What next for UK cancer care?

What next for UK cancer care?

Breast cancer specialist DR HUGO DE LA PEÑA looks at how Covid-19 affected cancer care in the UK and what should happen now.

I have to start by talking about the pandemic. This context is important when we consider where we are with cancer now and where we will be in the coming months and years. Even without the benefit of hindsight, if you know anything about history and vaguely about immunology, it was very clear even before the first case of Covid-19 was ever detected in the UK, we were facing an unprecedented historic global event.

It was also very clear in my mind (with the way we move and travel now) that we were all going to be exposed and get Covid-19 sooner or later. For us in the UK, the pandemic first became real when Italy was hit. The news and scenes coming out of the Italian hospitals were truly horrific.

We were no longer talking about a far-away country not able to cope, we were now talking about a major European economy very near to us, and a much-loved neighbour now collapsing before our very eyes. It was astonishing to see how extreme the cases were, from infected people with not many symptoms at all, to death just days after infection.

I remember having crisis meetings in cancer care. For us oncologists treating cancer patients, we were faced with an impossible dilemma. On one hand we simply didn’t know then if cancer itself would put our patients at a higher risk of death. Our first Hippocratic oath as medics is “Do no harm” but equally, it was very clear that if we didn’t treat our cancer patients because of fear of what could happen, the alternative was certain death.

Dr Hugo loved taking part in the London Marathon

We were left, as individual centres, with the awful choice to decide what would be best: to treat or not to treat?

Could we “safely” delay or not treat certain groups of patients?

There was also a degree of fear amongst colleagues about their personal safety. You certainly don’t become a doctor and go to work to put your own life (or that of your family) at risk. Personally, and even having three young kids at home and an amazing wife, I never felt fear or hesitation about what could happen to me.

I actually got Covid very early on (pre-jabs of course). I had a temperature, felt achy for a few days and lost my sense of smell for a few weeks, still, if not being able to taste beer and wine was the price for me to pay, so be it. I was then feeling like a lion ready to go to war after that: not over-confident, but ready to help.

I volunteered to see Covid-19 patients in our wards on top of seeing my own cancer patients in clinic. This was another challenge because you certainly do not want to cross-contaminate anyone by doing so. Yet this was necessary for me, it was about protecting patients, my colleagues and stepping up at a time of national crisis.

The NHS was inevitably at the heart of it all.

I will never forget driving to the hospital on the M3 with absolutely no other cars on the roads around me. It was like an apocalyptic movie scene, even petrol station staff were giving me free deli sandwiches for being a “brave” Key Worker.

Dr Hugo

But before I got Covid-19, and despite the unknowns regarding what the outcomes for our cancer patients undergoing curative and non-curative treatments would be, I felt it would be immoral to stop ANY anti-cancer treatment.

I will never criticise units that stopped anti-cancer treatment (and some across the country did), I know these were very difficult decisions to make, but I feel an ENORMOUS amount of pride that we, in breast cancer, dealing with the most common cancer in women, didn’t stop treating anyone.

As a group, we felt it would simply be unethical and immoral to do so, but of course we needed to have the support at all levels to keep to “business as usual” in the middle of chaos all around. We needed theatre capacity, enough anaesthesiologists, surgeons, radiologists, chemo nurses and us of course, us cancer consultants, to keep everything going for our curative treatments.

For palliative (noncurative) treatments,

however, it was simply up to me and my patient to decide whether to proceed with treatment or not.

My cancer clinics never stopped and when patients needed to be seen face-to-face, we always did. I hated seeing and talking to patients through face masks because the sympathy, emotion and understanding of the situation could not be felt and transmitted properly, but again, it was a small price to pay to keep on offering vital support and treatment.

It may be difficult for some people to understand that sometimes palliative (non-curative) treatment is more urgent than curative treatment, but sometimes it simply is, as some of our treatments rescue patients from certain death and those treatments never stopped under our watch.

It was incredibly reassuring, and I remember almost dropping to my knees in relief when the first Lancet paper came out showing UK data regarding cancer patients not being at higher risk from Covid-19 because of the cancer diagnosis or because of our anti-cancer treatments.

I felt like taking a massive breath of fresh air after a near drowning experience. That was not necessarily (and it isn’t still) the case for haematology patients, because they are often immunosuppressed for longer, but at least for our solid cancer patients, we were doing the right thing by treating them and we were not exposing our patients to extra risks.

The worst of the pandemic left many families broken (physically, psychologically and economically), isolated and in despair. It revealed the best and worst in humans. I became very cynical and angry for a while, but slowly I was put back together by my family, team and patients.

What now for us in cancer care?

There’s still so much to do ...

There are 200 different types of cancer. In the 1970s, we cured 25% of patients, we now cure 50% of patients, but by 2034, we will cure 75% of patients.

For some cancers however, like breast cancer, we already cure around 80% of our patients and we are now able to cure some metastatic cancers, which were simply incurable a few years ago. We can now cure metastatic testicular cancer routinely: we also cure many metastatic melanomas and Her2+ breast cancers.

How are we going to increase our cure rates further?

By bringing the screening age for mammograms forward 10 years, by having biopsy results reported in a few days instead of weeks, by bringing Artificial Intelligence into the screening and diagnosis processes, by having every cancer patient on clinical trials and by treating more and more cancer patients with precision and intelligent medicines (what I call “cancer kryptonite”).

All of this requires major investment by governments and we will keep pushing for that. I love curing cancer, that is my life’s goal, but a cancer prevented will always be better than a cancer cured.

Did you know 40% of cancers can be prevented? Therefore, we also need to increase cancer prevention awareness by working with governments and schools around the importance of not smoking, drinking less alcohol, enjoying the sun responsibly, having a healthy weight and looking after our immune systems.

About Dr Hugo

Dr Hugo De La Peña is a breast cancer specialist and immune-oncologist based at the University Hospital Southampton. Dr Hugo is passionate about the fight against cancer and is active in personally raising money for cancer research. He featured in a recent TV advertising campaign by Cancer Research and also took part in the London Marathon 2023, raising over £5,500, adding to the thousands of pounds he has already raised for the charity. He works tirelessly to raise money and awareness around cancer treatment and prevention. More information is available on Dr Hugo’s website here.

Dr Hugo completing the London Marathon