'Thousands' of lung cancer cases go undiagnosed during pandemic

‘Thousands’ of lung cancer cases have gone undiagnosed in England during coronavirus pandemic because people confuse the cough with Covid, NHS boss warns

  • NHS England said it has seen three quarters as many lung cancer patients 
  • People may mistake symptoms of lung cancer for tell-tale signs of coronavirus  
  • Late diagnosis of lung cancer has significantly worse chances of survival
  • Those with ongoing symptoms urged to see a doctor as soon as possible 

Thousands of people with lung cancer have gone undiagnosed in England in the past year, the NHS has warned.

Health chiefs say people may be mistaking symptoms of the disease for coronavirus or avoiding getting medical help because they think the NHS is too busy.

Lung cancer is one of the biggest killers in the UK and caused the deaths of almost 20,000 people in 2018 — behind only to dementia and heart disease.

It is extremely difficult to treat and only around one in 10 patients survive for more than a decade after first being diagnosed.

The NHS in England said it has only seen about three quarters of the number of lung cancer patients it usually would during the coronavirus pandemic, meaning ‘a few thousand’ people have gone without the medical care they need.

Doctors are urging people with long-lasting symptoms they think could be serious to come forward for medical help and not to put it off because they are afraid of being a burden on the health service.

Hospitals are still seeing cancer patients or those referred for suspected cancer, and GPs can still see people about concerns.

Symptoms of lung cancer include having a cough for more than three weeks, coughing up blood and chest pain. 

Steve McGregor, 48, developed breathing difficulties last March and, because of the Covid outbreak, couldn’t get an X-ray until May, when his doctor told him he didn’t have cancer. Another scan in November revealed he did have a lung tumour and he was told it was terminal

Malachy Watkins (left), from Stevenage, died aged 73 in September last year after his cancer treatment, which should have restarted in March, was delayed for three months. Andy Steels (right) died the day after his 54th birthday, just six weeks after his diagnosis with lung cancer

NHS England said more than 39,000 people are diagnosed with lung cancer each year. 

And late diagnosis has significantly worse chances of survival compared to cases caught in the earliest stages, before the disease has had a chance to spread. 

People whose cancer is caught early at stage one have an approximately 58 per cent chance of living for another five years, compared to 3 per cent for those diagnosed later at stage four.

NHS England said more people were coming forward for cancer checks since the first peak of the pandemic, but lung cancer referrals were ‘at 73 per cent of the same point last year’.

Professor Pete Johnson, the national director for cancer in NHS England, told Sky News: ‘We’ve worked really hard in the NHS, even while we’ve dealt with the coronavirus pandemic to make sure that cancer diagnosis and treatment has continued.


Andy Steels, 54, from Hull, tested negative on two occasions for Covid-19, despite developing a chesty cough around the same time the pandemic was taking its grip on the UK. 

The father and grandfather died the day after his 54th birthday, just six weeks after his diagnosis with lung cancer. 

Mr Steels, who lived with his wife Jo, was the popular co-owner of AJS Tyres and continued to graft despite falling ill, eventually getting a phone appointment with a doctor on June 15.

He was referred for an emergency chest x-ray in June and, after numerous tests, he was phoned at work by his GP who revealed his devastating diagnosis.

He had developed stage four lung cancer.

Andy was admitted to Castle Hill Hospital for treatment but was found to be too unwell for chemotherapy.

The cancer had spread throughout his body, including into his liver and kidneys. His funeral was held on August 18.

‘We’re really up to normal except in lung cancer where we’ve only seen about three quarters of the normal numbers of people we would expect to see during that time.

‘And I think a lot of that is because the symptoms of Covid – cough and breathlessness – are very similar to those of lung cancer.

‘So we want to really make sure that if people have had a cough that’s gone on for more than three weeks if they’ve got any of the other worrying signs such as losing weight, coughing up blood or pain in the chest, that they really do come forward for help.

‘We know that people are reluctant to seek help, they’re worried about putting more of a stress on the NHS, but it is very important that we catch lung cancer early because if we do catch it early that’s when we have a really good chance of curing it – if we find it at the earliest stage, more than half of people can actually be cured with something like an operation.

‘But if it’s spread around the body when we first catch it then less than 5 per cent of people are alive five years later.’

When asked whether he could identify how many cases have been missed, he said: ‘It’s about three quarters of the numbers that we would expect to have seen being referred.

‘And so that’s probably a few thousand people over the course of the pandemic that we haven’t seen that we would expect to.

‘There isn’t a big waiting list or difficulty in getting investigations done.

‘The main problem is we just haven’t been seeing people because they’ve been keeping it to themselves.’ 

The NHS chief’s warning is the latest in a string of experts who are worried about a delayed time-bomb of cancer cases caused by the Covid-19 pandemic.

World Health Organization’s Europe director, Dr Hans Kluge, said this month that Covid has had a ‘catastrophic’ impact on cancer treatments and ‘a crisis is brewing’.

Millions of people across Europe saw their scans or treatment delayed because of lockdowns put in place to control the coronavirus pandemic in 2020.

As a result, many will start treatment later when their disease is more advanced and harder to treat, meaning they are more likely to die from it or be left disabled. 

Dr Hans Kluge, the WHO’s regional director for Europe, said: ‘Due to travel restrictions and the enormous strain on health systems of fighting Covid-19, cancer services have been disrupted across the entire region, significantly delaying diagnosis and treatment, directly impacting the chances of a cure or survival for hundreds of thousands of cancer patients.’

He added: ‘Delayed diagnosis and treatment in the United Kingdom are expected to result in an increase in the number of deaths from colorectal [bowel] cancer by 15 per cent, and 9 per cent for breast cancer over the next 5 years.

‘A crisis of noncommunicable diseases, including cancer, is brewing, brought on by the pandemic.’     

Dr Kluge’s comments echo concerns raised last year by cancer charities in the UK, who said shutting out patients in the spring would lead to a cancer time-bomb. 

Except for urgent appointments and emergency treatment, many hospital services were shut down in 2020’s first lockdown in preparation for a surge in Covid patients. 

It took months for the NHS to get back on its feet and, during that time, the number of people waiting for routine operations surged to a record 4.46million.

Macmillan Cancer Support has been sounding the alarm for months that hundreds of thousands fewer appointments to discuss suspected cancer have happened during the pandemic, meaning growing numbers of people are living undiagnosed.

Macmillan said in January that the number of people who saw a cancer specialist doctor between March and November 2020 was 350,000 fewer than during the same period in 2019, a drop of 19 per cent.

The number of people starting treatment for cancer is also still significantly lower than average.

Head of policy at the charity, Sara Bainbridge, said: ‘It is critical cancer does not become the “Forgotten C” in this pandemic. 

‘We must see Government action to ensure cancer services are protected through winter and this second wave.’ 

The NHS’s campaign to encourage people to come forward is being backed by ex-England cricket captain Sir Andrew Strauss, whose wife Ruth died from a rare form of lung cancer aged 46 in 2018.

Sir Andrew said: ‘Lung cancer is a risk for everyone – Ruth had never smoked a cigarette in her life and was unbelievably fit and healthy.

‘It’s so important that if you notice any loved ones showing symptoms that could be a sign of cancer that you encourage them to contact their GP practice.’ 

Retired paramedic, 48, who was denied face-to-face appointment with his GP because of Covid pandemic is diagnosed with terminal lung cancer

Steve McGregor, 48, started having difficulties breathing last March and tried to get a face-to-face appointment at Trinity Medical Centre in Blythe Bridge, Stoke-on-Trent.

But restrictions on appointments because of the pandemic meant he had to wait until May to get an X-ray and phone consultation where he was told there were no issues.

Unconvinced of their findings because of his background in healthcare, he finally got a scan at Stafford’s County Hospital in November, when he was told he had inoperable, terminal lung cancer. 

Steve McGregor, 48, started having difficulties breathing last March and tried to get a face-to-face appointment at Trinity Medical Centre in Blythe Bridge, Stoke-on-Trent

Mr McGregor, who worked for West Midlands Ambulance Service, now believes the cancer could have been operable had it been detected sooner.

The father-of-one said: ‘I noticed changes in my breathing which were quite concerning. I felt like I couldn’t inflate the upper left lung. I felt like I couldn’t oxygenate effectively.

‘I was concerned I may suffer hypoxia in the night. I did say that I had a concern that I may stop breathing.’

But Mr McGregor claims his GP refused to see or refer him for eight months despite making 20 phone calls to the surgery.

He was however able to get a face-to-face GP appointment following the scan at Stafford Hospital.

‘I have now been diagnosed with an inoperable lung cancer, I have never smoked and have been fit and well, I am only 48 years old,’ he added. 

When approached, his GP Dr Bhalchandra Narayan Kulkarni said: ‘For reasons of patient confidentiality the practice is unable to discuss any aspects of patient care.’

West Midlands Ambulance Service were also contacted for comment. 

Pensioner, 73, dies of lung cancer after treatment ‘that could have given him a few more years’ was delayed for three months due to Covid

Malachy Watkins, 73, from Stevenage, died in September last year after his cancer treatment, which should have restarted in March, was delayed for three months. 

Mr Watkins had successful treatment in 2019 which had shrunk his tumours and he had been on a schedule of three-monthly check-ups before the pandemic struck.

In February, he was given the news his cancer had returned but medics decided that because of the coronavirus situation it would be too risky to restart treatment.

Mr Watkins did finally start treatment at the end of May but had already started to become unwell.

He had pain in his chest and back and ended up with a collapsed lung. He started chemotherapy and immunotherapy treatment at Lister Hospital, in Stevenage, but his weakened body could not cope and so the interventions had to stop.

In February, Mr Watkins was given the news his cancer had returned after successful treatment last year, but medics decided that because of the coronavirus situation it would be too risky to restart treatment. Pictured: He was treated at Lister Hospital in Stevenage

His wife wife Sheila, 71, believes that if treatment had started when it was originally due to – at the start of February – her husband was then ‘well in himself’ and would have been able to tolerate it more.

She was also unable to go into hospital with her husband for appointments, even though he had lost his voice . 

When Mr Watkins was admitted to hospital for the final time, in September, and was gravely ill, his and his wife’s children were not allowed to visit them until very late.

Their adult son Craig told The Times that by the time he got onto his father’s ward – after being forced to complete a risk assessment – he was taking his ‘final breaths’.

He said he and his sister had no time with him in his final moments.

Mrs Watkins said she does not want the NHS to ‘forgo everything else for the sake of coronavirus.’

Nick Carver, chief executive at East and North Hertfordshire NHS Trust which runs Lister Hospital, said: ‘We offer our sincere condolences to Mr Watkins’ loved ones at this incredibly sad time.

‘Cancer treatment continued throughout the pandemic for all patients for who it was safe to do so, and we have worked in partnership with the independent sector to maintain high levels of activity in line with all national guidance.

‘The pandemic has been a global health challenge and we have had to work very differently to keep patients, staff and visitors as safe as possible.’  

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