was postponed and I’d be sent a further appointment once they’d had time to prioritise and rearrange.
“I then received an appointment for the end of the month – but having spoken to my neuro-oncology nurse again last week about getting the results of my scan, I fully expect that to be cancelled, too.”
Meredrew, who was an educational and child psychologist before she took retirement for ill health, said the new round of adjuvant chemotherapy – which comes after her main treatment of chemotherapy and radiotherapy – was “unlikely to impact” her tumour.
But, she explained, her doctor thought it “worth a try” to keep the tumour stable.
“Statistically, since I first presented with seizures in June 2018, I should already be dead (glioblastoma carries a life expectancy of 12-15 months),” she said, adding: “But, fortunately, my tumour appears surprisingly stable.”
She continued: “Though my followup scan, which I’m still awaiting results of, was looking into a possible cyst developing where my tumour has shrunk following radiotherapy.”
When she went for her recent scan, Meredrew said the hospital was “deserted in terms of patients” but it had been “full of staff preparing for COVID-19.”
She added: “From that, I’d assumed cancer patients were still considered urgent and would continue to be treated.
“I only had two cycles of chemotherapy left and my blood counts have been fine throughout, so I’d thought, perhaps, they’d send my chemotherapy (I take it orally) to my GP to avoid me going in for hospital appointments, so I could finish the course.”
‘I’m very scared’
Meanwhile, others on social media have also shared their stories of cancer treatments and tests being stopped for themselves, friends and family.
Mary Ball, from Wigan, said her husband “won’t be counted in the statistics” after he was told he couldn’t have surgery, and now wasn’t sure if he could have chemotherapy either.
She said: “It’s all because of COVID-19 but he won’t be counted in the statistics. It’s not fair. He deserves a chance but everything’s stopped for the virus. He should have hope.”
A Derbyshire-based Twitter user called Paul said his partner had recently had “a growth spotted” on her liver.
He added: “She has been told they can’t perform a biopsy to check for cancer due to COVID.
“I am very scared this could be the difference between a positive outcome and one that doesn’t bear thinking about.”
According to professor Karol Sikora, young patients with Hodgkin’s disease, leukaemia and testicular cancer should “continue [treatment] as planned”, but assured for others that he believed the pandemic would be a “temporary blip”.
“If they are just starting chemotherapy or radiotherapy, it may be best to delay through the peak [of coronavirus cases] just in case they get ill,” he said.
“After the peak goes down, we need to get cancer and cardio patients their treatment – we have to reconsider and start prioritising the cancer and cardiac care.”
Speaking further about the peak of COVID-19 in the UK, which is expected this week, he added: “This weekend is a bad time to be ill. Don’t be ill on Easter.”
‘Not yet clear’ how coronavirus will affect cancer care
Cancer Research UK’s chief clinician professor Charles Swanton told Euronews in an email that the “complete picture” of how COVID-19 will affect cancer “is not yet clear.”
He added: “These are unprecedented times and the NHS will have to make some very difficult decisions.
“But as the virus becomes more common in the UK, it will undoubtedly add more pressure to the NHS, bed and [intensive treatment unit] availability and hence service delivery.
“We also know that patients suffering from cancer are at higher risk of complications from viral infections such as flu, and COVID-19 is likely no different.”
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Turning to NHS staff in particular, Swanton said they “are working tirelessly, and doctors and the NHS are adapting to the virus pandemic accordingly.
“Case-by-case treatment decisions will have to be based on patient risks and benefits across the service, as in-patient hospital care may expose cancer patients to the virus.
“And hospital services will be increasingly prioritised for patients with COVID-19 needing urgent care during this very difficult time which will impact on the national healthcare resources across all areas of medicine.
“Any patients who are concerned about their treatment should speak to their doctor and follow any updates to NHS guidance.”
‘I worry about the well-being of hospital staff’
Meredrew said her former role as a psychologist had now left her wondering about the long-term mental strain the COVID-19 crisis would have on healthcare staff.
She said: “Having had to work in stretched services as a psychologist, I fully appreciate that everyone is doing their best in a very under-resourced system.
“With my professional head on I really worry about the long term impact of all of this on the well-being of hospital staff.
“In my former role, I was part of a critical incident team where we’d offer psychological support to schools after traumatic incidents, and I wonder what is in place for NHS staff as this goes beyond what would normally be expected of them.”