We need to focus on cancer
COUNTRIES have re-prioritised budgets, systems and political will to focus on protecting their populations from Covid-19. Unfortunately, this has resulted in trade-offs that have or will likely increase the burden of other diseases on healthcare systems and communities for years to come. Cancer is one of these diseases.
Malaysia has made significant progress in providing universal coverage of cancer care through its health system. However, over the past decade, nearly a quarter of a million cancer cases and 150,000 deaths from cancer have been reported. By 2030, these numbers are expected to rise by 50%. Cancer is the second leading cause of premature death in the country.
The average likelihood of surviving certain types of cancers beyond five years is significantly lower among Malaysians, compared with countries like Singapore and Japan.
For common cancers like breast and colorectal cancer, this is due to the high proportion of the disease being detected at late stages.
Accessing and linking patients with effective treatment are also major challenges. The mortality-to-incidence ratio for Malaysia is higher than the global average. Many of these cancer deaths, even those at later stages, were premature.
Not only is Malaysia experiencing comparatively high mortality due to this disease, people living with cancer, and their families, often bear a heavy economic toll to survive. Families are struck by financial catastrophe, which often results in difficult choices such as between seeking treatment for cancer or ensuring that your children will be able to afford to go to school.
Globally, 42% of countries surveyed by the World Health Organisation in its “Rapid assessment of service delivery for NCDs (non-communicable diseases) during the Covid-19 pandemic” report experienced disruption in cancer diagnoses and treatment. Screening programmes for breast and cervical cancer were postponed in 50% of responding countries.
Studies have shown that cancer patients appear to be more vulnerable to Covid-19 complications, with increased mortality among those who are positive. The fear of infection coupled with the suspension of diagnostic services may cause individuals to be delayed in being screened for cancer or not be screened at all. Treatment pathways modified to minimise exposure have resulted in delays or deferments. The scaling down of certain aspects of care could also cause treatment to be delayed or be of suboptimal standard.
The same dire situation is expected or has already occurred in Malaysia. Amid the ongoing pandemic, cancer patients face an increasingly higher risk of economic hardship and reduced survival than ever before.
Health outcomes will be impacted for decades to come unless remedial action is taken now, and long-term commitment and investments are made. Cancer control efforts, unlike swift public health responses that curb infectious diseases, must be sustained to have any impact on health outcomes.
The goal in cancer care is to increase early detection, expand effective treatment, provide care and improve survival of those living with cancer. To mitigate the situation affecting cancer patients in Malaysia, three priority areas need to have the attention and commitment of policymakers.
Screening and diagnosis: It is a fact that screening more people earlier, getting a diagnosis and linking them with effective treatment, will increase their likelihood of survival. Investing in ensuring that more people are aware and concerned about cancer so that they can get screened is a cost-effective approach.
Treatment: It is a fact that more than 70% of people living with cancer in Malaysia are diagnosed when they are at stage three or four. Nevertheless, timely and effective treatment at the later stages of cancer needs to be made available and expanded. The healthcare system must not leave behind those diagnosed with advanced disease. The burden of undertreated cancer is more costly both in terms of funding and lives.
Governance: The financing and governance of cancer-care need to be reformed and optimised to focus on ensuring better health outcomes, namely working towards the survival of people living with cancer and reducing the burden on the healthcare system through early diagnosis and effective treatments.
The impact of the Covid-19 outbreak and of the measures imposed to control its spread on the prevention and management of NCDs such as cancer in Malaysia is still being researched. What is certain is that the implications of policies made for Covid-19 will have an impact for years to come, beyond the epidemic. We need to ensure that people living with cancer are not left behind.
Source: The Star By AZRUL MOHD KHALIB
Galen Centre for Health & Social Policy, Kuala Lumpur
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