On the 29th March 2020, my uncle John Gallagher (community worker, activist, conservationist, politician and loyal soccer supporter) became one of the earliest victims of the COVID pandemic on this island. A national lockdown and health restrictions meant that none of our family or any of his many friends and colleagues, were able to attend his funeral, having to watch disconnectedly online. Five years on, we finally got to celebrate my uncle’s life, with his many former colleagues and friends, in a special event that took place in City Hall in Dublin recently. While the last 5 years have been challenging, a chance remark following my uncle’s death led to a body of ground-breaking research, much of which is published in high impact international journals,1-8 that has resonated globally and influenced cancer policy, allowing me to constantly remember and pay tribute to my uncle.
Originally from the Coombe area of the Liberties in inner-city Dublin, where my uncle worked tirelessly for his community, whether they be three or one hundred and three (a local biography gave him the moniker of Knight of the Coombe), I’m a cancer researcher and Professor of Digital Health at Queen’s University Belfast (which was a great source of pride for my uncle). A colleague of mine, Professor Eduard Vrdoljak, a Croatian oncologist, while reaching out to sympathise with me on the Saturday after my uncle’s death, said something that chilled my bones. Eduard remarked that people in Croatia “feared a COVID diagnosis more than a cancer diagnosis.” His comments unsettled me and I could think of little else over the weekend, despite my loss.
Early Monday morning, I reached out to colleague and great friend, Professor Richard Sullivan at King’s College London, and we both agreed this was something that required urgent investigation. Working with a “coalition of the willing” UK-wide, we rapidly established a research study to determine whether Eduard’s statement was correct, by examining, in near real-time, data from hospital trusts across the UK.
What we found was extremely disturbing. Diagnostically, 7 of 10 people presenting to their GPs with symptoms that might suggest cancer, didn’t get to see a cancer specialist, either because they were afraid to enter a hospital in case they caught COVID (echoing Eduard’s statement), or because cancer services were disrupted. Therapeutically, 4 of 10 cancer patients didn’t receive their chemotherapy at the correct time. The results struck us like a thunderbolt – we immediately contacted the Chief Medical Officers of the 4 UK nations to share our data intelligence. This was the UK’s first evidence of COVID’s devastating impact on cancer, a conclusion we subsequently showed was also the case in Ireland. Its policy implications were significant.
Soon after, we were contacted by the European Cancer Organisation (ECO) the largest organisation representing cancer professionals and patient advocates in Europe, to present our research to their Board. ECO were very unsettled by our data, immediately establishing a Special Focussed Network on COVID’s Impact on Cancer, which they asked me to co-chair – a great honour which I gratefully accepted. We immediately performed a more detailed European version of our UK analysis, to see if the European experience mimicked that of the UK.
Our results were devastating. Due to the pandemic and national lockdowns, >100 million cancer screening tests were not performed; 1 million cancer diagnoses were missed; chemotherapy and surgery dropped to 50% of capacity; 4 of 10 cancer health professional were burned-out, while 3 of 10 exhibited signs of clinical depression.
Recognising the cataclysmic impact of these findings, we established a Time-To-Act campaign (#TimeToAct): “Don’t Let Covid Stop You From Tackling Cancer.” Translated into 32 languages, we launched the campaign in 12 countries across Europe, working closely with Ministers’ of Health (or their equivalent), their departments, national cancer charities and patient advocacy groups, all coming together to amplify the campaign’s message and impact.
#TimeToAct’s impact was far-reaching, enthusiastically adopted across Europe. We received several awards – the Royal College of Physicians Excellence in Patient Care Award, the prestigious European Communique Award and numerous national measures-of-esteem. More important was the influence that the research exerted, with European Commission President Ursula Van Der Leyen and Health Commissioner Stella Kyriakides regularly quoting our data, while Europe’s Parliamentary COVID-19 Committee adopted our recommendations in its influential report. We subsequently developed a COVID and Cancer Data Navigator, so that the impact of COVID on cancer could be captured and viewed across the different nations of Europe on a straightforward dashboard that anyone could access.
timetoactcancer.com/data-navigator
Five years on, while I still miss him, I definitely feel that my uncle’s death was not in vain, given the practice-changing research that it inadvertently prompted. I’m frequently invited to present the work and its implications at influential international conferences and venues; it’s a special pleasure to have my uncle virtually with me, whether in the European Parliament in Brussels, the House of Commons in Westminster or the American Society of Clinical Oncology in Chicago, allowing me to acknowledge his (unbeknownst to him) precious contribution to international cancer research. That would have amused him and humbled him in equal measure. So, a serendipitous comment provoked a world-leading cancer study that has delivered global impact.
References
1. Couespel N, Venegoni E, Lawler M. The European Cancer Pulse: tracking inequalities in cancer control for citizen benefit. Lancet Oncol. 2023 May; 24(5):441-442. doi: 10.1016/S1470-2045(23)00140-7.PMID: 37142370
2. Banerjee A, Sudlow C, Lawler M.Indirect effects of the pandemic: highlighting the need for data-driven policy and preparedness. J R Soc Med. 2022 10:1410768221095245. doi: 10.1177/01410768221095245. PMID: 35537476
3. Lawler M, Crul M.Data must underpin our response to the covid-19 pandemic’s disastrous impact on cancer. BMJ. 2022 ;376:o282. doi: 10.1136/bmj.o282.PMID: 35115384
4. Ho KMA, Banerjee A, Lawler M, Rutter MD, Lovat LB Predicting endoscopic activity recovery in England after COVID-19: a national analysis. Lancet Gastroenterol Hepatol. 2021; 6:381-390. DOI: 10.1016/S2468-1253(21)00058-3 . PMID: 33713606
5. Lai AG, Pasea L, Banerjee A, Hall G, Denaxas S, Chang WH, Katsoulis M, Williams B, Pillay D, Noursadeghi M, Linch D, Hughes D, Forster D, Turnbull C, Fitzpatrick NK, Boyd K, Foster GR, Enver T, DATA-CAN, Cooper M, Jones M, Pritchard-Jones K, Sullivan R, Davie C, Lawler M, Hemingway H. Estimated impact of the Covid-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near-real-time data on cancer care, cancer deaths and a population-based cohort study BMJ Open. 2020 Nov 17; 10(11):e043828. DOI: 10.1136/bmjopen-2020-043828 .BMJ Open. 2020. PMID: 33203640
6. Loveday C, Sud A, Jones M, Broggio J, Scott S, Torr B,; Garrett, A, Nicol DL, Jhanji S, Boyce SA, Williams M, Lyratzopoulos G, Barry C, Riboli E, Kipps E, McFerran E, Muller DC, Lawler M, Abulafi M, Houlston R, Turnbull C. Prioritisation by FIT to mitigate the impact of delays in the 2-week wait colorectal cancer referral pathway during the COVID-19 pandemic: a UK modelling study Gut 2020 Aug 27:gutjnl-2020-321650. DOI: 10.1136/gutjnl-2020-321650 PMID: 32855306
7. Sud A, Torr B, Loveday C, Jones M, Broggio J, Scott S, Gronthoud F, , Nicol DL, Garrett A, Jhanji S, Boyce SA, Williams M, Lyratzopoulos G, Barry C, Riboli E, Kipps E, Larkin Navani N, Swanton C, McFerran E, Muller DC, Lawler M, Houlston R, Turnbull C. Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study Lancet Oncol 2020 21:1035-1044. DOI: 10.1016/S1470-2045(20)30392-2. PMID: 32702311
8. Vrdoljak E, Sullivan R, Lawler M.Cancer and coronavirus disease 2019; how do we manage cancer optimally through a public health crisis? Eur J Cancer. 2020; 132:98-99. Doi: 10.1016/j.ejca.2020.04.001 . PMID: 32335477