As a cancer specialist I think it’s important to respond to the #HealthSecretary’s comments about cancer treatment not being available if #COVID19 gets out of control. Firstly, it’s important to state that #Hancock and his own Government’s failures have contributed to the problem
Secondly, I think it’s unlikely that those in most need will miss out. We have learnt an enormous amount about managing cancer in a #COVID19 environment and are now much better prepared. At present we are managing generally very well, although surgical waiting lists are a problem
Non surgical cancer treatment like chemotherapy and radiotherapy is mainly outpatient based and we should be able to cope. Initial concerns about risks to patients on chemo have not turned out to be as serious as we first thought.
Radiotherapy services have managed well and will continue to do so. In certain cases, radiotherapy is a good alternative to surgery and can replace it in selected situations if the #COVID19 situation becomes really dire
Diagnostics is a major issue, but again, we can adapt and focus on initial diagnosis of cancer rather than the follow up of cancer, where the benefits of repeat imaging are largely unproven.
We clearly need to avoid the situation of a major second wave causing the health system to be overwhelmed, so we need to continue to take our public health measures very seriously. Hopefully this will minimise flu outbreaks too. We also need to ensure high uptake of flu vaccine.
The public must be told to seek medical help if they have worrying medical symptoms. GPs and hospital services will still be running. We must not sacrifice lives due to fear of seeking help. If we are all sensible and follow the key public health messages, we’ll get through this
We need to find the right balance between addressing the seriousness of #COVID19 & the seriousness of collateral effects. It isn’t easy. That’s why transparency & honesty from Government is essential. Public trust is at the heart of managing the pandemic, but it’s in short supply

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More from @cpeedell

4 Oct
THREAD on healthcare for US voters:
Republicans repeatedly claim that “socialised” medicine means taking healthcare away from people. I come from the UK, the home of socialised medicine since 1948 in the form of the NHS.
I have worked as a doctor in the NHS for over 25 years
The NHS may not be perfect, but it’s loved & respected by the UK public. It’s founding principles are universal healthcare for all, free at the point of use, regardless of the ability to pay. Every citizen gets access to care.
It’s funded by taxpayers, so the state insures us all
The remarkable thing about the #NHS is that it’s survived decades of right wing Governments, who’ve chronically underfunded it and part privatised it. Despite this, the public & NHS healthcare workers have kept fighting for it, because it forms the social fabric of our society
Read 9 tweets
10 Jun
Oncologists and cancer surgeons need to open up a debate about which surgical patients should receive radiotherapy instead. My suggestions will follow.
Coronavirus: NHS waiting list 'could hit 10 million this year' - BBC News #COVID19 bbc.co.uk/news/health-52…
I specialize in thoracic & urological malignancy, so will only start #cancerdebate in these areas.
Prostate
1. Offer Active Surveillance or SBRT instead of prostatectomy for vast majority of low risk & low-intermediate risk disease
2. SBRT for intermediate risk disease.
3. If things get really desperate then consider SBRT for higher risk groups as well eg PACE C criteria

Renal:
1. Consider SBRT instead of partial nephrectomy in selected cases (<6cm size).

Bladder
1. Offer RT over surgery in most cases. Surgery for salvage

#cancerdebate
Read 5 tweets
7 Jun
An early lockdown would have:
1. Minimised overall number of infections
2. Lowered R0 number
3. Saved lives
4. Reduced long term morbidity
5. Reduced burden on health services, allowing more non-#COVID19 services to have stayed open
6. Limited geographical spread around country
7. Allowed earlier release of lockdown
8. Reduced economic damage
9. Improved test, trace, isolate effectiveness
10. Bought more time and resources to help rebuild public health teams
11. Built trust in our political leaders, essential for ongoing public health messages
12. Increase the possibilty of preventing a second wave through ongoing stringent public health measures like test, trace, isolate, face masks etc whilst continuing to open up the economy over time
13. Buy more time to develop vaccine and more effective treatments
#COVID19
Read 5 tweets
31 May
THREAD: Summary of UK’s #COVID19 Crisis
1. Viral pandemics are top of Government’s risk register
2. Despite this, Cygnus report showed we were unprepared
3. We had advanced warning in January
4. PM put his free market ideology ahead of public health (Feb 3rd “Superman” speech)
5. Herd immunity strategy adopted instead of strict early lockdown, which eventually came but far too late
6. PM’s “hand shaking” speech was a public health calamity
7. Sporting events like Cheltenham, Liverpool/Madrid, & Rugby internationals were a public health calamity
8. Test, Trace, Isolate dropped, when it should have been a key measure
9. Failure to protect nursing/care homes. Hospitals told to discharge patients into these vulnerable places
10. Failure to protect NHS & social care staff, & other frontline staff with adequate PPE or no PPE
Read 9 tweets
21 May
As an #NHS cancer consultant , I have a public duty to raise the alarm that the Government is failing cancer patients during the #COVID19 crisis. A key cancer treatment that will be crucial to tackling the upcoming surge in cancer cases is still being rationed by NHS England 1/
Stereotactic radiotherapy (#SABR or SBRT) is a method of radiation delivery that can accurately deliver very high doses of radiation to localised cancers. It’s used to treat a wide variety of cancers including lung, prostate, kidney, and liver cancers. 2/
SABR requires fewer outpatient visits (typically 1-5) compared to conventional radiotherapy (20-30). It frees up radiotherapy capacity, reduces #COVID19 exposure, and is more cost-effective. This is crucial in #COVID19 era, because more patients are going to need radiotherapy 3/
Read 10 tweets
16 May
THREAD on cancer treatment in #COVID19 pandemic.
The @CovidSurg collaborative have estimated that in the UK, >500,000 operations have been cancelled, including 36,000 cancer surgeries. Globally, the figures are 28.4m and 2.3m. (During peak 12 weeks of disruption) #cancer 1/
Although surgical activity is increasing again and cancer surgery is being prioritised, we are far from returning to normal levels and there is going to be an enormous backlog of cases. This will be particularly detrimental to overall cancer outcomes 2/
It gets worse. We now have data via @CovidSurg (across a range of different types of surgery) that shows a 30-day mortality rate of 23.8% in patients who develop #COVID19 infections in the post-operative period. Mortality rates of 30% have been reported after cancer surgery 3/
Read 16 tweets

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