Panorama 2020 E24
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🦄
CreativityTranscript
00:00I'm Deborah James, and for the past three years, my cancer treatment has been keeping
00:06me alive, even during COVID-19. But not everyone has been given that chance.
00:13Dear Mr Hancock, I am appealing to you regarding life-saving treatment.
00:18Best case is two years. I am upset and I am devastated.
00:21The impact of the pandemic on people with cancer has been enormous.
00:26Cancelled drug trials, cancelled radiotherapy, chemotherapy cancelled.
00:31Tonight on Panorama, I want to find out what the real cost of COVID-19 could be for fellow
00:36patients with cancer.
00:38The worst case scenario, there could be 35,000 excess deaths.
00:43All we can do is our best to try and get the service running again.
00:47And how Britain might be lunging from one health crisis straight into another.
00:54I've got so much more to do. I don't want to die.
01:08Ever since I was diagnosed with state-of-the-art bowel cancer in 2016, I've been a regular
01:13here at the Royal Marsden Hospital in London.
01:19As a private patient treated in an NHS setting, I've had everything. Surgery, chemotherapy,
01:26radiotherapy to enable me to live with cancer.
01:30But when COVID-19 hit, I counted myself lucky that my treatment continued.
01:35Ready, go. You just mucked it up. Yeah, you did. Yeah, you did.
01:44And lockdown has given me precious family time.
01:47OK, that was cool. I'm happy with that. Yeah. High five.
01:53Since my diagnosis, I've shared my story on social media where I'm Bowel Babe and on a
01:59podcast I co-host.
02:02It's been strangely cathartic and it's meant I've met some incredible people also living
02:07with cancer.
02:09This is my friend Kelly.
02:11She was diagnosed with bowel cancer soon after me, also sharing her story on social
02:16media where she's kick-ass Kel.
02:19It's in my lung. It's in my liver. It's in my brain. It's in lymph nodes up and around
02:30my body. So, yeah, chemotherapy. We'll see what it does.
02:43When we met, Kelly was just 28 and mum to little Finn. She's become not just my friend,
02:49but a friend to all the team in the You, Me and Big C podcast family.
02:53Kelly's here. Yay, I'm so excited.
02:56I've been following your story really closely. I can't feel like I just follow your stories
03:01every day.
03:02At lockdown, her treatment was put on hold. And today she's joining us on the podcast
03:08to tell us what's happened since.
03:09Hi Kel, are you well?
03:12Hi, I'm good. Apart from this voice.
03:15Because of COVID-19, we can't all be in the same place, but everyone is here.
03:19Steve, how are you?
03:20Pressing record. We are in business.
03:22This is Steve. The podcast was the brainchild of his wife, my friend Rachel, who died of
03:27breast cancer in 2018.
03:30We actually saw Kelly in hospital having treatment when Rachel was having treatment. You had
03:33short hair then, I think, didn't you?
03:36Yeah, really short hair. Hi Lozza, how are you?
03:39Oh, hang on, mate. I'm going to do a picture.
03:42And Lauren. She got breast cancer nearly four years ago and is now cancer free.
03:46You look great, Kel.
03:48Oh Kel, it's so good to see you. I got a text message from you in the end of March. Can
03:54I read it to you?
03:55Go on.
03:56I don't want to make you cry though. But it says, just a quick question, is your treatment
04:01going ahead? My chemo has been paused for 12 weeks and I'm fuming about it. It happens
04:07all the time. I get amazing results and then get knocked back again. It's happened three
04:12times now. And you just said, I'm scared and I'm crying. It was March the 23rd.
04:19That's the day lockdown was announced, wasn't it?
04:20It was the day that lockdown was announced.
04:22Yeah, I'd gone in. She told me about the great scan results and said, I think now, because
04:27of the COVID, it's a good time that we could afford to take a break. You've had great scan
04:33results and you've done the six chemotherapies. So now is the time where I'd probably give
04:37you a break anyway. I wasn't happy with it, but because...
04:41Did you feel like you had a choice? Were you able to challenge that?
04:43I challenged it and I didn't want it. I was like, I don't think it's a good idea. Every
04:49time that I get so far, I'm knocked back again. It happened when it was on the aorta. They
04:57said it would never go and it did. And it's just like, it's happening again. Then I said,
05:03well, I'm not happy with three months. Can we do a blood test halfway through? If we
05:09do that, then we've got a good idea of what's going on. But it didn't get to that.
05:17Kelly's been told her conditions reached the point where nothing more can be done for her.
05:22Since lockdown, the cancer has just progressed too far.
05:26Do you believe if COVID had never happened, do you believe you would be in this position?
05:31I don't think I'd be in this position.
05:34Are you angry?
05:35Yeah.
05:36Are you angry at COVID? Are you angry at the team? Is it a mixture of both?
05:39Mixture of both. Yeah, I'm angry that I got put on this break because I don't think I
05:48should have. I'm angry at COVID because it's made me have this six week break. It's made
05:54me be put into this situation now.
05:57Are you worried about the future? About dying? Are you scared?
06:02Terrified. Absolutely terrified. I don't want to die. Like, I feel like I've got so much
06:09more to do. But yeah, terrified.
06:20Since her health has gone downhill, Kelly and six-year-old Finn have been staying with
06:24Mandy, her mum. She's desperate for answers as to why Kelly's treatment was halted.
06:31She's very angry at what's happened to her through the whole cancer diagnosis and the
06:36COVID. She was devastated when she found out the chemo was going to stop. She was so upset
06:43because she knows that when she has a break on the chemo, the disease progresses. She
06:49started becoming more poorly, so she was admitted to hospital. So that's when we knew that the
06:54disease had progressed quite considerably.
06:58Mandy knows how much time Kelly has left, but Kelly doesn't want to know.
07:03She's asking questions. Should I buy these clothes? Should I buy this makeup? Should
07:08I buy this for Finn Lee? Do I need to buy a memory box? So it's like a question, but
07:15she's asking me. And she doesn't want to know, so I can't tell her.
07:21The sad truth is Kelly's story isn't unique. Almost every day of lockdown, I've had messages
07:26from other patients, some who've continued with their treatment, but many have worried
07:30about it being postponed, tests not taking place. Asking if it's safe or sensible to
07:37go to their GP or a hospital appointment to get the signs or symptoms of cancer checked.
07:45When the crisis hit, we were told to stay at home to protect the NHS and save lives.
07:51But cancer wasn't just going to stop because of COVID-19.
07:55We all know that early diagnosis is really important when it comes to cancer and most
08:00diseases in fact. So an early diagnosis increases your chances of survival.
08:04OK, all right. Get a plain flour.
08:07Yep, sprinkle.
08:08I've learned how important it is to catch cancer quickly. It took me six months of trying
08:14to get a diagnosis. I had a six centimetre tumour in my bowel and another eight tumours
08:21in my lungs. Since then, it's spread to my liver and my lymph nodes too.
08:27You're the boss of me, aren't you?
08:29Who knows how different it would have been if the cancer had been caught on my first
08:34trip to the doctor.
08:35Alexa, put a timer on for 10 minutes.
08:41In the UK, we catch cancer as early as possible by screening around 11 million people a year
08:47for breast, bowel and cervical cancers.
08:52If you are diagnosed at an early stage, your chances, for example, of surviving bowel cancer
08:57are 90%. If you're diagnosed at a late stage, stage four, your chances of surviving long
09:03term are 10%. So screening is one of the most effective ways of detecting bowel cancer at
09:09the earliest possible stage. For breast cancer, it's mammography. For cervical screening,
09:13it's the smear test. They work in different ways, but effectively, they are all good for
09:17diagnosing cancer at the earliest possible stage.
09:21As the country locked down, the NHS published new guidelines for hospital trusts about diagnosing
09:27and managing cancer care during COVID-19. Many staff were deployed to frontline services.
09:34Scotland, Wales and Northern Ireland officially suspended their screening programmes. In England,
09:42some screenings continued, but most NHS trusts put them on hold.
09:48How many screenings during COVID have been missed to date?
09:53So we estimate that over 2 million screening appointments have not been, well, they have
10:01not been sent out. And this will mean that thousands of cancers will have missed the
10:07opportunity to be diagnosed via screening through that time. And those are the cancers
10:12that are picked up at the earliest possible stage when treatment is most effective.
10:17But screening is only one of the ways cancers are spotted. The majority are diagnosed after
10:23a concerned patient has gone to their GP.
10:27So they just wanted us to just to check up on you as far as that injection, but it sounds
10:30like it's not causing any real problems at the moment.
10:34And if the GP is also concerned, they make an urgent referral to a cancer consultant
10:39to investigate further.
10:41So when do you start the radiotherapy?
10:44Gary Marlow is a GP in East London.
10:48Since lockdown, we have probably been doing one or less a week. So a phenomenally decreased
10:54level of referrals. If you had spread it across the whole of England, that's still thousands
10:58of patients.
10:59At the peak of the pandemic, the number of cancer referrals went down by almost two thirds.
11:06The latest data seen by Panorama shows they're still a long way from pre-Covid-19 levels.
11:13The public have responded fantastically well to the message, don't overstress the NHS and
11:18many people thinking, oh, I better not bother them.
11:21The second thing, there's a significant cohort of people who are also very worried about
11:25coming anywhere near the NHS, because coming near the NHS means I'm going to get Covid
11:30and therefore I'm going to get very, very ill.
11:33The most common response I had was, can we not leave it for a couple of months?
11:39Unfortunately, Covid is not going to go away in a couple of months and their illnesses
11:43could well deteriorate over that couple of months.
11:46And fewer referrals means fewer people diagnosed. According to Cancer Research UK, normally
11:52around 3,000 cancers a week are picked up through urgent suspected referrals.
11:58But in April in some areas, only around 700 people a week got their diagnosis, leaving
12:06thousands more not knowing.
12:09The stay at home to protect the NHS message had a profound impact, especially in A&E departments,
12:16where over one in 10 cancers are normally spotted.
12:21In April and May, attendances were half of what they were this time last year.
12:25For those who did attend, resources were stretched.
12:28In March, Sherwin Hall went to his A&E, suffering with groin pain.
12:34They just kept giving me painkillers. I begged them for a scan because I knew something was
12:39wrong, I couldn't sleep, I was in bad shape and it was just groin pains.
12:43And I kept going back to the A&E, kept going back to the A&E.
12:47Sherwin went to A&E around 13 times, asking for a scan.
12:52They said that due to COVID-19, it's a delay. They said I'll be lucky to get my scan in
12:57two months. After that, I kept going into A&E and I still was denied my scan and they
13:03kept giving me painkillers.
13:06After two months, Sherwin was finally given a scan.
13:10It showed I had a 14 centimetre tumour in my pelvis. That was the first scan I'd done.
13:16Then I had a CT scan which showed the rest of my lungs and I have about 20-something
13:27tumours in my lungs and I have a few big ones as well.
13:33He's suffering from a very rare and aggressive cancer which has spread throughout his body.
13:39His prognosis is not good.
13:42Between three months and a year, best case is two years.
13:46I do blame COVID and I am upset and I am devastated.
13:51I'm a father of two and I have an 11-week-old baby now and I might not be able to see him soon.
13:59I might not be able to see him.
14:04It hurts to watch somebody that you love go through something.
14:07Surgery is not an option for him now. The mass in his pelvis is way too big.
14:12But if they had found it maybe when it was a couple of centimetres smaller,
14:15his life expectancy would be higher.
14:20No words could describe how I feel.
14:23I'm very upset at not getting the treatment I was supposed to get in the beginning.
14:30But I'm ready to fight for my family and for my child.
14:33I don't like to hear him talk like that.
14:36Because you can hear it in his voice how it wavers and it shakes.
14:40And it makes you wish that it was you.
14:43Do you know what I mean? You don't want to see someone that you love go through it.
14:46I've even told him that I just wish we could trade places
14:49or at least I could have half of it or take some of his pain.
14:53Just, it breaks my heart.
14:56I don't want the baby to have to grow up without knowing his daddy.
15:00This is the best man I know.
15:11The NHS have acknowledged that cancer diagnosis is taking longer than it should.
15:19The man with ultimate responsibility for cancer care in the NHS
15:23is oncologist Peter Johnson.
15:26There are, I'm afraid, occasions, even in normal times,
15:30when cancer isn't diagnosed as quickly as we would all want.
15:33And when the service is under huge pressure,
15:36the effect of a lot of people with coronavirus, things will happen.
15:39And it's awful.
15:41And we want to try and stop that as much as we possibly can.
15:46A lot of the work we're doing in cancer diagnosis at the moment
15:50is trying to set up rapid diagnosis centres
15:52so that we can find ways of getting quicker to a diagnosis
15:56for people whose symptoms aren't very obvious.
16:01It's not just diagnosis that's the problem.
16:04At every stage, cancer treatment seems to have slowed down since lockdown,
16:09for some, with devastating consequences.
16:14Dear Mr Hancock, I am appealing to you personally
16:17for urgent assistance regarding life-saving treatment.
16:21Wendy Peake wrote this letter right after her clinical trial
16:24was cancelled by the NHS.
16:26This was apparently a decision made according to government guidelines.
16:31Almost half of all clinical trials were stopped across the country.
16:35Wendy was diagnosed with a rare form of eye cancer
16:38that has spread to her liver.
16:40She was put on a trial that was showing good results
16:43and told it was the only way to save her life.
16:47But at the end of March, her trial was halted.
16:50It was because of COVID-19.
16:52It is a complex procedure,
16:54and they said they just wouldn't have the staff to do it.
16:57We sat there and we cried.
17:01To see such anguish on my girls' faces...
17:06..to see their desperation, which was way more than mine...
17:12..was just heartbreaking.
17:15By June, her tumour had grown by 50%
17:18and her oncologist suggested one last option, to go private.
17:23It was going to cost her almost a quarter of a million pounds.
17:29I gasped at the cost of it.
17:31My husband said, well, whatever, we will do it.
17:34If that means remortgaging the house, we will do it.
17:37But to me, it seems grossly unfair
17:43that we have been put in this situation
17:48when we are all so vulnerable
17:51and we were offered it on a non-private basis,
17:55on the NHS, as part of a trial.
17:59Her family are now crowdfunding
18:02to raise the money they need to pay for the treatment.
18:11Having recognised the scale of the challenge,
18:14the NHS told trusts to pair up with private hospitals
18:17to create COVID-free cancer hubs.
18:20They were coordinated by 21 alliances across the country.
18:25This is the Wellington Hospital in North London, a private clinic.
18:29It's now a breast cancer hub for patients from 10 nearby hospitals.
18:34I've been through all the notes for tomorrow.
18:36We've got two different trusts operating.
18:38Breast surgeon Jo Franks normally splits her working week
18:41between her NHS patients and her private ones here.
18:45We have a series of theatres here.
18:47They would ordinarily have gone to sleep in the anaesthetic room,
18:50but now they'll go to sleep in the actual main theatre.
18:54And once they are asleep, then the case will start.
18:58The extra precautions taken to make sure this place stays COVID-19 free
19:03means medics can't perform the same number of operations
19:06in any one day as they could pre-pandemic.
19:10We have to think about how long each case is going to take
19:12and that we need to safely recover the patients.
19:15Some of that time now has to be in the operating theatre,
19:17so that's reduced a little bit our efficiency.
19:20Once they're safe to leave the operating theatre,
19:21they'll go through to recovery
19:23and there the recovery team will look after them
19:25until they're ready to go up to the ward.
19:28Reports say this extra capacity is costing millions,
19:32but we've been told that staff in some private hospitals
19:35are frustrated by not having enough to do.
19:38Some say the private capacity is lying idle.
19:43The cancer hubs that are in place across the country
19:47are working really hard, but it is logistically very complicated.
19:51I think as much as anything else,
19:52it's a question of people getting used to how the system works
19:55and what we've seen week on week
19:57is the number of operations going up steadily
20:00and the use of the independent sector facilities
20:03has been going up steadily as people have got better tuned
20:06to how to make the best use of it.
20:09Mary Smith's a former lawyer for the NHS,
20:12now working with clients desperate
20:14to get diagnostics or treatment.
20:17The medical experts that I work with are telling me
20:19that the private hospitals that they work from
20:22are requisitioned but broadly are not being used
20:24at anywhere near capacity.
20:26The beds are empty, the diagnostic suites are empty
20:29and that's of real concern
20:30because if those were being fully utilised,
20:33then many, many patients would have access
20:36to diagnostics and treatment.
20:38Have you got examples of people who actually,
20:41had they been transferred across to the private sector,
20:44it could ultimately change their diagnosis?
20:47Absolutely, I've instances of people
20:49who had chemotherapy stopped part way through,
20:52who could have remained on chemotherapy for years
20:56and are now dead.
20:59And had their treatment been transferred over
21:01to the private sector and their chemotherapy continued,
21:04then for them that may have been a very different story.
21:08What we were concerned to do when the virus
21:11was increasing very rapidly in the population
21:14was to make sure that we could get the right balance
21:17between the risk of catching the virus
21:20and the risk of having people's cancer get worse.
21:23And in particular, the risks and benefits
21:26of things like chemotherapy,
21:27where if the chemotherapy isn't absolutely crucial
21:31but it might be dangerous in terms of increasing
21:33your risk of coronavirus,
21:35this wasn't a kind of attempt to police
21:37who should have treatment and who shouldn't,
21:39it was more an attempt to try
21:41and help people think very clearly.
21:44Many cancer patients had their treatment stopped
21:47or delayed under the new cancer care guidelines.
21:50The NHS based these in part
21:52on a small research study from China.
21:55Now more up-to-date research has challenged those findings.
22:00The impact's been really tremendous and really harrowing.
22:04I'm seeing cases involving cancelled radiotherapy,
22:08cancelled drug trials,
22:10so for patients who have no other option.
22:13I've had people who have had chemotherapy cancelled
22:17and young parents who have died.
22:21The last time I spoke to Kelly,
22:23she was pinning her hopes on the results of a blood test
22:26to try to get things moving again.
22:30But she's been in touch and it's not good news.
22:34So I just got off the phone to Kelly
22:37for what I think will be the last time.
22:40I'm now waiting for my friend to die.
22:44Praying that she's not in pain.
22:46And it's just, it's just not fair.
22:54I feel incredibly guilty that so many people
22:57haven't been able to have treatment,
23:00especially because I have.
23:05Shortly after lockdown, a worrying set of blood tests
23:08meant I was called back into the hospital
23:10for what's called targeted radiotherapy.
23:13All done.
23:15This is me getting that vital treatment.
23:18Nearly one in two patients have radiotherapy at some point.
23:23This is the linear accelerator here.
23:25You'll recognise all these.
23:27And as you see...
23:28Professor Pat Price is a clinical oncologist
23:31and a champion for radiotherapy.
23:34The guidelines for radiotherapy in COVID
23:36advise people to delay and avoid radiotherapy
23:39in some circumstances.
23:41I think the guidelines were suggesting
23:43that we should be not giving it all the time at that time,
23:48which was, in retrospect, not the best advice.
23:51I think it was a very high-risk strategy.
23:55For patients who are having curative cancer treatment,
23:58there has to be a really, really good reason
24:00to delay or avoid that.
24:03How did it affect capacity?
24:05We did a flash survey to find out.
24:07So we asked people on the front line, end of April,
24:11what was their capacity like?
24:13Some places, where they didn't have a COVID problem
24:16and they didn't have an accident or emergency,
24:17they were almost up to 100% and could carry on.
24:20Other places, they were down
24:23from treating 30 patients a day to six.
24:26That's an 80% drop.
24:28Down by 80%.
24:2980%.
24:30So you had machines like this, which were lying idle.
24:34That could save lives.
24:35That could save lives, yes.
24:36Is that all right then?
24:37Yes.
24:38Radiotherapy should have taken over
24:39where chemotherapy and surgery left off,
24:42and it still should be doing that now.
24:44It has been safe to give radiotherapy during COVID.
24:47We know that now.
24:48It's outpatient.
24:50It doesn't affect the immune system.
24:52Radiotherapy is a lifesaver.
24:54Pat's also concerned that a more precisely targeted type
24:57of radiotherapy has not been used to its full potential.
25:01For COVID particularly, this is what we need for patients.
25:04Outpatient treatment, not a lot of time in the hospital.
25:07Cure them.
25:08The machines are here.
25:09We haven't been allowed to switch them on properly.
25:12We have been told not to do this.
25:15She's worried the lack of treatment
25:16is storing up problems for the future.
25:19As we go forward with the cancer backlog,
25:22we are looking at a huge number of avoidable deaths,
25:25and we need to address it because they're patients
25:29we can cure and we want to get on with it.
25:32I'm afraid it's not a great time
25:33for having cancer at the moment.
25:36Professor Mark Lawler is part of a team
25:38researching how many more people might die of cancer
25:42over the next year compared to previous years.
25:45Panorama has been given exclusive access to his data.
25:48Anecdotally, people have been telling us
25:50that there were problems,
25:51but I think the other critical thing
25:53was being able to actually have routine data
25:56from hospital trusts.
25:58What we've modelled here is different possibilities
26:01in relation to excess deaths.
26:03Probably somewhere in between these two is the real figure.
26:06We felt that the worst case scenario,
26:08there could be 35,000 excess deaths.
26:10As a scientist, I hope I'm wrong in relation to that,
26:14but that certainly was one of the figures
26:16that came out of our analysis.
26:18Do you acknowledge that there will be excess deaths
26:20from cancer because of COVID?
26:23I honestly don't know.
26:24It's impossible to say.
26:26I'm hoping that we will get back to where we need to be
26:30by the end of the year,
26:31but I think all we can do is our best
26:33to try and get the service running again,
26:35to get the diagnosis going,
26:37to get the treatments going again,
26:38to avoid that being so.
26:47On the 13th of June, Kelly died.
26:54She was just 31.
26:57Today, it's her funeral.
27:01And because of the pandemic,
27:02we have to say goodbye from the street.
27:08All of her friends are here to see her for the last time.
27:14And we're here too,
27:16the You, Me and the Big C podcast family.
27:26Oh, God, it's sparkly.
27:28Oh, my God, only Kelly would have a pink, sparkly coffin.
27:34Amazingly, Kelly chose the coffin two years ago.
27:39Just gland to the end, girls.
27:40Gland to the end.
27:41Pink and sparkly coffin.
27:42She's the only one I know
27:43who can make us, like, smile in the darkest of times.
27:48You know, we've lost a friend, a daughter, a mum.
27:51Like, because of COVID, we can't get in there and...
27:56Say goodbye.
27:57Hopefully.
27:57Or wave goodbye to their mate.
27:59You know, from the side of the road.
28:01It's just, it's just heartbreaking.
28:04The reason Kelly shared her story
28:07is because she didn't want other people
28:08to have to go through it.
28:10And she always said if they,
28:12just before she died,
28:15I said to her,
28:17thank you for sharing your story.
28:19And she said, do you think it will make a difference?
28:25I really hope it does make a difference.