CAMPAIGNERS warn that “everything must be done” to prevent a resurgence of Covid delaying cancer diagnosis and treatment, as figures reveal that referrals fell by a fifth during the first wave.

A report by Public Health Scotland shows that 3,056 cancer patients were referred for tests and scans or started treatment between April and June this year, down by 22 per cent compared to 2019.

It states: “The reduction in eligible referrals is likely to be due to a combination of patients not seeking out help so as to be referred, and because of delays in patients having diagnostic tests and/or starting treatment because hospitals have been treating Covid-19 patients.”

The figures relate to the 62-day waiting times target, which stipulates that patients urgently referred with a suspicion of cancer - who are subsequently found to have the disease - should begin treatment within 62 days of that referral.

Referrals can be triggered by patients presenting to their GP or in A&E with symptoms, or if routine cancer screening has detected potential anomalies.

During the pandemic, GPs reported a decline in patients presenting with symptoms, while many key tests - such as

colonoscopies - were either cancelled or severely restricted by health boards due to fears they could help to spread coronavirus.

Screening programmes for breast, cervical and bowel cancer were also paused, and only began to resume in August.

The report adds: "The numbers of eligible referrals for screened breast, cervical and colorectal cancer [in April-June] have decreased substantially when compared with the average of the past four quarters, by 55.8 per cent, 22.7% and 58.5% respectively.

"These will relate to patients screened and referral to secondary care prior to the programmes being paused."

Despite the reduction in referrals, only 84.1% began treatment with the 62-day window - up slightly from 82.4% during April-June 2019, but falling far short of the Scottish Government's 95% target.

This was particularly acute in relation to patients whose cancer had been initially detected through the bowel cancer screening programme prior to the pandemic.

Only 46% of those referred as a result of bowel screening began treatment within 62 days, compared to 65.5% between January and March.

PHS said treatment delays for these patients were "likely to be due to the additional consequence of Covid-19 meaning that colonoscopies were also paused".

A breakdown of the feedback provided by health boards to PHS highlights backlogs with endoscopies and colonoscopies as a particular cause for concern.

NHS Forth Valley states that colonoscopy and endoscopy procedures "were cancelled other than emergencies for part of this time period", adding that its capacity for endoscopy "has been significantly impacted as a consequence of room cleaning times and PPE requirements".

The health board said this "has had limited impact of the waiting times reported for this quarter but will have an impact on the 62-day pathway moving forwards".

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NHS Ayrshire and Arran said it was making a "very cautious" restart to endoscopy and colonoscopy, having previously paused the procedures.

It added: "Overall outpatient capacity in clinics and radiology is very restricted due to social distancing, and concerning [in terms of] waiting times, especially in higher volume services, for example breast."

NHS Fife said its "clinically urgent cancer patients were treated in the private sector" between April and June, while NHS Grampian described "significant issues" scoping backlogs - adding that there were "over 900 patients" waiting for procedures such as endoscopies and colonoscopies.

The health board also reported "significant nurse staffing issues in theatre with 70 vacancies", adding that "reduced bed capacity as a result of social distancing measures has resulted in the cancellation of surgery for patients".

There were some improvements, however.

Overall, half of patients on the 62-day pathway received their first cancer treatment within 37 days of referral, up from 41 days in the previous quarter.

Once a decision was taken to refer a patient for treatment, such as cancer surgery, they waited just two days on average.

However, there are fears that delays in people coming forward with symptoms and delays to diagnosis are storing up problems.

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Marion O’Neill, head of external affairs for Cancer Research UK in Scotland, said: “The growing backlog of people waiting is very worrying and must be tackled as a matter of urgency.

"The early diagnosis of cancer can significantly improve someone’s chances of survival.

“With a second wave of COVID-19 likely, everything possible must be done so patient care doesn’t suffer and waiting lists don’t get longer.”

Scottish Conservative health spokesman Donald Cameron said: “Scotland’s NHS has rightly focused on dealing with Covid for most of this year, but it is extremely worrying to see the number of cancer referrals drop so significantly.

“This is a ticking time-bomb for the health of Scottish people if it’s not tackled urgently.”

Scottish Labour's health spokeswoman Monica Lennon MSP added: “With the number of referrals plummeting and health boards failing to meet targets, we are running the risk of thousands of Scots receiving treatment too late and even more missing treatment all together. ”

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Health Secretary Jeane Freeman said: “We are continuing to ensure patients are seen and treated as safely and as quickly as possible, and if necessary, changes will be made to treatment plans to minimise risk.

"While the overall aim is to recover cancer waiting times performance, our priority remains ensuring vital services are delivered to patients based on their clinical priority and clinical risk. We have invested £10 million to support cancer services during and beyond the Covid-19 pandemic and the new cancer recovery plan will be published in the autumn.”

It comes as the latest Scottish Health Survey reveals a decline in adults who rated their general health as "good or very good", from 77% in 2009 to 72% now - and 54% in the over-75s.

The survey, carried out before the pandemic, also found that 13% of adults in the most deprived areas had an angina, heart attack or stroke diagnosis, with 20% living with cardiovascular disease.

Overall, 47% of adults are living with long-term conditions, rising to 73% amongst over 75s.

Jane-Claire Judson, chief executive at Chest Heart & Stroke Scotland, said: “These figures show that even before the virus, there were huge challenges with our nation’s health and wellbeing.

"Without coordinated action, these challenges are likely to get even worse as the second wave of Covid-19 hits.

"We need coordinated action to make sure that the Covid-19 crisis doesn’t push our health services into a permanent state of crisis."