Mapping out the Affect of Covid-19 on Cancer Care in the UK: Reflections on a Changed Landscape

CLARA FABIAN-THEROND

As a medical anthropology PhD student my plan was to start ethnographic research, examining the socio-cultural impact of personalised therapeutics in the NHS colorectal and ovarian cancer treatment setting, in late spring. The arrival of coronavirus in the UK, however, halted this planned start date. Instead, over the last three or so months I have been at home working and thinking about how Covid-19 is impacting cancer patients and health professionals at the forefront of these developments.

Indeed, as the opening words taken from Cancer Research UK’s June 1st  Science blog indicate, “Covid-19 has placed a huge strain on cancer services in the UK” NHS.

When lockdown began in the UK on March 23rd most NHS Trusts put many cancer services on hold, and it is now estimated that over 2 million people face delayed diagnosis, screening and treatment [1].

In fact, the figures are even starker when broken down. For every week of lockdown, Cancer Research UK estimate that patient referrals for further tests are not taking place for approximately 7,000 people [2]. With every week that passes, with referrals remaining well below normal levels, undiagnosed cancer cases are building up creating a backlog for NHS cancer services to clear.

As Cancer Research UK’s Chief Clinician Professor Charles Swanton notes, for patients caught up in this delay many may well receive the bad news that their cancer is now inoperable, adding that “cancer patients shouldn’t need to wait for the pandemic to pass before getting the treatment they need” [3].

In late April, University College London published figures which indicate that the coronavirus pandemic could lead to 18,000 more cancer deaths in England [4]. These numbers reveal the stark reality that a wave of cancer deaths may be on the horizon. Whilst a study conducted by DATA-CAN, the Health Care Research Hub (HDR UK) paints the same bleak picture, estimating that as a consequence of reduced cancer services, England may see “at least 20% more deaths over the next twelve months in people who have been newly diagnosed with cancer.”

It is not only the numbers that make for sombre reading, as I watched the BBC Panorama programme “Britain’s Cancer Crisis” aired on July 6th the stories of patients left waiting and wondering if and/ or when treatment would (re)start was a heart breaking and poignant reminder of the profound impact Covid-19 is having on patients and carers.

Thinking about the devastating socio-cultural consequences of Covid-19 and the way it has inflicted such a deep wound on the individual patient and collective bodies of cancer care makes my recollection of the inaugural 2019 UCL Cancer Domain Symposium seem a somewhat distant and surreal memory. Many of the same scientists now warning of the dire situation some cancer patients, and those who care for them, find themselves in, are those same speakers who took to the stage at this uplifting event. Only back then, they stood at the front of an auditorium packed full of over 430 scientists from across life and social sciences and members of the public, to showcase their latest innovative research findings and treatment advances being made in cancer research at UCL and across the UK.

For instance, the Chief Executive from a world leading research hospital stood at the podium to present his upbeat assessment on the impact of new cancer drugs being developed in the twenty-first century. Medicine has never been so good, he stated, patients are not just living longer but afforded a better life as a result of the ground-breaking collaborative work being conducted across UK cancer research and clinical practice.

Each talk was infused with high octane notes of anticipation, hope and the promise of what Mary DelVecchio Good describes as the “medical imaginary” (2001) as oncologists and indeed  increasing numbers of patients at the frontiers of receiving personalised oncology technologies, are enveloped by the “biotechnical embrace” [5].

The Symposium ended on a buoyant note confirming not only the importance of bringing together diverse socio-technical, clinical and economic perspectives in the effort to beat cancer but firmly anchoring the position of UK cancer research as a global leader in a rapidly changing biopolitical landscape.

Yet, Covid-19 has dramatically changed this landscape. And as an open letter to the Prime Minister, signed by over 60 prominent cancer and cardiovascular researchers, on July 7th makes clear, there is now an urgent need to support UK medical research charities. In fact, Cancer Research UK could now face the prospect of being “forced to cut £150 million per year from its research funding”, potentially throwing away decades of investment into research on improving cancer survival and progress made on life saving discoveries, whilst also putting in jeopardy the chance to train the next generation of cancer research scientists  [6].

The devasting impact of coronavirus is being felt across cancer research. As Professor Bhavik Patel explains on Cancer Research UK’s science blog 7th July, closing laboratories since the end of March was as he put it “a real kick in the stomach” as he goes on to say “we were in a period with our research where it was the most exciting it’s ever been” [7].

Although it may take some time to get laboratory research back up and running again, the NHS is taking the next steps to alleviate the impact of Covid-19 on cancer care and things are moving forward [8]. On the 30th June the government announced that some Nightingale hospitals will be converted into cancer testing centres to help get services back on track, and alongside remote consultations between oncologists and their patients, face-to-face clinical encounters are gradually restarting [9].

Yet, with approximately 6,000 fewer patients receiving chemotherapy since lockdown began and 12, 750 patients in the UK waiting for cancer surgery the implications of Covid-19 on patient’s lived experience is only just starting to emerge [10].  

Today, July 23rd, nearly three weeks after a further easing of the lockdown and a year on from my initial preparations to begin clinically grounded ethnographic work in the NHS cancer setting, I contemplate what the pandemic (and the figures and stories above) means for the Anthropologies of Cancer.

As many cancer scholars point out cancer is not solely a physical disease, but a social and economic condition grounded in diverse material realities spread within and across high-low and middle-income countries [11;12;13]. With this focus on (blurred) boundaries, borders and margins anthropological research has an important role to play in understanding the affect of Covid-19 on cancers complex entanglements. In what way then, does the emergence of this new disease evoke a closer look at tackling existing socio-economic disparities which often shape if, how and/or when patients from different communities engage with primary and /or tertiary cancer care? As governments respond to Covid-19, and seek to prepare for future pandemics, how might differences between healthcare systems widen cancer disparities, in relation to treatment access and survivorship? As we learn more about the virus what will be the affect on notions of susceptibility, risk and suffering in the context of treating and caring for cancer patients? And how will patients, cancer charities, and the vital work they do across the globe manage and adapt to the challenges presented by the pandemic?

By focusing on dynamics between culture, health, disease, medicine and the body, and drawing on a number of theoretical approaches, medical anthropology provides an important contribution to understanding the socio-cultural and political consequences of Covid-19 as it travels into the local worlds of people affected by cancer.

Anthropologists and fellow social scientists are already setting out to map the (additional) emotional and embodied burdens patients and their carers will have to carry as they navigate an even more uncertain terrain of hoping to live with and beyond cancer, in this time of Covid-19.

ABOUT THE AUTHOR:

Clara Fabian-Therond is an Economic and Social Research Council funded Ph.D. student at the Department of Anthropology, University College London.

 [1] Roberts. K. June 1, 2020. Available at : https://scienceblog.cancerresearchuk.org/2020/06/01/impact-of-coronavirus-on-cancer-services-revealed-over-2-million-people-waiting-for-screening-tests-and-treatments/

[2] Roberts. K. June 1, 2020. Available at : https://scienceblog.cancerresearchuk.org/2020/06/01/impact-of-coronavirus-on-cancer-services-revealed-over-2-million-people-waiting-for-screening-tests-and-treatments/

[3] Hiom, S. April 21, 2020. Available at: https://scienceblog.cancerresearchuk.org/2020/04/21/how-coronavirus-is-impacting-cancer-services-in-the-uk/

[4] Roberts, K. March 19, 2020. Available at: https://scienceblog.cancerresearchuk.org/2020/03/19/coronavirus-and-cancer-latest-updates/

[5] DelVecchio Good 2001. “The Biotechnical Embrace.” Culture, Medicine, and Psychiatry, 25, 395-410.

[6] Roberts, K. July 7, 2020. Available at:

[7] Matson, L. July 7, 2020.  Available at: https://scienceblog.cancerresearchuk.org/2020/07/07/covid-19-the-really-hard-part-is-we-know-what-needs-to-be-done/

[8] Mitchell, M. June 24, 2020. Available at: https://scienceblog.cancerresearchuk.org/2020/06/24/opinion-uk-cancer-research-could-be-set-back-years-by-covid-19-we-must-act-now/

[9] Roberts, K. June 4, 2020. Available at https://scienceblog.cancerresearchuk.org/2020/06/04/coronavirus-and-cancer-june-updates/

Shrotri, K. June 22, 2020. Available at: https://scienceblog.cancerresearchuk.org/2020/06/22/getting-cancer-services-back-on-track-during-the-covid-19-pandemic/

[10] Roberts. K. June 1, 2020. Available at : https://scienceblog.cancerresearchuk.org/2020/06/01/impact-of-coronavirus-on-cancer-services-revealed-over-2-million-people-waiting-for-screening-tests-and-treatments/

Booth, R. June 29, 2020. “Petrified cancer patients fearful of lockdown easing, says charity.” Available at: https://www.theguardian.com/society/2020/jun/29/petrified-cancer-patients-fearful-of-lockdown-easing-says-charity

[11] Kerr, A. and Cunningham-Burley, S. 2015. “Embodied innovation and regulation of medical technoscience: transformations in cancer patienthood.” Law. Innovation and Technology. Vol 7 (2): 187-205.

[12] Livingston J. 2012. “Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic.” Duke University Press: Durham and London.

[13] Mathews, H. Burke, N and Kampriani E. 2015. “Anthropologies of cancer in Transnational Worlds.” Routledge: New York.

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One Comment Add yours

  1. Rafa Tomas says:

    What an interesting topic.

    Congratulations, Rebbeca

    I have relatives and friends affected by this problem and I have thought about it a lot during these months.

    Thanks and regards

    Rafa Tomás

    El vie., 24 jul. 2020 a las 10:00, Medical Anthropology at UCL () escribió:

    > Rebecca_Irons posted: ” CLARA FABIAN-THEROND As a medical anthropology PhD > student my plan was to start ethnographic research, examining the > socio-cultural impact of personalised therapeutics in the NHS colorectal > and ovarian cancer treatment setting, in late spring. The arr” >

    Like

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