Covid has had a huge and lasting impact on us all, and it was clear that gynaecological cancer care was no different, but now we have a clearer picture of what happened – and how the impacts continue. The paper published today led by Prof Ranjit Manchanda, Queen Mary University of London and funded and supported by the British Gynaecological Cancer Society (BGCS) showed that during the first wave of covid, urgent referrals for cancer investigations halved and there was a significant impact with staff shortages through to wave three of the pandemic.
During the first wave of covid-19 in 2020 almost half of hospitals reported staffing issues, theatre capacity was down by 40%, which led to 30% of planned operations being postponed.
Huge changes had to be made to gynaecological cancer care in the UK to ensure the safety of the patients- balancing their risk of Covid-19 and their cancer care. The majority of gynae cancer patients are older, and if on chemotherapy may be immunocompromised. This meant that for the majority of gynae cancer patients, catching covid-19 could have been very serious. During wave one, 75% of consultations moved to be remote, to help reduce the risk of catching covid-19 for patients.
In April 2020 guidance was released from NHS England on cancer surgery, which made it clear that it was important that the diagnosing of cancer and its essential treatment and urgent care must continue. To help cancer care teams make decisions and balance patients risk the BGCS created a framework, and further guidance was produced for radiotherapy by NICE (the National Institute for Health and Care Excellence). Changes were made to care to make sure patients got the treatment they needed in the safest way, such as hypo-fractionated radiotherapy, where people could get their radio treatment over a shorter period, needing to attend hospital fewer times.
By the second wave of covid-19, urgent gynae cancer referrals to investigate whether people with symptoms had cancer were back up to normal levels, but 5% of surgeries were still postponed with theatre capacity down by 10%.
Unfortunately, the third wave of the pandemic in 2022 hit staffing levels again, to the same extent as wave one, with the majority of people off due to sickness. Yet, even with reduced staff, urgent referrals and surgeries were continuing at a normal rate.
“The impacts of the covid pandemic further compounds pre-existing workforce shortages identified by the BGCS” says Professor Manchanda. “Our paper highlights persistent capacity constraints that need urgent redress. This is essential to provide ongoing care for women with gynaecological cancer and also address the impact form the COVID19 backlog.”
“The staff shortages are of great concern” says the BGCS President, Dr Stephen Dobbs: “At the BGCS we have already highlighted concerns regarding a reduction in trainees and a shortfall in new/replacement Gynaecological oncology posts.”
This study surveyed all members of the BGCS during the three waves of covid in 2020 through to 2022, which covered over 50 hospitals (32 of which were specialist cancer centres). It showed the extent of the disruption to gynae cancer services in the UK during the pandemic. The researchers hope this work will provide learnings on how we can move forward to counteract the impact of covid on gynae cancer care and how cancer care can adapt during any potential future pandemics. It is too soon to see the long-term impacts that this disruption will have had on patients, but the BGCS is continuing to monitor outcomes with this survey.
At The Eve Appeal we are seeing first-hand the impact these changes are having on patients, our Ask Eve nurse service co-ordinator, Helen, says: “The team are currently inundated with calls from people waiting for diagnostic tests and referrals or being told they aren’t a priority, even though they have potential cancer symptoms that need to be checked. It can be an anxious time waiting for investigations and appointments, especially when you are worried your symptoms may be caused by something serious, like cancer.”
Eve CEO, Athena says: “There are a number of factors contributing to delays in gynae referrals at the moment and the impacts of Covid is one of them. When and how are the capacity constraints going to be addressed? Because cancer doesn’t wait.”
“The BGCS is urging the commissioners to increase staff recruitment of all members of the Gynaecological oncology MDT to enable safe and effective treatment of women with gynaecological cancers.” says Dr Stephen Dobbs
What this study, and the concerns coming into Ask Eve make clear is that more needs to be done to address the backlog and workforce crisis in cancer care.
If you are concerned about any gynae cancer symptoms you are having, or any delays you are facing, our Ask Eve team is here to provide free and confidential advice and information. You can get in touch by emailing nurse@eveappeal.org.uk or calling 0808 802 0019.