Health Professional COVID-19 and Cancer Hub

Coronavirus (COVID-19)

We have created a central resources hub for Health Professionals which hosts all of our CRUK resources and further materials to help with managing the pandemic. We are updating the information as guidance changes. There is also a page specifically for patients on our about cancer hub.

Health Professional COVID-19 and Cancer Hub

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COVID-19 has had far-reaching impact, with significant alterations in health services across the UK, including screening, cancer diagnostics, pathways, and treatment, as well as changes in public confidence and behaviour.

At Cancer Research UK, we have been working to keep on top of the latest intelligence, data, research and guidance that both allows us to understand what the impact of COVID-19 continues to be on cancer services, and how we might best mitigate it.

On this page you can find links to COVID-19 related information and resources that have been developed for health professionals. Each resource is being kept under review and will be updated with new information as and when required.

If you are looking for patient facing information, please see our COVID-19 and Patient Cancer Hub.

 

COVID-19 has had a significant impact on primary care – patient presentation levels decreased, and CRUK estimates Around 430,000 fewer people than normal in the UK were on an urgent suspected cancer referral during March 2020-February 2021 compared with the same time the previous year.

Overall, the number of urgent suspected cancer referrals seen in secondary care dropped to the lowest point in April 2020 with around a 60% decrease compared to April 2019 (according to data from England and Wales). Since then, the numbers have been steadily improving, but according to e-Referrals Service data in England, In September numbers were, for the first time since March, around the same level as the previous year. Numbers stayed approximately similar to the previous year’s levels through to December too, with 2% more referrals, or around 3,700 more patients (around 200,900 in December 2020 compared to around 197,200 in December 2019). The graph below shows the impact on the weekly number of urgent suspected cancer referrals in England between February 2020 and February 2021. Referrals for some cancer types such as lung cancer have been more impacted than others and are further behind recovering.

Monthly numbers of urgent (2ww) suspected cancer referrals, England (CWT data)

This is mirrored by a decrease in diagnostic testing – in England, over March 2020-February 2021 there was a 24% reduction in the number of key radiology and endoscopy tests undertaken (around 4.6 million fewer of these were undertaken compared to the same time in the previous year).

 

 

Lung cancer can be challenging to diagnose even under normal circumstances; therefore, it is more important than ever to be alert to the risk of suspected lung cancer in your patients, with the added possibility of symptoms now being disguised by potential COVID-19 symptoms.

Urgent referrals for suspected lung cancer have seen a sustained reduction as a result of the COVID-19 pandemic.

In England and Wales, urgent referrals for suspected lung cancer were 34% lower between March-December 2020 compared with the same time period in 2019, which equates to around 18,400 fewer people.

While the equivalent data isn’t available in Scotland, the picture is similar and 19% fewer patients started treatment for lung cancer following an urgent referral for suspected cancer between April-September 2020 compared with the same time period in 2019. This equates to around 450 fewer people.

Public Health England are running a public facing campaign from February 2021 to raise awareness lung cancer symptoms during Covid. The campaign is to alert the public to seek help from their GP if they have a cough for 3 weeks or more and reassure them that it is safe to visit the GP. To access the PHE Health Professional resources for this campaign please click here.

The Scottish Government also ran a public facing campaign throughout February 2021, to raise awareness of lung cancer symptoms during Covid including a cough for 3 weeks and let the public know that visiting the GP is safe.

Download our one-page guide highlighting some of the key messages for health professionals, particularly GPs, on managing patients who are presenting with suspected lung cancer during the pandemic and reinforcing the importance of being alert to the risk of lung cancer in patients.

Download the recognition and referral of suspected lung cancer during COVID-19 guide

See how national actions on referrals and diagnostic tests are incorporated into the GP contract requirements for 2021/22 or QOF QI for 21/22 in England

Urgent referrals for suspected urological cancer have been among the slowest to recover during the COVID-19 pandemic with urgent referrals 26%* lower in England and Wales from March‒December compared to the same period in 2019, which translates to:

  • Around 48,800 fewer people* on an urgent referral for suspected urological cancer in England and Wales

Key actions:

  1. Be alert to signs and symptoms of suspected urological cancer in your patients. Use national and local guidance to help guide decision making and make use of the low referral thresholds in line NG12 and SRG where possible.
  2. Safety net all patients whether they are referred for tests or an urgent referral or not.

*While this data is just for England and Wales, we anticipate the picture is similar in Scotland and Northern Ireland.

View our guide to safety netting during the COVID-19 pandemic

 

Watch a short video with Dr Joe Mays, Cancer Research UK GP, discussing the impact of the pandemic on urgent referrals for suspected urological cancer.

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The COVID-19 pandemic has had a significant impact on patient behaviour, with fewer patients seeking help for serious diseases than expected. There have been a number of national campaigns to encourage the public to contact their GP and NHS more generally. in England, Scotland, and Wales.

CRUK ran a short film on Digital TV and social media channels in June and again throughout September and October 2020 to support this. Patient presentation and urgent referrals continue to slowly recover, however referrals for some cancer types such as lung cancer have been more impacted and are further behind recovery compared to that seen in others.

Public Health England and the Scottish Government also recently ran public facing campaigns to raise awareness of lung cancer symptoms and to encourage people to seek help from their GP.

On the 7th of June, CRUK will be launching a multi-channel campaign in Wales which aims to positively influence the public's attitudes to help seeking to ultimately encourage timely presentation to their GP for potential signs/symptoms of cancer. It will run for 6 weeks over TV, social media, and printed publications.

GPs in Wales will be informed of the campaign prior to launch, through marketing channels including emails and promoted posts on Twitter. They will be provided with information on safety netting to support the management and onward referral of patients.

Download our guide for GPs for more information on the public-facing campaign in Wales and what you can do to prepare your surgery

See links below for previous campaigns to encourage patients to seek help from their GP.

During COVID-19 around 3 million fewer people were screened via the bowel, breast or cervical cancer screening programmes in the UK than we would expect under normal circumstances*  Cancer screening was effectively paused from late March 2020 across the UK nations, and restarted from ~June 2020

Screening programmes are now working through the backlog but due to the impact of COVID-19 on health services access continues to vary across each nation and programme.

As invitations are sent and follow up tests resume, there will be perceived risks as well as emotional and physical barriers to attending appointments for patients. Practice staff are in an ideal position to reassure patients of the safety measures in place for cervical screening as well as informing patients about participating in bowel and breast screening. 

See the screening resource below for some useful tips for how your practice can support people to access cancer screening services.

*CRUK estimate based on weekly average number of people screened via bowel, breast and cervical screening programmes.

COVID-19 has reinforced the importance of safety netting. These unprecedented times have prompted rapid changes to pathways and shifts in patient and health professional behaviour, as well as creating a significant patient backlog. This has the potential to impact patients and undermine our efforts to see fewer people diagnosed with late stage cancer. During the recovery phase, robust safety netting protocols are important for mitigating the impact of COVID-19 on patients.

Our guide includes key safety netting tips, organised around some of the patient scenarios that the pandemic has brought to the fore. 

Download safety netting guide

 

Prior to COVID-19, there was variable use of the Faecal Immunochemical Test (FIT) in low risk patients who didn’t meet the criteria for urgent suspected cancer referral (NICE NG12 or Scottish Cancer Referral guidelines, where applicable) with pockets of FIT being used in other, including higher risk; patients prior to referral with lower GI symptoms.

The impact of COVID-19 on health services has meant local health systems have sought to manage demand and reduce unnecessary patient risk. The use of FIT in patients who meet criteria for urgent suspected cancer referral (‘high risk’) has been accelerated with a view to helping to prioritise the limited endoscopic capacity to those most in need.

 

For patient facing information see our COVID-19 and Patient Cancer Hub

For information on the impact of COVID-19 on cancer services see our CRUK COVID-19 and cancer blog

Our CRUK Facilitators support GPs to deliver best practice in cancer prevention and early diagnosis, enquire about free remote support in your area here

For information on the GP contract 21/22 for practices and PCNs see our GP Contract Hub

If you have any questions or feedback on the about this information please contact earlydiagnosis@cancer.org.uk