LAST year, the number of new cancer cases reported in Malaysia was 48,639 and the number of people living with cancer (for five years) was a whopping 128,018 (Global Cancer Observatory, World Health Organisation; 2020 figures). Central to this discussion is that there has been a reallocation of healthcare resources to cater for the influx of Covid-19-related hospitalisations.
During the first movement control order in March 2020, cancer-screening services were limited, cancer surgeries were postponed, and clinical visits and imaging appointments deferred. While these measures were taken to ensure that we had enough medical personnel, hospital beds and personal protective equipment to accommodate the high number of Covid-19 admissions, they resulted in widespread disruptions to cancer care service delivery in the nation. Cancer survivors were also torn between having to leave their homes to attend hospital appointments and postponing hospital visits to a later date due to fear of exposing themselves to the coronavirus.
Now that MCO 2.0 has been imposed, we wish to remind everyone concerned that cancer patients may again be facing similar problems and that it is not ethical to let them (as well as patients with other chronic diseases) suffer due to the pandemic. While fighting the invisible virus remains the utmost priority currently, cancer care cannot be delayed. Here, we would like to propose several measures that could be taken to maintain cancer care continuity.
> Anyone with new cancer symptoms (lumps, pain in specific areas, unexplained bleeding) should seek medical advice promptly. Do not ignore persistent symptoms.
> Check with your clinic if your appointment has been rescheduled due to the MCO.
> Take note of your appointment time slots so that physical distancing can be maintained in the waiting area of the healthcare facility.
> Obtain a travel permit if your healthcare facility is more than 10km away from your home. Take along your hospital appointment card as proof to the police station.
> If you are receiving chemotherapy, radiotherapy or any other cancer therapy, you should comply with the treatment. Discuss any concerns with your doctor.
> Those with personal medical insurance who wish to fast-track their treatment may want to explore treatment options at private hospitals. And here’s a reminder to the general public – review your existing insurance policies to ensure sufficient coverage for rainy days.
> Always practise good preventive measures – wear a mask and maintain physical distancing and hand hygiene whenever you leave your home. Carry a hand sanitiser and keep an extra face mask on you.
> Contact cancer support groups and NGOs such as the National Cancer Council (more well-known as Makna), National Cancer Society of Malaysia, Breast Cancer Welfare Association, Lung Cancer Network Malaysia, Colorectal Cancer Sur-vivorship Society Malaysia, and Hospis Malaysia for psychosocial needs.
> Establish a clear referral pathway from primary care to receiving hospitals. Communication is vital to ensure that the receiving hospitals have the capacity to take in new referrals.
> Reach out to patients who live more than 10km away from the hospital (especially tertiary referral centres). Clear communication with patients on the necessary SOP is needed to ensure that they can continue to access treatment in a timely manner.
> Establish good coordination of cancer services between various departments in the hospital so that patients need not go for different appointments on different days.
> Have a clear workflow for patients whose care has been deferred. Ensure a working hotline is ready for them to call if they experience symptoms.
> If the hospital is unable to manage the patient in a timely manner, direct them to a nearby hospital to ensure continuity of care. This, however, must be done after counselling the patient adequately and ensuring that individual patients have been passed over to a dedicated team in the receiving hospital.
> Consider migrating stable patients to teleconsult services via a proper workflow.
Cancer is a disease which can take a heavy toll on the country’s health resources, particularly advanced stage cancers which require more complicated and expensive therapies. Therefore, cancer care – including screening and early diagnosis, treatment, surveillance, and supportive and palliative care – should be re-strategised according to the new norm so that the continuity and quality of care are not compromised.
DR TEOH SOO PENG & DR NIRMALA BHOO-PATHY
Note: Dr Teoh is a doctor of public health candidate, and Dr Bhoo-Pathy is a public health medicine specialist and associate professor of epidemiology at the Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya.
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