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Thousands of patients may have undiagnosed and untreated bowel cancer due to COVID-19 disruption.

A new study led by the University of Oxford has found that since the first coronavirus lockdown, the number of people diagnosed with bowel cancer in England has fallen sharply. Between April and October 2020, over 3,500 fewer patients than expected were diagnosed with bowel cancer in England. Since bowel cancer is more likely to be curable if it is detected at an early stage, these results suggest that many patients, whose diagnosis has yet to be made, may die unnecessarily.

For this study, a team of clinicians and academic researchers from the Universities of Oxford, Leeds and Newcastle assessed the patterns of referral for bowel cancer investigation, diagnosis and treatment within the English NHS from 1 January 2019 to 31 October 2020. The results published in The Lancet Gastroenterology & Hepatology showed that, compared with an average month in 2019, during April 2020 at the peak of the first wave of coronavirus:

  • the monthly number of referrals by GPs to hospital clinics for investigation of possible bowel cancer reduced by 63% (from 36,274 to 13,440);
  • the number of colonoscopies performed fell by 92% (from 46,441 to 3,484); and
  • the monthly number of people with confirmed bowel cancer referred for treatment fell by 22% (from 2,781 to 2,158), and the number of operations performed fell by 31% from (2,003 to 1,378).

This is the first study to assess the impact of the COVID-19 pandemic on the diagnosis and management of bowel cancer across England. The researchers are continuing to monitor these figures to inform decisions about treatment and help ensure that the issue of undetected and untreated bowel cancer in England is addressed.

‘These results reflect serious disruption in the normal identification and treatment of patients with bowel cancer’ said lead author of the study Professor Eva Morris (Nuffield Department of Population Health, University of Oxford). ‘Early diagnosis is key to obtaining the best survival for bowel cancer so these delays in diagnosis are likely to have severe consequences on survival rates from the disease.’ Over 90% of patients diagnosed with bowel cancer at Stage I of the disease survive for at least five years, compared with only 10% of patients diagnosed at Stage IV.

Dr Brian Nicholson, a GP involved in the study, said ‘This study shows that during the pandemic the NHS has changed pathways to create capacity to ensure they can still treat patients with bowel cancer rapidly. Hospital services and GPs have taken care to develop safer ways of working to reduce the risk of infection. If people have symptoms like altered bowel habit or blood in their poo that may suggest bowel cancer, they must talk to their GPs as soon as possible as early diagnosis saves lives. We need to get this message out there.’

Genevieve Edwards, Chief Executive at Bowel Cancer UK, says ‘This research shows the clear impact of the pandemic on bowel cancer patients, and ultimately, their long-term chances of survival. It also highlights the unintended consequences of the ‘stay at home’ message and the impact of the temporary disruption to bowel cancer screening and diagnostic services. Sadly, for many, that will have meant a later diagnosis and poorer outcomes as a result. NHS staff have worked incredibly hard to keep vital cancer services going, and the NHS continues to be open for anyone worried about symptoms. But it needs additional resources to withstand the pressures caused by the new variant coronavirus sweeping the country, or cancer services – and the patients that rely on them – will suffer in the months ahead.’ 

This study was funded by Cancer Research UK and Yorkshire Cancer Research. Further support was provided by Public Health England, Health Data Research UK and NHS Digital and the National Institute for Health Research Oxford Biomedical Research Centre and Bowel Cancer UK. 

For more information about this story, visit the Nuffield Department of Population Health website.


Image credit: hey_paul CC BY 2.0