It is undeniable that COVID-19 has pushed clinical practice into different ways of working. Remote consultations, digital technologies and in-community or at-home treatments are just some of the ways that the healthcare system across the UK has had to adapt. The phrase ‘a new normal’ has been used in conversations up and down the country, as we try to predict how life will change going forward. Guided by research and evaluation of the modifications made during this pandemic, we have a real opportunity to establish not just a new normal, but a better normal for cancer patients today and in the future.
Digital technology has come to the fore over the past two months, not least with the rise of remote consultations. Going forward, remote consultations may still be problematic for patients with complex clinical needs or atypical cancer symptoms. However the General Medical Council has now issued guidance to help mitigate some of these concerns, and the increased convenience and efficiency of remote consultation is likely to ensure that this way of working continues in some form after the COVID-19 pressure eases.
The Single Cancer Pathway was set out by the Wales Cancer Network to improve the unacceptable delays within cancer treatment and care across Wales. Whilst this bold initiative was welcome, many inefficiencies still exist, and have been highlighted more as a result of the current situation. In England, the number of cancer assessments following referral has dropped by 60% compared to the same time last year, and patients starting treatment is down by 20%. Data from Wales has not yet been released, but is expected to follow the same trend. The clear pattern emerging is that because of COVID-19, existing cancer pathways have been truly disassembled.
As always, research can help to inform best practice, and learning from the experiences of current patients will improve service delivery in future. For example in North Wales, Cancer Research Wales scientists are collecting data on prostate cancer diagnosis from patients, diagnosing GPs and hospital specialists. By studying these real-life journeys, researchers will be able to develop new interventions that could help to prevent unnecessary delays in diagnosis going forward.
As we move out of the pandemic response period, digital technology can be further used to great effect to create more agile pathways. Researchers funded by Cancer Research Wales are investigating how digital patient reporting can be adopted via tablets in hospital waiting rooms, to make consultation time more meaningful and beneficial for both the patient and doctor. At-home use of these reporting systems will also be explored, so that symptoms and patient wellbeing can be managed more effectively from a remote setting. When established, these have the potential to be used in many other areas of medicine, something that is urgently needed following the current crisis.
Professor Tom Crosby OBE, National Cancer Clinical Director for Wales, said:
“The COVID-19 pandemic has caused severe disruption to cancer services in Wales. The reduction in urgent suspected cancer referrals, the cessation of the cancer screening programmes and the delay in some important cancer tests and treatment means that there is a growing backlog of patients that we need to get back into, and through the system as soon as possible.
This effect on the back of an already fragile cancer diagnostic and treatment system in terms of workforce, equipment and configuration of services could be catastrophic for already poor patient cancer outcomes.
However, it also provides a huge opportunity. Cancer services have in many ways been ‘deconstructed’ providing a unique opportunity to reconstruct the system with benefits, not just during the pandemic but for years, possibly decades to come. Welsh Government and NHS Wales have an opportunity to work through the Cancer Network and all cancer stakeholders to transform cancer services; to think boldly beyond hospital and organisational boundaries in terms of providing consistent and equitable access to excellent care, where necessary on a regional basis; to diagnose and treat patients in days rather than weeks and months; to introduce new technology Nationally that allow systems to communicate together and collect vital intelligence; to plan a workforce and infrastructure to meet the needs of prevention and early diagnosis and to deliver the outcomes that we want to see and the people of Wales deserve.”
The significant disruptions that the current pandemic has caused to cancer services are plain to see. However, we now have an opportunity rebuild cancer pathways in a way that will transform cancer prevention, diagnosis and treatment across Wales. Guided by the best scientific evidence, we can create improved experiences and better outcomes for patients. Getting research back on track is key in ensuring that we can deliver a better normal for cancer patients following COVID-19.