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16th October 2020

The NHS is Still Here: We have to act quickly

View all Early detection

When it comes to lung cancer, time is of the essence so it’s vital anyone with potential symptoms contacts their GP and is referred for an x-ray where you’ll meet someone like chest consultant, Matt Evison.

For everybody that comes to see us, three quarters of them don’t have lung cancer.

Lots and lots of the time, it turns out to be, to be nothing. But we absolutely want to see them and want to investigate those people.

Things have changed since the peak of the pandemic. We now contact patients before any kind of appointment. If they were coming for a CT scan, we will contact them the day before to check they are ok and to see if they have had any new symptoms that just might make us worried about coronavirus. If there are then we provide advice, or even defer when we do the CT scan.

When that that person comes for their tests, we have changed the appointment system so its very spread out now. This means that we can manage the flow as that person arrives at hospital and has the test and leaves hospital. This way there are minimal other people around so we can maintain social distancing.

The whole area, wherever that test is being done, is cleaned before and afterwards and we now all wear PPE anywhere in the hospital. We all wear masks at every single point in the hospital and, when someone arrives, they’re invited to clean their hands, wash their hands.

When the national lockdown hit in March there was a rapid reduction in suspected lung cancer referrals. To about 20% of what they would normally be. It’s only recovered to about 50%, so that’s a massive worry for us, that we’re still only receiving only about half of the referrals we would do normally.

One of the real concerns and worries we’ve all had during COVID-19 is that there’s now this whole new reason for a cough. This could mean lung cancers get buried within this new cause of cough. As a result, we’ve seen a huge reduction in the number of chest x-rays being done.

Before Covid, the message was ‘If you’ve got a cough, go and see your GP. Go and get a chest x-ray’. Now the message is ‘If you’ve got a cough, stay at home. Don’t go anywhere’. They’re completely opposite messages, which, at the outset of coronavirus when there was all this worry about what is going to happen, it is understandable.

Now we’re in a time where we’ve we know that that’s causing other harms by people not being worried about going to see their GP, about being worried to come for a chest x-ray or worried to come to hospital and we’ve really got to push to try and counteract that.

I have had patients say to me ‘I don’t want to bother anyone at a time like this’. ‘Everyone’s working so hard because of covid’, but we have the resources to be doing exactly what we should be doing – investigating those where there are symptoms, so people should be seeing their GPs. We should be doing chest x-rays. We should be referring to the hospital.

We’ve tried to maintain a really consistent message that the NHS is open, and wants, needs to see you. For us in our line of work, we want and need to see patients where there’s any worry about chest symptoms, and about even if there’s a remote chance that that could be lung cancer. We want to see them, in the hospital doing tests. That is a necessary visit and travel and well within those guidelines that are in, even within local lockdowns.

There has been a cohort of patients that have been terrified by coronavirus. Lung cancer often affects people with other health problems. Some of that is because it tends to affect us later in our lives rather than at a young age. Some of it is related to smoking – not an entire link, anybody can get lung cancer. Absolutely anybody. But smoking is often related to other health problems. So, the patients that are referred to us where there is a potential suspicion of lung cancer often have other health problems and these are the people who have received this repeated message, been bombarded with this message – ‘Don’t leave home. Stay at home. Don’t see anybody. This is awful. You’re at risk’ and that message has really sunk in.

Through the pandemic, we have been doing a lot by telephone to say we’ve received your referral, we’d like you to come to the hospital at this time. There are a number of occasions where someone has said ‘I don’t want to’. ‘I do not want to come in. I’m shielding. I’ve been told to. That’s what I need to do. I would be really nervous about coming into hospital.’ There have been lots of examples of that. Now, in the majority of times that’s, we come to an agreement, we discuss it through because lung cancer moves quickly, and so, days matter, and so anytime there is a concern about lung cancer, we have to be acting very quickly.

We do sometimes face a historic view of lung cancer that it can’t be treated. It’s really important that we explain that there is so much that can be done in lung cancer. Treatments are changing so quickly. What we do today is different to what we did two years ago, which is different to what we did two years before that. It’s changing that quickly. And the earlier we find it, the better and the more that can be done.

So if anyone has symptoms in their chest and they’re worried about them, we are here to look after them. We’re here to make sure that they’re safe, and it just may save a life.