Dr. Clive Kilgallen:

The impact of Covid-19 on our health services, and particularly on our cancer services, will be felt for years to come. Up to 45,000 people in Ireland are diagnosed with cancer each year. Approximately 9,000 people, or one in three deaths each year, are from invasive cancer. While survival rates vary depending on the type of cancer, it is estimated that 190,000 people living in Ireland have survived cancer. Early detection is key both to survival rates and to good outcomes for patients. Delays in treatment can mean the difference between routine surgery for early stage cancer or more complex surgery, radiotherapy or chemotherapy at a more advanced and aggressive stage.

Covid-19 has had a significant negative impact on our cancer services, with patients presenting late or in some cases even declining appointments for fear of catching the virus. In addition, social distancing and infection control measures have restricted both diagnostic and treatment capacity within the hospital system. We have a growing backlog of patients waiting for urgent time-critical diagnostics services and treatment services, while, for reasons connected to the pandemic, our life-saving screening services are falling below annual targets. The recent cyberattack on the HSE has compounded delays, with radiotherapy and screening appointments having to be postponed or rescheduled.

On diagnostics, in March and April 2020 during the first wave, rapid access clinics for breast and lung cancer saw referrals fall by a third and referrals for prostate cancer fell by half. While referrals have recovered, they remain significantly below 2019 levels, particularly for lung and prostate cancer. Many patients have also experienced delays in accessing services. In September 2020, just 60% of new patients attending rapid access breast, lung and prostate clinics were seen within the recommended timeframe. More recent figures show that for the first three months of this year, 450 people per month were not seen within the recommended four weeks for an urgent colonoscopy.

Treatment activity has also declined. Figures for 2020 show that activity in medical, radiation and surgical oncology services fell well below the equivalent 2019 levels, despite the fact that demand for services is predicted to increase by 5% per annum. Chemotherapy activity in 2020 fell 12% below 2019 levels, while radiation therapy fell 10% below and urgent cancer surgery cases in public hospitals fell by 24%, although some of this decline was offset by surgery performed in private hospitals. Data gathered by the faculty of pathology in the Royal College of Physicians of Ireland in the March to June 2020 period, show that there were 668, or 12.5%, fewer cancer resections performed. That is the surgical or precision removal of a tissue or organ that has cancer in it. Non-urgent cancer care has also declined. In 2020, there were 36,120 fewer elective cancer admissions compared with 2019. Since pre-Covid times, the number of people waiting more than three months for a gastrointestinal endoscopy service has doubled to 23,800.

Our cancer screening services have also been affected. They were paused in March 2020. CervicalCheck and BowelScreen resumed in the summer of 2020, while BreastCheck resumed in October 2020. However, as a result, all screening programmes still fell far below their annual targets for 2020. The full impact of Covid-19 on cancer care has yet to be assessed. However, without urgent investment, we will be dealing with a backlog of patients with much more complex and advanced stage cancers for years to come, with all the complications and side effects they will have.

The IMO recommends that we urgently invest in a national public health messaging campaign to help patients identify the signs and symptoms of different cancers, as well as encouraging individuals to visit their GP at the first sign of symptoms and to attend for hospital appointments. These messages should be communicated widely. It needs to be emphasised that patients will be cared for in a safe environment. National cancer screening programmes should be fully reinstated. We need an urgent and rapid expansion of access to diagnostic infrastructure, including radiography, endoscopy and laboratory services.

To date, there has been no assessment of diagnostic requirements to deal with our growing population, let alone the requirements to deliver this service under pandemic conditions. Cancer care is multidisciplinary, with patients requiring input from a range of different specialties involved in diagnosis and treatment and depending on the type of cancer diagnosed. Consultants are working flat out to catch up but we need to increase the number of consultants across our services, including specialists in diagnostic and clinical radiology, pathology, haemotology, radiation and medical oncology, colorectal surgery, urology, and ear nose and throat. Some one in five consultant posts are unfilled on a temporary basis, while between 1,600 and 2,000 additional consultant posts are required to meet current population needs.

In addition to employing consultants, we need to increase capacity across the system including, staffed theatre space and additional ICU, inpatient and day case units. There is no point in employing a surgeon if he or she does not have an operating room to work in. We need investment in secure IT systems, including investment in electronic health records and the roll-out of the unique patient identifier.

Additional supports are required to support follow-on care in general practice for cancer patients, where appropriate.