Bowel cancer waiting times 2022: how big is NHS backlog for tests, screenings and treatments?

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Long waits for diagnosis and key treatment targets missed - how bowel cancer patients face “potentially serious consequences” from a system under strain even as Bowel Babe Dame Deborah James brings attention to the disease

Bowel cancer is firmly on the agenda thanks to the fundraising efforts of Bowel Babe and co-host of You, Me and the Big C podcast, Dame Deborah James.

The 40-year-old mother of two has so far raised an enormous £6.6 million for bowel cancer research, after revealing earlier this month that she was receiving end of life care after being diagnosed with the disease in 2016.

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40,126 people in England were diagnosed with colorectal cancer in 202140,126 people in England were diagnosed with colorectal cancer in 2021
40,126 people in England were diagnosed with colorectal cancer in 2021 | Mark Hall/National World

But the renewed focus has come at a time when the NHS cancer care system is creaking at the seams after the Covid pandemic, with one charity warning patients are facing “potentially serious consequences”.

An analysis by NationalWorld can now shine a light on long backlogs for bowel cancer diagnosis and treatment, persistent failure to hit key waiting time targets, and an increase in people being diagnosed with stage three or four cancer.

However, the problems faced by the NHS and its staff were “exacerbated” by Covid and “not caused by it”, charity Cancer Research UK has said, with “far too many people facing unacceptable waits before the pandemic”.

Fewer bowel cancer cases caught

The pandemic and initial lockdown in 2020 had a seismic impact on cancer services, with screening programmes paused and treatment for some patients interrupted.

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According to our analysis of NHS Digital figures, the number of people diagnosed with colorectal (bowel) cancer in England in 2020 fell by 3,600 from the year before - suggesting cases were missed.

There were 32,875 cases of colorectal cancer diagnosed in England in 2020, a 10% drop from the 2019 figure of 36,505.

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The trend reversed in 2021, with 40,126 people diagnosed - a four-year high.

There was also a big drop in the number of lower gastrointestinal patients starting treatment, with just 826 in May 2020 compared to 1,086 in April 2020 and 1,445 in March 2020.

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Dr Lisa Wilde, director of research and external affairs at Bowel Cancer UK, said bowel cancer remains the UK’s second biggest cancer killer, but this shouldn’t be the case as bowel cancer is “treatable and curable, especially if diagnosed early”.

She said “nearly everyone diagnosed at the earliest stage will survive bowel cancer”, but this “drops significantly” as the disease develops.

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Long waits for treatment

Performance against key cancer waiting times has deteriorated during the pandemic.

Even now, around half of bowel cancer patients have to wait more than two months to begin treatment - far below NHS standards.

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According to NHS rules, at least 85% of patients should start treatment within a maximum of 62 days of an urgent referral for suspected cancer.

The performance against this 62-day treatment standard – already poor – massively deteriorated during the pandemic and has failed to recover.

NHS England data shows in March 2020, 70% of lower-gastrointestinal cancer patients who started treatment had been seen within 62 days.

But by May 2020, it had plummeted to 42%. It has stayed at levels of about 50% ever since.

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In the past two years, nearly 17,000 patients have had to wait longer than two months to start treatment for lower-gastrointestinal cancer after being referred.

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Lower gastrointestinal cancer includes all types of large bowel cancer (anus, rectum and colon) and all but one type of small bowel cancer.

NHS rules also state at least 75% of patients should receive a diagnosis or the all-clear within 28 days of an urgent referral for suspected cancer.

This target was only introduced last year and has so far never been met for bowel cancer patients.

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In total, throughout 2021/22, 219,000 patients (49%) have had to wait longer than 28 days to find out whether they have bowel cancer. Around one in 10 of the patients (11%) waited more than two months.

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Patients across England faced a postcode lottery.

North Middlesex University Hospital NHS Trust met the 28-day target for just 9% of patients.   East Sussex Healthcare Trust meanwhile met it in 81% of cases.

Performance for lower gastrointestinal cancer across England was also found to be much worse than the average for all cancers, where 73% of patients got their diagnosis within 28 days.

The waiting list for key diagnostic tests has grown and grown

NHS waiting lists for key diagnostic tests used to diagnose bowel cancer have rocketed since the start of the pandemic.

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According to NHS England monthly diagnostics data, in March 2022, there were 91,482 people waiting for either a colonoscopy, flexi sigmoidoscopy or barium enema - 30,167 more than in March 2020.

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Of them, 35% had been waiting for six or more weeks, compared to 21% in March 2020, and 20% had been waiting 13 or more weeks, compared to 5% in March 2020.

Lynn Dunne, chief executive officer of Bowel Research UK, said the Covid lockdowns led to “serious interruptions” as both bowel cancer screening programmes were paused and diagnostic services postponed in order to support the NHS response to the pandemic.

She said doctors were unable to perform normal procedures like colonoscopies and endoscopies, and patients were “reluctant” to go to hospitals and attend clinics because of “fear of catching Covid”.

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Although the NHS is trying its best to clear backlogs, Ms Dunne said it is still catching up when it comes to these procedures.

“Sadly, delays have potentially serious consequences for anyone who might already have bowel cancer because early diagnosis of the disease offers the best chance of a full cure,” she added.

“Delays risk more hazardous and potentially lengthy emergency procedures for people who have advanced disease.”

However, Jodie Moffat, head of early diagnosis at Cancer Research UK, said although the full impact of Covid on cancer is not yet known, the problems faced by the NHS were “exacerbated by Covid-19, not caused by it”.

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Ms Moffat said “far too many people were facing unacceptable waits before the pandemic” and that there has been a “long-standing, serious lack of staff and facilities to provide the endoscopy tests vital to diagnosing bowel cancer”.

She hopes the Government’s upcoming 10 Year Plan will produce “a cancer plan for all, which must include more staff and diagnostic equipment – so that cancer patients get the care they deserve”.

More people diagnosed with late-stage cancer during the pandemic

There was also a clear deterioration during the first year of the Covid pandemic in the proportion of English colorectal (bowel) cancer patients diagnosed at stage three and four, according to data from NHS Digital and the National Disease Registration Service.

In the 12 months to January 2021, 54% of people were diagnosed at stages three and four and 21% at stage four.

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That was higher than in the 12 months to January 2019, when 52% were diagnosed at stages three and four (20% at stage four) and in the 12 months to January 2020, when it was 52% at stage three or four (19% at stage four).

There was a similar deterioration for cancer as a whole during the pandemic.

The NHS Digital and National Disease Registration Service said there had been a “particular decrease” in the proportion of colorectal cancer diagnosed at an early stage in April 2020, which they said was “likely to reflect the initial impact of the pandemic on the bowel cancer screening programme”.

Dr Wilde urged people who notice any signs of bowel cancer, or “if things just don’t feel right for you”, to visit their GP.

She added: “It’s really important people seek advice as soon as possible - whatever their age - if they’re worried.”

NHS England was approached for comment.

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