Cancer services may be rationed to those most likely to survive, says NHS report 

National Health Service insist limited care for cancer patients is 'unlikely scenario'

Cancer services should be rationed to patients with the highest chance of survival if hospitals become overwhelmed with coronavirus, a new NHS protocol states.

It warns the frequency of treatments such as immunotherapy could be halved and long-term follow-up postponed indefinitely, as staff are diverted to fight Covid-19.

Published by NHS England last week, the document also predicts that access to CT scanners  crucial for some cancer diagnoses  could be limited because of their use by coronavirus patients.

Although its authors state that disruption of cancer services remains an “unlikely scenario”, they warn: “We need to consider the small possibility that the facility for cancer services may be compromised due to a combination of factors including staff sickness and supply chain shortages among others.

“In the event of disruption to cancer services, clinicians may also need to prioritise treatment for those most in need.”

It comes after Prime Minister Boris Johnson warned the NHS is facing an Italian-style crisis (as illustrated in the below video), and cancer patients in London alleged that their treatment plans have been postponed within the last few days.

Meanwhile on Saturday the National Institute for Health and Care Excellence (Nice) issued a new framework for intensive care which effectively allows doctors to ration precious beds and ventilators to those with the greatest chance of survival.

Hospital bosses were given permission by NHS England last Tuesday to suspend all non-urgent treatment, to ready services for a flood of Covid-19 patients that appears already to have started, particularly in London.

However, health leaders have promised to protect urgent services such as cancer.

Under the new protocol, cancer patients in hospitals under pressure from coronavirus will be grouped into one of six categories, with treatments rationed accordingly.

They range from, at the top, curative therapy with a greater than 50 per cent chance of success, to, at the bottom, non-curative therapy with an sub-50 per cent chance of palliation, or temporary tumour control yielding less than one year’s life extension.

One patient with advanced bowel cancer at the Royal Free hospital in London, who falls into category five, said she had been informed last week that her next batch of treatment, due to start in the next three to six weeks, would not take place for at least three months.

“It’s incredibly stressful, to be honest,” she told The Telegraph. “I wasn’t told why the delay was happening but I can’t believe that this outbreak won’t affect treatment.

“Friends I have made in the unit say their treatment plans have been altered as well.”

The Royal Free denies that any treatments are being delayed by the coronavirus outbreak, insisting that cancer services are running normally.

The new NHS cancer protocols are predicated on the expectation that a surge of coronavirus cases would deprive cancer services of some personnel, due both to staff illness and redeployment, and equipment.

It even quotes an Italian doctor involved in fighting coronavirus in northern Italy, Daniele Macchine, who said: “There are no more surgeons, urologists, orthopaedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.”

This reflects the expectation, prompted by a letter from Chief Medical Officer Professor Chris Whitty earlier this month, that clinicians would have to work outside their normal areas of training.

Cancer doctors faced with hospital flooded with Covid-19 patients are urged to consider “using 4-weekly or 6-weekly immunotherapy regimens rather than two-weekly and three-weekly”, and “considering treatment breaks for long-term treatments when risk of coronavirus is high”.

Even where NHS cancer services are available, the new guidance published on Saturday from the Nice advises patients to consider delaying treatment because of their heightened risk from Covid-19.

These include those whose immune systems have been weakened by treatments such as chemotherapy and immunotherapy.

To deal with the expected surge in patients with Covid-19, the health service has struck a deal with private hospitals to make use of 20,000 staff and 8,000 beds. An extra 1,200 ventilators will also come into circulation from next week.

The new Nice guidance asks doctors to score patients on an nine point “clinical frailty scale” [CFS] as they might normally do.

At one end of the scale, with a score of one, are the “Very Fit”  people who are “robust, active, energetic and motivated”, and who “exercise regularly”. At the other end, with a score of nine, are the “Terminally ill”.

This weekend a senior director a London acute trust said the NHS was only in the "foothills" of the outbreak.

He told Health Service Journal: “The trusts in outer London seem to be hit much worse at the moment, probably about two weeks ahead of the rest of the country. Barnet, Lewisham and Greenwich, Epsom and St Helier, North Middlesex and Hillingdon are all struggling.

“I was in denial about the seriousness of this virus a couple of weeks ago, but not anymore… things are going completely nuts”.

A spokesman for the Royal Free London said: "All cancer services are running as normal and treatments are not being delayed by the response to the Covid-19 outbreak."