As hospitals focus on coronavirus, attention shifts away from cancer

The novel coronavirus pandemic has seen health services worldwide put under levels of strain rarely seen in peacetime, with surgeries and hospitals facing overwhelming demand.

While preventative and containment measures may have at least temporarily slowed the progress of the virus, that is only half the story, as COVID-19's ripple effects have diverted attention away from other conditions, particularly cancer.

Since England's lockdown began in March, urgent two-week referral waits for suspected cancer cases have fallen by as much as 84 percent, causing a backlog and increasing the likelihood of cases remaining undiagnosed until advanced stages.

For more than 100 years, the Institute of Cancer Research, which is a college of the University of London, has been a world-leading research center of excellence. Now it is working to remind the world cancer has not been locked down, and must remain a priority for health workers and patients.

Clare Turnbull is one of the leaders of the ICR team that highlighted the problem, and said initially, it came to light when they were investigating a different issue.

Drop in referrals

"At the start of the pandemic, we were looking at whether we would need to prioritise surgical patients, and who would benefit the most from not being delayed, but it soon became clear that there was a substantial drop in referrals for primary care," she said.

"The real problem wasn't at the point of surgery, but at the point of diagnostics. This caused a bottleneck that is only playing out now. We're still at the early stage of being able to establish its extent but there are many people awaiting investigation, which could then cause another backlog at the point of surgery."

As a National Health Service doctor herself, Turnbull knows how the pandemic has laid siege to resources. While many other conditions have also been pushed to one side by COVID-19, cancer's demand for attention is more pressing than most.

"In March and April, the NHS was nearly paralyzed as it dealt with COVID-19, meaning a lot of scans were delayed," she explained.

"This will have affected patients with many conditions but what's special about cancer is that in the early stages, it's localized, so we aim to catch it as early as possible and restore life expectancy. Even if you find the horse has already bolted, delaying treatment increases the likelihood that a horse that hasn't already bolted could do so later on."

The job of the NHS is to protect the health of the nation, and when it comes to cancer, the ICR's contribution to making that happen is vital.

"As a research institute, we use our skills to produce an evidence-based way forward, to formulate an expectation of the impact, and present a prioritization strategy," she said. "With that knowledge, the NHS uses its resources to mitigate these issues as best it can."

Cancer is a global concern, and the ICR reflects this, with more than 50 nationalities on its workforce. Part of that multinational team is Yuan Yinyin, who studied at the University of Science and Technology of China before joining the ICR eight years ago as the leader of the Computational Pathology and Integrative Genomics team. Her field of expertise is using computational approaches and artificial intelligence to study tumors as evolving ecosystems.

"We've been building up evidence to study the evolution of cancer, because we know cancer cells within the same patient can have different functions because of genetics, which can be one of the major factors relating to drug resistance which leads to relapse, which is the major challenge in cancer management," she said.

"Charles Darwin studied the diversity of finches on the Galapagos Islands to map the islands' ecology and see how they evolved－using AI, I'm doing something similar, mapping new landscapes for individual cancer patients," she said.

Reducing drug toxicity

"As well as extending life, we're also looking at reducing drug toxicity. It's not just about using more drugs in combination, but delivering more effective and targeted therapy that kills cancer cells and works out the most effective treatment combinations."

The butterfly effect of the COVID-19 crisis has made the ICR's work more vital than ever, but also economically, more challenging.

An appeal to kick-start research funding has picked up some of the slack caused by a revenue downturn, and the financial squeeze has come at a particularly bad time as 2020 was the year the ICR was making the final push on the completion of its soon-to-open£75 million ($98 million) new Centre for Cancer Drug Discovery in Sutton, just outside London, where Yuan's research team will be based, working on the world's first Darwinian drug discovery program.

"Like everyone else we're feeling the squeeze, which means less research and less drug discovery," said Clare Turnbull.

"It's very unfortunate that the crisis has come along at this time when we're getting ready to make such progress, but the world has been so focused on COVID-19."