‘Covid has turned cancer treatment upside down’

Throughout the Covid-19 pandemic, and especially during the first lockdown, the total focus on coronavirus has meant other diseases, like cancer, have been neglected. Important treatments and screenings were cancelled to make way for a wave of infections, the scale of which turned out to be much smaller than expected. Will our myopic focus on Covid end up costing more lives than it saves?

Karol Sikora is an oncologist and leading authority on cancer. From 1997 to 1999, he was chief of the cancer programme at the World Health Organisation. spiked caught up with him to discuss lockdown’s impact on cancer treatment and on non-Covid health in general.

spiked: How bad have things got this year in terms of cancer care?

Karol Sikora: What has happened with cancer is very curious. When we went into lockdown in March, the hospitals stopped all routine surgery, which meant many cancer patients could not be diagnosed, and cancer surgery could not be done. The first three months were the worst – there was a massive drop-off in new cancer patients.

The reasons were threefold. Firstly, people were too scared to go to their GP. Secondly, GPs were not seeing patients in the normal way. Thirdly, hospitals were not receiving cancer patients. All three systems were breaking down.

In June, there was a patchwork recovery, but it’s been very slow. It’s not that people are not getting cancer – far from it. They are getting it but not being diagnosed. We have bottled up a whole lot of trouble for ourselves in the early part of next year, when people with more advanced cancer than we would normally expect will present for treatment.

spiked: What does a cancer pathway look like in normal times, and what has changed?

Sikora: In normal times, if you get persistent symptoms, you go to your GP. The GP suggests you go to hospital for a checkup, which may involve a test.

The trouble with cancer is that it presents in many different organs at different times and in different ways. It mimics all sorts of other illnesses. There’s nothing definitive about cancer, so the only way to sort out cancer patients is just to do all the tests on everybody. We have to speed up diagnosis for everybody.

Things are improving every year. But, obviously, what Covid has done is turn everything upside down. It has really been a major block in the whole diagnostic pathway for cancer.

spiked: The government says that any impact of lockdown on non-Covid health is a direct result of Covid and of hospitals being too full. Do you accept that characterisation?

Sikora: No. There’s no doubt that Covid was given priority in the first three months. Subsequently, we have tried to bring other services back, but it’s proven very difficult. The NHS is rather like a big battleship on the ocean. Suddenly, you want to change course and you can’t – it has to turn around very slowly. When it started dealing with Covid it was different. It changed immediately. It stopped all routine procedures. But it’s very difficult to turn back to normal.

spiked: Would you say that in the early months, more operations, tests, diagnoses and checkups were cancelled than was necessary given the actual levels of Covid in hospitals?

Sikora: That’s a fair assessment. And the reason, of course, is that the first time round, we didn’t know how bad it was going to be. Epidemiologists scared everybody right at the beginning, but it wasn’t as bad as we thought. The Nightingale hospitals were never needed, for example – it just wasn’t that bad.

The second time around, hospitalisations are now going down and the use of ventilation beds is going down. And we have not been so scared this time.

The majority of cancer patients are curable. But they are not if you delay. The average age of cancer patients is in the 50s and 60s. The average age of Covid death is 82.4 years. The number of life-years lost from cancer is going to be massive compared to Covid, when we are able to analyse it. Since 82.4 years is very similar to the average age of death in Britain anyway, the loss of life-years model favours cancer every time and it favours heart disease and to a certain extent strokes as well.

spiked: The Institute of Cancer Research says that there will be only around 5,000 excess cancer deaths from this year’s disruptions. Do you think it’s higher than that?

Sikora: It’s going to be higher than that. One estimate in October was that up to 50,000 people have cancer but have not been diagnosed due to Covid. And if you work forward with that, then there’s probably going to be a significant change in the outcomes for large numbers of people, some of whom will die because of the delay.

The problem with cancer is that it doesn’t stop. Stage One cancer, which is confined to one organ, will spread if untreated and become a Stage Two and then a Stage Three cancer. And although we can treat the cancer, even Stage Three or Stage Four cancer, the treatment is not as effective as for Stage One. Early-stage cancers have high chances for being cured – more than 90 per cent in Stage One. For Stages Three and Four, it drops precipitously, with only about five per cent of patients surviving when diagnosed in Stage Four. Any delay just pushes the stage of the cancer upwards so that there is less chance of it being successfully treated.

spiked: Do you think there’s a danger that non-Covid health problems more broadly will continue to be overlooked as we come in and out of lockdown?

Sikora: I think the worst issues, for the majority of people, are the mental-health ones. I can’t stand these politicians who are very self-righteous, but just ignore the mental-health problems.

It’s connected with the economy. If you are running your own business, or are a gig employee who is paid for what you do by the hour, you are seriously disadvantaged and your future is threatened. If you want to go out and enjoy yourself, the options are not there. In Wales, you can’t even get an alcoholic drink in a pub, and the pub has to shut at six o’clock. This is just complete madness, and is not based on any scientific foundation whatsoever. As a society, we are used to certain norms, and liberty is in those norms. We have got to get back to a normal society to allow people to have better mental health.

Let’s get the football going, let’s get the pubs open, so that people can do what they were doing for enjoyment before. It’s the simple things that make life pleasurable. Let’s not keep people hidden away.

spiked: Do you think we are likely to be able to go back to normal, given the way the epidemic is going?

Sikora: It’s quite remarkable that, in the second lockdown, the schools remained open. Some children have been sent home from school and so on, but on the whole, it’s gone remarkably well. And that’s how I see society as a whole going, so that by Easter we will look back and wonder what this was all about. Things will get back to a state of reasonable normality.

Karol Sikora was speaking to Fraser Myers.