Collateral Global

Cancer is the leading cause of deaths globally. Reduction in modifiable risk factors such as stopping smoking and early identification through screening can considerably reduce the burden of cancer. Specific symptoms such as persistent cough, change in bowel habit, unexplained weight loss suggests cancer. The results of our review of the impact of restrictions on cancer services highlight that global access to care was substantially reduced for various cancers.

Because of the delays, late-stage cancer presentations increased, even after restrictions were lifted. From mid-March until the end of April 2020, a cervical cancer screening unit in Cameroon saw screening numbers drop by nearly 80%. This is troubling because late-stage presentations are linked to decreased cervical cancer survival. The five-year survival rate for US women diagnosed with advanced cervical cancer is 15% compared with 93% for those presenting much earlier with localized disease.

A similar outcome is seen In low-income countries. In India, for example, the 5-year survival is 9% for advanced disease compared with 78% when the cancer is diagnosed at stage 1 when it is localized to the cervix. Several studies in our review reported that when routine services resumed after restrictions were lifted, there was still a shift to later-stage disease presentations, even in countries that were relatively unaffected by the pandemic. In a Japanese regional treatment centre, no significant changes were seen in the number of patients undergoing surgery.

However, the number of patients undergoing surgery with advanced disease increased compared with before the emergency. Not all cancers have the same prognosis but presenting late with lung cancer is bad news. In those with early disease, more than 55 out of 100 people will survive for 5 years or more after diagnosis. But in later stage 4 disease — which has spread beyond the lungs — only five out of 100 survive for five years or more.

These delays in care were not restricted to adults as children were affected in a variety of countries. In Turkey, a major Paediatric Oncology Department reported reductions in children undergoing chemotherapy, radiotherapy, surgery, and imaging studies during the COVID-19 period. The early phase of the Covid 19 pandemic substantially exacerbated these delays. Early recognition of those with red flags symptoms and maintaining access to effective cancer care is essential for maintaining health and wellbeing.

Our review found 69 published studies done in 23 countries that compared changes in the pattern of screening, diagnosis, waiting lists and treatments for cancer in the first wave of the covid pandemic. This evidence shows a consistent global drop in access to cancer care.

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Source: Carl Heneghan, Tom Jefferson | Collateral Global

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