STAFF shortages, problems with equipment, and delays to colonoscopies and MRI scans have been blamed as NHS Scotland fell short of its cancer waiting times target for the seventh year in a row.
Patients with colorectal and urological cancers such as bowel, prostate, bladder and kidney cancer were worst hit, with one in three waiting too long from referral for tests to treatment starting.
It comes amid fears that cancer patients will now face even longer waits for diagnosis as the NHS grapples with a backlog of cases missed while screening was paused and GP cancer referrals plunged.
NHS Tayside also warned that its endoscopy capacity has been "significantly impacted" by Covid.
The latest figures from ISD Scotland, which cover January to March, show that just under 85 per cent of patients urgently referred with possible cancer symptoms - and who were subsequently found to have the disease - began treatment within 62 days.
READ MORE: Fewer than 40% of bowel cancer patients detected through screening start treatment on time
The national target is 95 per cent, but that has not been achieved since the end of 2012.
Janice Preston, head of Macmillan in Scotland, said: “Seven years on since the cancer waiting times target was last hit, it’s clear this is symptomatic of a cancer care system that is struggling.
“The NHS has been under additional pressure because of coronavirus, but these figures are a stark reminder that the system wasn’t working as it should long before the pandemic.”
The data reveals that there has been a 41% increase in cancer referrals over the past seven years - from 2,722 in the first quarter of 2013 to 3,833 for the same period in 2020 - largely due to Scotland's ageing population. Half of patients are starting treatment within 41 days now, compared to 37 days in 2013.
At the start of 2020, the 62-day standard was met nationally for just two types of cancer - breast and ovarian - while colorectal and urological fell furthest behind.
In the three months to the end of March, just 65.5% of colorectal cancer patients detected through routine screening started treatment within 62 days of referral for tests - though this was an improvement from 35.9% a year ago.
For urological cancers - which include prostate, kidney, testicular and bladder - more than 37% of patients waited too long.
Rates of both are on the increase, but waiting times have also been hit by bottlenecks in diagnosis.
NHS Borders told statisticians at ISD Scotland that it had experienced "capacity issues" in relation to colonoscopies and prostate cancer investigations.
READ MORE: NHS Fife says patients will wait up to 20 weeks for routine MRI
NHS Dumfries and Galloway reported a "backlog of prostate MRI reporting" which was "now resolved", while NHS Grampian bemoaned "a lack of medical, nursing and radiology staff due to national shortages".
Urology and colorectal were the main services affected, said NHS Grampian, adding that there was "not enough capacity for colorectal screening despite extensive use of the independent sector".
NHS Greater Glasgow and Clyde reported absences and vacancies within urology, while NHS Forth Valley said vacancies in pathology - now filled - and a national recall of some biopsy equipment had slowed down its turnaround times for diagnosis.
NHS Tayside, where 92% of cancer patients started treatment within 62 days of referral, expressed concern about the impact of Covid, stating: "NHS Tayside has been able to maintain treatment for cancer patients, however capacity for endoscopy has been significantly impacted as a consequence of room cleaning times and PPE requirements.
"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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Marion O’Neill, of Cancer Research UK in Scotland, said: “These statistics are for the first quarter of this year, before the full impact of Covid-19 on cancer services was being felt.
“Unfortunately, in future, we’re likely to see a significant increase in cancer waiting times. This is due to the backlog created by the pausing of many diagnostic services due to Covid-19.
"New infection control procedures also mean appointments will likely take longer.
"As health services work hard to get back on track, this backlog will need to be tackled against a backdrop of long-standing staff shortages.”
Health Secretary Jeane Freeman welcomed figures showing that, once diagnosed, 96% of patients start treatment within 31 days, and said progress had been made towards meeting the 62-day target prior to lockdown.
The Scottish Government has given health boards an extra £10 million to help restore cancer services and prioritise the most urgent cases.
Ms Freeman added: “To help free up capacity we asked health boards to postpone non-urgent operations and procedures to allow vital NHS staff and resources to be redeployed to support the response to the pandemic.
"Throughout this period the majority of cancer treatments have continued, however some patient’s treatment plans have changed to minimise their individual risk."
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