As 2020 comes to a close, governments and people around the world are either waiting for word when the first batches of COVID-19 vaccines will be made available in their countries or watching the news of people already getting vaccinated. This is a time when countries have reprioritised their budgets, systems and political will to focus on protecting their populations from the outbreak of this coronavirus.
Unfortunately, this has resulted in trade-offs that have or will likely increase the burden of other diseases on health systems and communities for years to come. Cancer is one of these diseases.
At a time of heightened economic uncertainty, and a COVID-19 epidemic expected to last at least a couple of years, the burden of cancer on Malaysian society continues to climb.
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 to 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 (MIR) for Malaysia is higher than the global average. Many of these deaths due to cancer, 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 in order to survive. Households and families are struck by financial catastrophe which often results in difficult choices such as seeking treatment for cancer, or ensuring that your children will be able to afford to go to school.
All of this was known before the COVID-19 outbreak began.
Globally, 42 percent of countries surveyed by the World Health Organisation in its ‘Rapid assessment of service delivery for NCDs 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 amongst those who are positive. The fear of infection coupled with the suspension of diagnostic services may cause individuals to be delayed or not be screened at all for cancer. 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, 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 policy makers.
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 percent of people living with cancer in Malaysia find out about their diagnosis when they are at Stage 3 or 4. Nevertheless, timely and effective treatment at the later stages of cancer needs to be made available and expanded. The health 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, to the prevention and management of non-communicable diseases 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.