Why we need to act to address the bowel and bladder cancer emergency

Dr Cheng Boon

Consultant Clinical Oncologist, Rutherford Cancer Centres

The pandemic saw thousands of cancer patients miss their treatments due to the lockdown. Innovation and collaboration are key to helping clear the post-pandemic cancer backlog.

Some estimates suggest over 40,000 fewer people received treatment for cancer from April 2020 compared to the previous year. Referrals via the two-week wait urgent pathway decreased 84%. Whilst hospitals had no alternative, these delays created a cancer backlog that will take years to overcome. Concern is becoming particularly acute for bladder and bowel cancer patients, two of the 10 most common cancers in the UK.

Delay in diagnosis impact on survival

For bowel (colorectal) cancer and bladder cancer, a three-month delay in diagnosis is predicted to result in a reduction in long-term (10-year) survival of more than 10% in most age groups. Delays of six months are predicted to reduce 10-year mortality by more than 30% in many of these patients.

Over 42,000 patients are diagnosed with bowel cancer and over 20,500 patients with bladder cancer each year in the UK. Earlier diagnosis for these patients can make the difference between curable or incurable conditions. Bladder cancer has a mortality rate of around 50% but early diagnosis can lead to an 80% survival rate.

As we continue to return to normality, it is vital that we address the cancer emergency. Not acting now, both for diagnosis and treatment, can lead to tens of thousands of extra cancer deaths. The entire health system risks longer term difficulties without immediate action.

Delayed diagnosis leads to more late-stage cancer patients requiring more invasive treatments, resulting in turn to lower chances of longer-term cure and higher risks of treatment related side-effects – a vicious treatment cycle that can consume cancer care services for years to come.

Overcoming the cancer backlog

To overcome the backlog and ensure cancers such as bladder and bowel do not increase mortality, innovation and collaboration are key. Diagnostic capacity needs to be ramped up significantly, which should include collaboration with the independent sector to overcome the diagnostics bottleneck in the system. National cancer screening programmes, which halted during and after the pandemic, need to be re-established and beefed up with community diagnostics and screening hubs across the country. This will reduce the rate of patients presenting with symptoms of advanced cancers to our frontline services including emergency services.

To overcome the backlog and ensure cancers such as bladder and bowel do not increase mortality, innovation and collaboration are key.

Furthermore, there is an urgent need to expand provision of advanced cancer therapies, whether it’s conventional treatments such as surgery, radiotherapy and chemotherapy or more advanced proton beam therapy, robotic surgery and immunotherapy. The expected backlog and higher number of late-stage cancer patients will put increasing strain on limited treatment resources.

As more patients present with late-stage cancers, having advanced treatment options that can treat and cure these patients whilst limiting the risk of side-effects is critical not least because of the pressures this can alleviate from cancer care services, as well as other frontline services dealing with side effects of treatments generally.

Checking your symptoms

The public also have an important role to play. Anyone who thinks they have cancer symptoms should get checked without delay. All cancers have clear signs and symptoms. Noticing blood in the urine for instance is the most common symptom of bladder cancer. Bleeding or blood in the stool is also the most common symptom of bowel cancer and should immediately be checked.

It is only through a comprehensive national effort, one that includes collaboration and participation from the Government, hospitals, the independent sector with providers such as the Rutherford Cancer Centres and the general public, that we realistically stand a chance of reversing the cancer backlog.

The COVID-19 pandemic response has shown the way to respond to a genuine healthcare emergency with collaboration between academics, clinicians, patients, politicians and citizens to save countless lives. Let us recognise the coming cancer emergency and act accordingly. Late-stage cancer is a medical emergency.