Georgios Lyratzopoulos is Professor of Cancer Epidemiology at University College London (UCL).
Comment and opinion from Cancer Research UK’s community of experts. The opinions outlined in this article do not necessarily represent the views of Cancer Research UK.
The COVID-19 public health crisis is radically shaking up the way we organise and deliver healthcare for everyone. But diagnostic services – for cancer and other conditions – have been particularly affected.
Reducing deaths and hospital admissions from COVID-19 is rightly the most immediate priority, but how can early diagnosis research help to minimise disruptions in diagnostic services amidst the pandemic and during recovery in the coming months and years?
Understanding behaviour
Much prior research has highlighted the importance of factors such as health literacy, on people’s tendency to seek help for symptoms that could be cancer. However, combining messages about preventing COVID-19 with help-seeking for possible cancer symptoms is really challenging.
We therefore urgently need timely and ongoing research to understand the public’s knowledge, beliefs and attitudes about cancer risk and cancer symptoms amidst the pandemic, complemented by data on how people actually behave. That way we can see which symptoms patients may be less likely to seek help for during the pandemic, so that policy-makers can more finely target public health campaigns. Respiratory symptoms like coughs, that may clear up in most cases, may also be due to either COVID-19 or lung cancer – a poignant example of the need for such research.
Better tests
The pandemic has not only emphasised limitations in our strategies to detect cancer early, but also efficiently. In 2019/20, the last pre-pandemic financial year, there were around 2.4 million urgent referrals for suspected cancer under the ‘two-week-wait’ rule in England, of which around 1 in 15 (6.6%) was found to have cancer.
How we could achieve speedier cancer detection with fewer hospital referrals without undermining our aim to detect cancer at an earlier stage?
One area of huge, unrealised promise is to improve the tests available to GPs and community care services. Faecal Immunochemical Testing (for possible bowel cancer), CA125 measurement (for suspected ovarian cancer) and the use of chest X-Ray (for possible lung cancer) are tests whose potential is increasingly understood through research. However more, and more-accurate, tests still need to be developed, including tests where if the result is negative doctors can consider that cancer is an unlikely diagnosis (so-called ‘rule-out’ tests, that have high negative predictive value), saving a hospital referral.
An interesting new blood test, based on circulating DNA, is also going to be researched in the NHS in England. Tests with potential applications both as diagnostic and as screening investigations, and epidemiological knowledge to enable appropriate stratification, can be of particular value as they can be used for different indications and clinical scenarios.
The development, implementation and evaluation of new ways to improve cancer diagnosis is rightly the focus of much Cancer Research UK-funded research. This notion underpins the charity’s Early Detection and Diagnosis Roadmap, and is also exemplified by our CanTest research collaborative – a coalition of 4 UK Centres of Excellence in early diagnosis research, together with 5 international partners in Australia, the Netherlands, Denmark and the US.
Better infrastructure
But new tests, while necessary, won’t be sufficient. The pandemic has emphasised the need for sustained investment in the medical and nursing workforce, and in the healthcare infrastructure that supports it. Cancer services, both diagnostic and therapeutic, rely critically on the same health workforce and services shared across diseases. Diagnostic services need to be integrated with those used for investigating other diseases – the NHS Rapid Diagnostic Centres provide such a model. But we also need new coalitions of research funders and researchers focusing on improving diagnosis in healthcare across the disease spectrum.
Better use of data
Amidst the crises, an unanticipated ‘benefit’ of the COVID-19 public health crisis is that now, even more so than ever before, there is an appreciation of the value of public health, and of population-based collections of anonymous patient data. During the pandemic, we’ve seen that ‘Data Saves Lives’ literally, and more so than any other time in recent history. Through its high-quality cancer registries in England, Scotland, Wales and Northern Ireland, the UK has a rich tradition of collecting patient data for public good.
Extraordinary improvements in the availability, breadth and depth of (linked) cancer data have been achieved in recent years. It is beholden upon all of us involved in delivering and researching diagnostic pathways, tests and services that we accelerate the production, curation and use of timely and high-quality data for direct patient benefit, to improve health and reduce inequalities in access and cancer outcomes.
These are just few of the themes underpinning the 4 sessions that form the Cancer Research UK Early Diagnosis Research virtual series. The series got off to a great start today, and there will likely be some important discussions had amongst researchers, healthcare professions, policymakers, industry and people affected by cancer in the upcoming sessions.
Please come along to enjoy an outstanding programme of lectures and facilitated discussions, hosted by Cancer Research UK’s Strategic Evidence team, and help us to improve diagnosis of cancer during and beyond the pandemic.
Register for the Early Diagnosis Research virtual series on the Cancer Research UK website.
About the author
Georgios Lyratzopoulos is a Professor of Cancer Epidemiology at University College London and Associate Director of the CanTest Research Collaborative. Lyratzopoulos leads the Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group and CanTest@UCL. He is Cancer Research UK Senior Clinician Scientist Fellow. His research uses population-based data to help understand mechanisms leading to late diagnosis and guide efforts to improve cancer outcomes. He has published about 200 peer-reviewed papers, 60% of which as first or last author, and was awarded the Cancer Research UK ‘Future Leader’ Prize in 2016.
