Access to optimal cancer care is not equally available to everyone

Appropriate funding mechanisms are needed to help those who might have difficulty going for cancer screening, like a mammogram, due to constraints like a lack of childcare or transport. — Photos: Filepic

The incidence of cancer continues to rise significantly globally.

World Cancer Day is observed annually on Feb 4, with the aim of raising awareness, as well as providing inspiration to patients and loved ones who suffer(ed) from this chronic condition.

This year’s (2022) theme is “Close the Care Gap” – a recognition of the fact that there are vast differences in the availability of optimal cancer care within society, from prevention to diagnostics, and treatment to palliative and spiritual care.

The theme will remain the same until 2024 in recognition of the fact that addressing the issue of inequality is not straightforward.

The goal of this first year of the campaign is to ensure that all stakeholders realise that inequities in cancer care occur around the globe.

The stated aim is to have an open mind when challenging assumptions and looking at the hard facts, i.e.:

• Inequity in cancer care costs lives.
• People who seek cancer care hit barriers at every turn.
• Income, education, location and discrimination based on ethnicity, gender, sexual orientation, age, disability and lifestyle are just a few of the factors that can negatively affect care.
• The gap affects everyone, including you and your loved ones.
• These barriers are not set in stone; they can be changed.

Your socioeconomic environment

Living in places where there is a lack of space to exercise properly and safely is likely to result in inadequate physical activity, contributing to poor health behaviour.

A lot of inequity is related to social determinants of health.

The US Department of Health and Human Services defines these social determinants as conditions in the environments where people are born, live, learn, work, play, worship and age, which affect health, functioning and quality of life.

Obstacles in obtaining healthcare can occur due to a number of reasons.

There is evidence to show that diagnosis and treatment are more often suboptimal (i.e. not according to established guidelines) for those with lower levels of income, lower academic qualifications and low health literacy.

The 2019 National Health and Morbidity Survey (NHMS) identified 35.1% of Malaysian adults as having low health literacy, 28% with low health literacy in managing medical issues, and 32.3% with low health literacy related to disease prevention.

There are also significant differences for those who do not have sufficient health insurance, those who have trouble getting medical leave from work, and those who have to travel long distances to healthcare facilities.

Health Minister Khairy Jamaluddin recently acknowledged the need to improve access to cancer treatment for those who live in rural areas, noting that of the 36 cancer treatment centres nationwide, six are under the Health Ministry, four in university hospitals and the remaining 27 in the private sector.

The environment in which one grows up or works in can also increase one’s risk of cancer as a consequence of excessive exposure to carcinogens such as tobacco, air pollution and asbestos.

One’s immediate environment also has an influence on health behaviour.

For example, those who live in areas lacking in affordable healthy foods or adequate areas to safely indulge in exercise are more likely to be physically unfit, obese and have poor diets – all of which are risk factors for cancer.

The impact of these obstacles is not merely academic, but has real world implications.

One can imagine how a delay in diagnosis can lead to a higher likelihood of being diagnosed with late stage cancer.

The example of lung cancer

Lung cancer is a microcosm of the issues plaguing cancer in general.

It is the third most common cancer in Malaysia, the most common cancer to afflict males and the most common cause of cancer deaths, accounting for one in five of all medically-certified cancer deaths in this country.

The majority of cases are preventable as they are linked to smoking, but the even more devastating statistic is that in Malaysia, more than three-quarters of cases are diagnosed too late, with either locally-advanced tumours or distant metastasis.

In other words, by the time the patient presents to a doctor, the cancer has already spread to areas beyond the lung, thus precluding curative treatment.

Diagnosis of the exact cancer type and stage is essential in order to ascertain the appropriate treatment.

This entails access to specialists who can obtain the necessary biopsies, appropriately-trained pathologists and lab techniques that can give a detailed diagnosis, and equipment such as a PET-CT (positron emission tomography-computed tomography) scanner.

Once the diagnosis is reached, a decision needs to be made regarding the best treatment.

This can range from chemotherapy to immunotherapy to radiotherapy, each with differing levels of availability and costs to the individual.

The duration of treatment may vary, as is the opportunity for palliative and spiritual support.

Stopping it early

Access to equipment like a PET-CT scan machine to help diagnose and stage cancer is not equally available to everyone.

Many things can, and need to, be done to not only improve overall outcome for cancer patients, but also reduce the disparity in access.

This starts with prevention and early detection.

Although not as sexy as talking about genomic studies and treatment based on genetic mutations at a molecular level, the more mundane public health measures are just as essential.

The World Health Organization (WHO) reported that: “Between 30% and 50% of cancer deaths could be prevented by modifying or avoiding key risk factors and implementing existing evidence- based prevention strategies.”

The upcoming Tobacco and Smoking Control Act that will be presented by Khairy is a one such important step that seeks to reduce the prevalence of smoking in the country.

This includes measures such as the generational endgame, whereby those born after 2005 will never be allowed to purchase smoking products.

Current smokers will also be given more support in quitting smoking, especially those who fall within the B40 group.

Alongside implementation of the National Health Literacy Policy, this will help improve awareness, with the aim of changing behaviour.

Screening helps with early detection and a subsequent reduction in healthcare burden.

It can take the form of low-dose CT scans for lung cancer, mammograms for breast cancer, endoscopies for colorectal cancer and Pap smears for cervical cancers.

These can be made more readily available to those who traditionally fall outside more established areas via appropriate funding mechanisms.

These funds would not only help educate the public, but also reduce barriers such as transport, and even childcare (to allow parents to undergo the necessary check-up).

The first step to improving cancer outcome is acknowledging our deficiencies.

It is with this mindset that we then seek to reduce disparities by pushing for policy changes that are cognisant of the systemic inequalities that need to be overcome.

Dr Helmy Haja Mydin is a respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidence-based policies. For further information, email [e-mail]. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.