WAKING up this morning, Beth Purvis was supposed to be cancer-free. Instead, she is now sitting at home terrified she could die – leaving her two young children motherless.
The 40-year-old, from Essex, was devastated last week after a life-extending operation to remove a 19mm cancerous tumour from her right lung was cancelled without warning, thanks to the coronavirus.
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“It was supposed to buy me more time with my husband and children,’ says Beth, a legal assistant who lives with her husband Richard and their two children Abigail, 10, and Joseph, 11.
“My future was already uncertain, but there were still things that could be done to extend my life. Now we feel lost, there are no options."
Beth is the latest victim of tough new measures the NHS is being forced to introduce in order to free up medics and beds to fight the deadly Covid-19 crisis.
Cancer operations like hers are now being 'scored' to determine whether they need to be prioritised – with those whose surgeries are deemed 'delayable' facing traumatising cancellations.
"The tiny light at the end of the tunnel we might one day reach has been snuffed out. Fear has set back in," Beth says.
"I am frightened that coronavirus might kill me if I catch it. I am also frightened it might indirectly kill me if my cancer can’t be treated.”
Last week Beth was told all surgical procedures were cancelled due to the coronavirus.
There was no explanation from her surgeon at the Royal Brompton Hospital in London – just a call from a harassed secretary with no answers.
“I can only assume that a lung operation was considered too risky with a virus circulating that attacks the lungs or else that hospital resources are having to be deployed elsewhere,” says Beth.
Sadly, the cancellation of her operation is not a one off – with thousands more like her facing a bleak future.
Medics' agonising choice
As the spread of the coronavirus leaves hospitals overwhelmed, NHS trusts have been told to choose which patients should receive chemotherapy or surgery first.
This is forcing doctors to make agonising decisions which could end up with more people waiting anxiously for treatment – or even having their lives cut short.
With the crisis possibly stretching out for several months, it could potentially mean tens of or even hundreds of thousands of cancelled operations, in fields ranging from orthopedics to neurosurgery.
Maggie Hollick, from Shropshire, is another casualty of the pandemic.
The retired teacher, 67, has just had her urgent cancer operation cancelled because beds at the Queen Elizabeth Hospital in Birmingham were needed for coronavirus patients.
Maggie had a skin cancer removed from her thigh five years ago and was told it had spread after finding a lump in her groin a few months ago.
The surgeon himself rang me and apologised sincerely, explaining that he could not go ahead with operations
She was due to have a major operation to removed lymph nodes this week, but two days before the surgery Maggie was told it was cancelled – despite it being deemed urgent.
“The surgeon himself rang me and apologised sincerely, explaining that he could not go ahead with operations as the hospital was keeping beds free for coronavirus patients,” she told the Shropshire Star.
“He also explained that his expertise was needed in theatres and also ventilators were needed.”
Shockingly, he even agreed when Maggie said that her operation was an urgent one.
'I have no good options now'
Patients like Maggie and Beth are now left in limbo.
Beth, who was diagnosed two years ago with stage four bowel cancer that spread to her lungs, currently has no idea when her doctors might consider rescheduling surgery.
Given the scale of the outbreak she can only assume it may be months, not weeks – which could have devastating and fatal consequences.
“Before any new plans can be made, I will need a scan to find out how my cancer has behaved, whether it has grown or spread further,” she says.
There are no guarantees chemo will actually work. But, without chemo the cancer is left to do whatever it wants
“They may discover it has progressed to a point where this operation is no longer considered beneficial and if that happens I will be left with palliative options only.”
The other option is chemotherapy to try and slow the cancer down, but chemo will compromise her immune system and Beth fears this could leave her vulnerable to the coronavirus itself.
“There are no guarantees chemo will actually work. But, without chemo the cancer is left to do whatever it wants," she says.
"I have no good options right now."
'Doctors feel very uncomfortable'
The number of patients struck down with coronavirus is having a harrowing ripple effect on the entire NHS.
Barking, Havering and Redbridge University Hospitals was the first Trust to announce it has cancelled all cancer surgery and chemotherapy for at least two weeks because of the surge in coronavirus patients.
All planned surgery at the Trust has been postponed, chemotherapy and endoscopy appointments have been halted and patients cannot see their doctors face-to-face.
Professor Karol Sikora, chief medical officer of Rutherford Cancer Centre, says blanket bans like these are not the way forward and more lives will be lost as a result.
“Many of these operations might be diagnosing cancer,” he tells Sun Online.
“Breast cancer biopsies might not be affected as they can be done more easily but bowel or lung operations are more complex and if they’re cancelled, their cancer will be left undiagnosed for a longer period of time.
If a woman with breast cancer is about to start chemo and then she’s told she won’t be having it, she’ll feel that the rug has been pulled from beneath her
"People will lose the chance of long-term survival just because they’re caught right at the heart of the coronavirus.”
Professor Sikora also fears delaying treatment will also create untold emotional damage to patients' mental state.
“If a woman with breast cancer is about to start chemo and then she’s told she won’t be having it, she’ll feel that the rug has been pulled from beneath her," he says.
"With so much going on, there’s no time for proper explanations. This makes doctors feel very uncomfortable.”
Surgery 'score cards'
Surgeries are being 'scored', with those needing an operation within 24 hours to save their life deemed a level 1 priority.
Those who have to be operated on within four weeks to save their life or stop the progression of the disease beyond operability are deemed level 2.
The lowest prioritisation is where “elective surgery can be delayed for 10-12 weeks with… no predicted negative outcome”.
NHS doctors were told that decisions about treatment will need to be made on a case-by-case basis, taking into account the risk-benefit ratio.
Prasaana Sooriakumaran, prostate cancer surgeon at University College London Hospital (UCLH), says the impact of the coronavirus will be far-reaching.
“UCLH hasn’t been so overwhelmed with coronavirus like other London hospitals and we’ve had ventilators and lots of capacity in ITU, but the crisis has thrown the rest of cancer care into uncertainty,” he says.
“But now we’ve set up a cold site at UCLH where cancer patients can be treated, which is exclusively Covid-free, and other hospitals are doing the same too.
The tap doesn’t stop running – there are always new cancers being diagnosed
"A number of my patients’ operations had to be cancelled last week and we’re now having to prioritise everyone on their cancer risk as well as their risk of catching Covid-19, which does mean elective surgeries are cancelled."
Mr Sooriakumaran is calling for the government to ensure proper resources are put in place to ensure the "ripple effect" of scrapped surgery appointments is minimised after the pandemic dies down.
"The tap doesn’t stop running – there are always new cancers being diagnosed," he says.
"And what will happen to the non-urgent, non-Covid conditions that always need managing, such as heart disease or diabetes?
"The knock-on effects could be devastating as we will have a backlog of these cases as well as everything else."
Saving our NHS
Last week the NHS insisted hospitals have been told that cancer treatment and other clinically urgent care should continue to be prioritised.
However, MacMillan Cancer Support say treatment plans may be modified, adding: “We understand this is a particularly anxious time for people living with cancer and those awaiting treatment."
There was some good news over the weekend as it was confirmed that private hospitals were supplying 20,000 extra staff and thousand of beds and ventilators to help fight off the coronavirus.
Health Secretary Matt Hancock also revealed on Tuesday groundbreaking new plans for the Army to turn London's Excel centre into a new hospital to provide 4,000 extra beds for coronavirus patients.
Gruelling fight for life
Beth is praying such measures are successful.
She’s already survived against the odds, having been told initially she’d live three years at best.
“When I was diagnosed with bowel cancer at the age of 37 I had 'curative' surgery followed by 'mop up' chemotherapy, and that was supposed to be it,” she says.
“But a year later the cancer was back and had spread to my lungs. Even worse they initially told me they couldn’t operate.
I made it to 40 last year, feeling fit and well – and then February this year a tumour came back
"My prognosis was poor – I had six months at worst and three years at best. I couldn’t tolerate chemo and made the decision I would take quality of life over quantity.
"But another year later and I was beating the odds. My doctors decided two lung operations were possible and they removed 10 tumours from my lungs.
"I went back to work, and started looking to the future. I made it to 40 last year, feeling fit and well – and then February this year a tumour came back.”
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All Beth hopes for now is that her operation can be rescheduled.
“The longer our hospitals are overwhelmed by coronavirus means the longer cancer patients and people with other long term chronic health conditions aren’t getting treatment,” she says.
“I think some people don’t realise that coronavirus has life and death implications for many other groups – not just those who get it severely themselves.
Every single person in this country has a part to play in getting this virus under control. All you have to do is stay at home
"Every single person in this country has a part to play in getting this virus under control. All you have to do is stay at home!
"Please, please help our NHS to help us and stay at home so that your mum, your grandad, your cousin’s daughter, and even people like me can get our life-saving treatments.”
Comprehensive cancer information and support, including the latest guidance on the impact of coronavirus on cancer care, is available on macmillan.org.uk. Ring support on 0808 808 00 00.
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