Under the current circumstances, it is easy to focus on the most direct impact of COVID-19 to the exclusion of almost everything else, but the current public health crisis is much further reaching than the immediate concern of the coronavirus:
- 3 million fewer people had a routine cancer screening between March & September 2020 compared to pre-COVID levels
- 58% decrease in patients beginning treatment for cancer following a referral from screening (comparing Apr-Nov 2020 and the same period in 2019)
- 8 x the number of patients on endoscopy waiting lists for 6 or more weeks, and 11 x the number on waiting lists for 6 weeks or more for radiology (as at the end of November 2020 compared to November 2019)
On 4th February, for World Cancer Day, we focus on the impact of the pandemic on both short- and long-term cancer care, and look at what employers can do to support employees.
Shorter-term considerations
During the early stages of the pandemic, routine NHS cancer screening programmes (for breast, bowel and cervical cancer) were paused both due to infection concerns and due to staff being seconded to immediately critical services. Additionally, many people with symptoms may have faced delays in accessing help due to unavailability of treatment and interruptions to the two week target – the time between a GP referral and seeing a specialist – that the NHS usually maintains. It is also understood that some people may not have sought help as they usually would: fears about the pandemic resulted in a widespread reluctance to travel or be in a medical setting.
In October 2020, Macmillan estimated that around 50,000 people in the UK have missed a cancer diagnosis – this figure will likely only have increased over the past few months.
As we all know, the sooner a cancer is picked up, the better the prognosis is and the lower the cost of the treatment pathway. This is relevant whether the cost is to an already stretched NHS, or to an employer – either directly via a self-insured arrangement such as a Healthcare Trust or indirectly by way of a private medical insurance arrangement.
While NHS screening services are currently back up and running, capacity is lower and there still remains a significant backlog. Private screening resources currently vary, with some screening providers undertaking face to face screenings, and others electing to limit their offering to remote screenings for the time being.
The concern, naturally, is that due to the many factors which are delaying diagnoses, outcomes will be worse for those individuals when they do eventually do get a diagnosis.
The longer-term picture
Figures from the Institute of Public Policy Research (IPPR) have indicated that across the next 6 years, up to £7.8 billion of investment in research could be lost as a direct result of the COVID-19 pandemic, predominantly due to lost charity income. By the end of last year, Cancer Research UK had already been forced to cut £44 million of planned research.
Following suit, Macmillan Cancer Support announced last year that they are expecting a £175 million fall in funding by the end of 2022 as a direct result of COVID-19, and is currently planning to cut over 300 jobs in order to try to protect the services delivered by the Macmillan nurses and support phone line.
This reduction in funding will have the impact of slowing progress in development of cancer treatments – an area in which great strides have been made in recent years. It remains to be seen if the funding deficit has an ameliorating impact on the increasing cost of cancer treatment, which has been a factor in recent years.
What can employers do?
A key area where employers can have an immediate impact is in education – through promoting what is available through their benefit programme, but also through signposting to free resources.
The key message is that individuals should be aware of which symptoms could be indicative of something concerning, and that if any symptoms are being experienced, help is still available and should be sought at the earliest opportunity.
The Public Health England “Be Clear on Cancer” campaign is a really good starting point for an employer wanting to do more in this area, with free resources available in several languages and formats.
The NHS also has really helpful educational resources including an overview of the main symptoms to watch out for, and Macmillan Cancer Support offers a variety of “Easy Read Guides” around aspects of cancer treatment.
Insurers also offer various resources which are open to everyone – Bupa offers a wide range of information and resources, including leaflets for children to explain what cancer is. AXA Health provides resources including a manager’s guide on how to speak to employees about cancer.
It is important to note that employees should be regularly reminded about their access to virtual healthcare services, where these are in place. Virtual GP services have become ever more common, with many insured arrangements offering these as a value-add benefit, and can offer immediate and safe access to a GP to discuss symptoms and answer questions.
Finally, while many businesses are already in a challenging financial position due to the pandemic, consideration could be given to nominating a cancer charity as your charity partner, and operating a matching offer for fundraising activities by employees.
A well promoted and embedded charity partnership can be a really valuable element of an employee wellbeing and engagement programme. While you are unlikely to manage raising the estimated £7.8 billion shortfall in funding, every contribution helps.