The impacts of the Covid-19 pandemic on breast cancer
The NHS has taken extensive steps to minimise the impact of the coronavirus outbreak on cancer services, however the situation continues be extremely difficult and uncertain for so many people affected by breast cancer.
There have been significant changes to people’s care across every stage of the breast cancer pathway. For example, thousands of screening appointments have been cancelled, a worrying drop in the number of referrals to cancer specialists, many people’s cancer treatment has been delayed or modified, and many clinical trials paused their recruitment.
At Breast Cancer Now, we’ve been almost overwhelmed by the number of people calling our helpline and emailing our specialist breast care nurses for information and support as they try to understand how coronavirus could affect them or their treatment.
As the UK continues to adapt to life during the pandemic, we expect the number of people contacting their GP to report possible breast cancer symptoms to start to return to pre-Covid-19 levels. In addition, those who have had a breast cancer diagnosis or have been receiving treatment during the outbreak may be looking for support as they come to terms with their diagnosis, potential side effects of treatment and an end to hospital visits when treatment finishes.
Primary care professionals will play a crucial role in ensuring the anticipated increase in demand is met and in addressing the needs of anyone affected by breast cancer, from sharing information about signs and symptoms to supporting those living with and beyond a diagnosis.
Breast Cancer Now is here for everyone affected by breast cancer, at every step of the way, and can provide patients with trustworthy clinical information and signpost them to services that support their specific needs.
Increasing early detection rates and promoting prevention
NHS England figures from April showed that at the peak of the Covid-19 pandemic, compared with the previous year, there was a 57% drop in the number of women being referred to see a breast cancer specialist with suspected breast cancer.1 While the number of referrals is increasing further each month, we are still some way from the figures we would normally expect to see, with many women still oncerned or uncertain about reporting new or existing symptoms to their GP.
Primary care is an ideal setting to let people know that they can and should get in touch with their GP surgery urgently if they notice any unusual breast changes. Many women know that a lump can be a possible symptom of breast cancer, but it’s vital that they’re aware of other signs to report, such as nipple discharge or dimpling or puckering of the skin of the breast.
Reminding women to check their breasts regularly is important. There’s no special way, it’s as simple as a: TLC; Touch, Look, Check. While most breast changes will not be breast cancer, it’s important women know they should get checked by their GP if they notice any unusual changes for them, as the sooner breast cancer is diagnosed, the more likely treatment is to be successful.
Breast Cancer Now publishes a range of information booklets, including about signs and symptoms, which practices can order in bulk or can download online.
It’s also vital for us as nurses to share how women can help reduce their risk of developing breast cancer. While the greatest risk factors for breast cancer – being a woman and getting older, and for some a strong family history – are out of our control, it’s important to communicate that there are some steps women can take to help lower their risk. These include maintaining a healthy weight, keeping active and limiting alcohol. Breast Cancer Now’s booklet, What causes breast cancer?, explains more about the complexities of risk and breast cancer.
Breast cancer diagnosis and treatment during the outbreak
We know how isolating breast cancer diagnosis can be and the experience of lockdown and shielding may have intensified these feelings for some. For many, being able to talk to someone who’s been through a diagnosis and treatment for the disease can be really helpful as part of their ongoing recovery, which is why our Someone Like Me service is so crucial. We have extended the service for people with a primary diagnosis to provide one-to-one phone or email support for people feeling isolated or anxious as a result of the pandemic. For those who want to access support at any hour of the day or night, our forum provides an online community of people who understand.
For many women, the end of breast cancer treatment is the hardest part as the safety net of regular hospitals appointments drops away. Adapting to life after breast cancer treatment can often be difficult and women may need support in adjusting. The impacts of the Covid-19 outbreak may worsen an already difficult time as many face disruptions to treatment, anxieties about catching the virus and delays to breast reconstruction, making it all the more challenging to start to move forward from breast cancer.
Breast Cancer Now has a range of services that primary care professionals can signpost patients to that provide support at the end of breast cancer treatment. Our Moving Forward courses are now online, providing information, support and expert guidance on adjusting to life after breast cancer treatment, covering topics like healthy eating, managing menopausal symptoms and breast and body awareness. In addition, our end-of-treatment support app, Becca, can be downloaded on mobile phones or tablets to deliver daily information and support from specialists, bloggers and trusted online sources to help women live well after treatment.
Supporting patients with secondary breast cancer
We know that, as a result of the pandemic, thousands living with secondary breast cancer have experienced significant fears for their ongoing survival amid delays to treatment, scans and access to trials.
In May, Breast Cancer Now reported on our survey of over 580 people affected by breast cancer. This found that of 190 respondents living with incurable secondary breast cancer, nearly a quarter (24%) had seen delays or cancellations to their potentially life-extending treatment – with a further 10% having their monitoring scans delayed or cancelled.2 This led to periods of weeks or potentially months without treatments that had been helping to keep their disease stable.
Primary care has an important role to play in supporting people living with secondary breast cancer who are impacted by the pandemic. You can signpost patients to Breast Cancer Now’s Living with Secondary Breast Cancer Online programme. This is a private group on our online forum where people can access specialist information and share experiences, understanding and support with others who are also dealing with the uncertainty and challenges that secondary breast cancer brings.
We’re also running regular virtual group meetings for up to ten people living with secondary breast cancer, providing a safe, confidential space to talk.
Adjusting to the ‘new normal’
Covid-19 has presented an unprecedented challenge for the UK’s healthcare system and the impact of the pandemic on the diagnosis and treatment of breast cancer will likely continue for some time. As the UK adjusts to the ‘new normal’, it’s so important that people feel confident to come forward with any symptoms that could be breast cancer and that anyone living with the disease receives consistent care and support, and primary care professionals can play a key role in ensuring this happens.
Breast Cancer Now’s information on Covid-19 and breast cancer can be found at breastcancernow.org/covid-19. The charity’s helpline is 0808 800 6000.
Notes to Editor