The Covid-19 pandemic has affected the world for slightly over a year to date.
The situation in Malaysia does not appear to be abating with 238,721 cases and 857 deaths on Feb 6, compared to 115,078 cases and 474 deaths on Jan 1.
The healthcare system is straining to cope with this unprecedented challenge.
There are global reports that cancer care, like other non-Covid-19 conditions, is being deprioritised, delayed, disrupted, and even discontinued by some health systems.
These decisions will impact on cancer death and burden health systems for years to come with delays in cancer screening resulting in delayed diagnosis and worse outcomes for the affected patients.
The Global Cancer Observatory reported that 128,018 Malaysians have been diagnosed with cancer since 2015, with 48,639 new cases and 29,530 deaths last year alone.
The five most frequent cancers in males are lung, colorectum, prostate, nasopharynx and liver, while the five most frequent in women are breast, colorectum, ovary, cervix and uterus.
Overall, the top five most frequent cancers are breast, colorectum, lung, nasopharynx and liver.
Many cancers were diagnosed late, according to the 2012-2106 National Cancer Registry Report.
A total of 63.7% of Malaysians were diagnosed with advanced cancer, i.e. in stages three and four, compared to 58.7% in the 2007-2011 report.
Delay in care
The redeployment of beds, equipment and staff to Covid-19 wards has impacted directly and indirectly on cancer care.
Healthcare staff who have been affected by Covid-19, whether as a patient or a close contact requiring self-isolation, has depleted hospital capacity for the care of non-Covid-19 diseases, including cancer.
There are also concerns about the susceptibility of cancer patients to severe Covid-19.
While the official position is that cancer care is continuing, the reality is that rationing is taking place, as evidenced by the relative allocation for cancer care in Budget 2021 approved by Parliament.
Because of treatment delays, operable or curable cancer will develop into inoperable cancer with worse outcome.
Doctors are being forced to make management decisions that may not be in their patients’ best interests with consequent sub-optimal care for some, if not many.
At the best of times, cancer screening and diagnosis in Malay-sia lags behind that of other countries at the same level of development.
Concerns about the spread and contracting of Covid-19, and fear that hospitals are dangerous places, do not encourage symptomatic patients to seek care early.
This has been accentuated with the Health Ministry’s advice to stay away from hospitals, which gave the impression that hospitals are dangerous places.
Delayed diagnosis leads to cancer cases going undetected and untreated with consequent in-
crease in demand for cancer services if and when the pandemic is contained.
This, together with increased advanced cancer cases because of diagnostic delays and sub-optimal treatment that may be related to fragmented care, will impact on the health system and contribute to excess cancer-related illness and death in the medium to long-term.
Cancer patients undergoing treatment or on follow-up have also been affected by the pandemic, which has impacted on access to treatment resources like transportation, funding, home care, medicines, etc.
Appropriate supportive care is vital to extend overall survival.
Its availability prevents premature death and helps facilitate a good death – defined in 1997 as a death “free from avoidable distress and suffering for patient, family and caregivers, in general accord with the patient’s and family’s wishes, and reasonably consistent with clinical, cultural, and ethical standards” in a US National Institute Report.
Cancer can and does lead to catastrophic health expenditure (CHE).
CHE, according to the World Health Organization (WHO), occurs “when out-of-pocket health payments equal or exceed 40% of its non-subsistence expenditure, or what is called its capacity to pay”.
The data on CHE in Malaysia prior to the advent of Covid-19 has been disturbing.
The 2012–2014 Asean Costs in Oncology Study, which prospectively followed 9,513 newly diagnosed cancer patients from eight countries for 12 months, found that the proportion of previously-solvent patients who experienced economic hardship following a cancer diagnosis was highest in Malaysia (45%) and Indonesia (42%), and lowest in Thailand (16%).
Meanwhile, a prospective study of 138 colorectal cancer patients at Universiti Malaya Medical Centre examined the cost of their treatment, and the prevalence and determinants of CHE.
The authors concluded that their research strongly “suggests that stakeholders and policymakers should provide individuals with financial protection against the consequences of cancer, a costly illness that often requires prolonged treatment”.
Among the consequences of Covid-19 and the movement control order are considerable economic disruption, decrease in income, and unemployment without a robust safety net.
Therefore, it is probable that CHE will increase in Malaysia.
The long-term impact on cancer care has yet to be seen.
World Cancer Day was commemorated on Feb 4.
The theme this year – “I am. I will” – was, in the words of the Union for International Cancer Control, a reminder that “our actions have an impact on everyone around us, within our neighbourhoods, communities and cities.
“And that more than ever, our actions are also being felt across borders and oceans.
“This year is a reminder of the enduring power of cooperation and collective action.
“When we choose to come together, we can achieve what we all wish for: a healthier, brighter world without cancer.
“Together, all of our actions matter.
“This World Cancer Day, who are you and what will you do?”
Like Covid-19, cancer does not distinguish who will be affected.
While this might be a moot point with the current Covid-19 situation demanding urgent attention, the government and the public should also remember that cancer and other non-communicable diseases also require resources.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email email@example.com. The views express-ed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.