A recent report from the Southeast London Cancer Alliance on cancer diagnoses over the last year of lockdowns showed a 51.4% drop in prostate cancer diagnoses in 2020 compared with 2019 – the highest drop of all cancers. More worryingly, there was also a 3.8% increase in men presenting with Stage 4 disease. It concluded:
“The experiences in cancer are a salient warning that pandemic control measures and policy need to balance all health and welfare. Alternative strategies need to be adopted during further waves of the current and any future pandemic to ensure that patients with cancer are prioritised for diagnosis and treatment to prevent late-stage presentation and an increase in avoidable deaths”
Navigating care following a prostate cancer diagnosis in these circumstances is challenging indeed, and we’ve spoken with cancer specialists, health policy experts and patients about this.
Professor Gordon Wishart of Check4Cancer joined a recent OnFocus episode to share his views on the impact of the pandemic and successive lockdowns on prostate cancer diagnostics and treatment. While he acknowledges the severity of delays and waiting lists, he also describes some real opportunities to improve both screening and diagnostics that have been accelerated by the pandemic:
“it’s now possible to do a finger prick blood test for PSA at home now… we know that through some laboratory tests that the fingerprint test is just as relevant and accurate as the traditional blood draw. And so it can be done really very easily. And we know what the ranges are for different age groups. And so men aged 40 plus can now access a very simple test that they register online, a kit is sent to their home. They take the fingerprint test, send it back to the lab. We get the results and we let them know the results. And then depending on what that result is, that also helps work out what future risk is. And so you can let them know when they should next have a test.”
He cites the future benefits of vaccines as well as new practices adopted in treatments:
“some developments in cancer diagnosis and treatment have been accelerated during lockdown. And I think there will be many more to come. The technology that’s been developed for covid vaccine, some of that could be applied to cancer treatments and to cancer vaccines in the future. So that’s really exciting. In breast cancer, traditionally radiotherapy has been for three weeks after surgery and the Fast Forward trial, was really pushed through quickly, because that showed that for a large number of patients, having one week of radiotherapy was the same as three weeks. So that was actually introduced during lockdown to benefit breast cancer patients. So I think we’re going to see really an avalanche of innovations coming through, which is great in cancer services in the next three to five years.”
While this is encouraging for the future, what can men do now to ensure they are getting access to the best care possible? The constant advice we hear from our patients is “question everything” – that is, try to understand how your diagnosis and treatment pathway is being managed and unpick each element of that pathway:
- Imaging: what is the quality of images produced at the centre recommended to me?
- Reporting: who is the reporting radiologist of my MRI scan? Can I see the report?
- Biopsying: What is the biopsy method I am asked to undergo? Is it TRUS? If so ask for a trans-perineal, and ideally MRI/US fusion biopsy to ensure accuracy
- Histopathology: what is the lab analysing my biopsy samples? What is their record?
- MDT: will a multidisciplinary team review my case? Who will be on that team?
- Treatment recommendations: what is the full range of treatment options available to me? Does this include those that are considered experimental, and if so, are there clinical trials I can join?
Two other things we’d like to share:
- Know your rights: Patient consent is enshrined in the Montgomery Ruling which upholds the right to informed consent on any medical treatment or procedure, and while patients do not have a legal right to a second opinion in the NHS, there are cases where this can be accommodated.
- Make your voice heard
The All-Party Parliamentary Group on Cancer aims to be the voice in Parliament of cancer patients and their families, and campaigns on multiple issues, including early diagnosis, workforce, rarer cancers and patient experience. The Group brings together MPs and Peers from across the political spectrum to debate key issues and campaign together to improve cancer services.
Chris’s Cancer Community is an influential online community of people affected by cancer, led by campaigner Chris Lewis.
Movember UK is a charity focused on men’s health, and actively campaigns to support improvement and access in prostate cancer care.
What has your experience been in accessing cancer services during the pandemic? We’d love to hear from you.