‘More people will die from pancreatic cancer’: How COVID-19 is diverting resources and costing lives

More people with pancreatic cancer will die from the disease if the COVID-19 crisis continues to demand the lion’s share of clinical time and resources.

That’s the stark warning from Pancreatic Cancer Action, which has been inundated with enquiries from people whose operations and chemotherapy have been cancelled in recent weeks.

Ali Stunt, the charity’s chief executive and founder, says: “Medical professionals are having to make really difficult decisions. They are having to choose between dealing with acutely unwell COVID-19 patients and those patients who could have elective surgery for operable pancreatic cancer.

“We know that on the ground, people’s surgeries are being postponed, but it varies from trust to trust. It really depends on where you are in the country.”

Diagnoses are also slowing, as people find it difficult to access primary care for a referral, and all non-emergency endoscopies, a mainstay of pancreatic cancer detection, have stopped due to the risk of the aerosol transmission of the novel coronavirus.

Many hospitals have paused immune system-sapping courses of chemotherapy, and patients themselves are concerned about attending hospital appointments in the midst of a pandemic.

At the same time, oncology healthcare professionals are being redeployed to the COVID-19 front line, leaving fewer doctors and nurses to administer the chemotherapy to those people who are able to continue with treatment.

Combined, these factors are rewriting the pancreatic cancer pathway and could potentially impact hundreds of patients and their families.

“It is so important that people are diagnosed and treated quickly. We know that if there is a substantial delay, those patients who could potentially have survived will not,” says Stunt.

“That’s really distressing, not just for the patients, but for people like us who support them and want to help them. It just makes you feel incredibly helpless.”

Increasing chances

Stunt, who was told she had pancreatic ductal adenocarcinoma in 2007, knows the importance of early diagnosis and treatment first-hand.

When doctors assumed her symptoms were related to gallstones, she was told it was a four to six week wait for an ultrasound. Instead, she used private healthcare insurance provided by her husband’s employers to access a private consultation. The resulting scan found a 5.5cm tumour in her pancreas.

“The doctor said if I had waited for the NHS appointment, it would not have been operable. And that is the crux of the problem we are dealing with right now,” she said.

Ali explained that the average life expectancy for someone with pancreatic cancer was just four to six months, but those suitable for resection did significantly better.

“Of the 10,000 people diagnosed with pancreatic cancer every year, roughly 10% go on to have potentially curative surgery. It's not a huge amount, but people who are able to have that surgery and follow it up with chemotherapy will see their five-year survival rate go from 7% to between 30 and 35%.

“My fear is, and I don’t want to be vindicated on this, but I worry that some people who were deemed operable, or who have only been diagnosed in the last few weeks, and could have had a much greater chance of surviving five years, are having that chance taken away.

“If we are going to stop the surgery, we're going to have potentially hundreds of patients who will unfortunately end up with metastatic disease.  Basically, fewer people are going to survive pancreatic cancer.”

Regional variations

Stunt’s charity is attempting to support the people it serves through this uncertain time, but the task is complicated by regional variations in how the crisis is being handled.

Decisions are being made on a trust-by-trust basis and seem to be largely driven by the burden of COVID-19 in each area.

“People are in limbo and are reaching out to organisations like ours for support because they just don’t know what to do. It’s a really difficult and frightening situation. But there’s nothing we can tell them other than to speak to their medical team, if they can, and to wait.

“There’s nothing we can do to influence this virus that is so rapidly tearing through our country at the minute.”

The charity is constantly updating its website with the latest information, but with the rapidly evolving landscape, it is proving impossible to provide everyone with the information they need, when they need it.

And just as demand for their services has soared, resources are being stretched to breaking point.

“Because we are so reliant on voluntary donations, our income has virtually dried up overnight,” says Stunt, adding that 60% of the team had been furloughed in a bid to keep the charity afloat.

Despite the challenges, Pancreatic Cancer Action is determined to be there for the people who need them.

“It’s a really difficult time, but our first priority is the patients. We need to do everything we can so that when this is over, we can hit the ground running and pick up where we left off,” Stunt says.

For more information on how COVID-19 is affecting people with pancreatic cancer, or to donate to the charity, go to https://pancreaticcanceraction.org/