It is that time again when policy makers at the Ministry of Finance are hard at work conferring with their colleagues in the other ministries, working hard to put together a budget for the coming year. This process typically involves a consultation process with different stakeholders, representatives from various industries, and even gathering input from the public.
Their task is to put together a national budget which informs on what the national priorities for the government will be, how public funding will be spent, which areas will receive funding or not, what types of investments are going to be prioritised, and how people’s lives and those who resides in this country will be affected.
Those living with cancer, caregivers as well as healthcare professionals are looking on anxiously. They are hoping that the upcoming Budget 2022 will not only be more transparent and clearer when it comes to allocations for cancer treatment and care, but that it will also reflect and respond to the recent realities which have impacted the cancer space due to the COVID-19 response.
This would be a bad time to under-invest or cut spending on cancer. Lives are at stake. Cancer does not take a break or wait its turn until this ongoing crisis is over.
This past year and a half has been anything but typical. The COVID-19 pandemic has overloaded health systems, consumed valuable resources, caused massive disruptions to livelihoods and businesses, and cost the lives of so many. Even the healthcare workers providing much needed care to those who have been afflicted with serious illness due to COVID-19, have not been spared.
The COVID-19 crisis has severely impacted cancer care. It has disrupted prevention, delayed diagnosis, and affected access to treatment.
People have been worried about going to the hospital to be screened. Community cancer programmes have been halted since last year. Screening measures such as mammograms and colonoscopies have been postponed. Surgeries have been deferred or delayed. Beds and personnel have been reassigned to COVID-19 wards.
Since the onset of the pandemic, though the number of cancer diagnoses has seemingly decreased during this past year, it is likely that there will be future increases in cases.
An estimated 65,000 people in Malaysia are now expected to be newly diagnosed with cancer in 2030. If current conditions are unchanged, most of them will continue to be late-stage cancers. Upstaging, where cancer is diagnosed at later stage, will be more common as opportunities for early detection are missed. It is not yet known how many more lives will be lost to cancer due to the disruptions caused by this pandemic.
Researchers have studied the effect caused by COVID-19-related delays in cancer treatment. They found that depending on the type of cancer, a treatment delay of four weeks increases the risk of death between 6% and 13%. For breast cancer, still the top cancer and among women in Malaysia, an 8-week delay in surgery increases the risk of death by 17%, while a 12-week delay increased it by 26%.
Delays in cancer treatment have a direct consequence to health outcomes.
Though this has been an extraordinary challenging time for healthcare systems and people living with cancer, it has forced healthcare practitioners to innovate. It has required a relook into how quality care can be delivered in a disruptive environment, how the negative impact on patients can be limited, and how equal or better outcomes can be achieved despite limited resources.
Another key lesson learnt from this crisis is that investments in strong and resilient health systems are critical in mitigating the country’s response to a pandemic such as this one. Malaysia’s decades of investment in its public health infrastructure have paid off. This country’s health system and the people behind it, despite the multiple surges and being under tremendous unprecedented pressure, continue to weather the storm and are still considered in better shape compared to several of Malaysia’s neighbours.
That lesson on the value of investment should be applied to cancer care.
The considerable expenditure and burden in dealing with COVID-19 as a disease in addition to providing financial support for social assistance programmes and for ailing business, will have a definite impact on the national budget for at least a couple of years.
The ongoing pandemic is expected to extend well into 2022. There is a risk of new health cost containment measures and potential reallocations or reprioritisation towards other disease areas or public health concerns. It could mean the introduction of austerity measures or more conservative, harsher prioritisation decisions. It could mean the reduction of existing budgets for cancer treatment and care. This would be a mistake.
Cancer budgets need to be safeguarded against such measures which favour short-term gains but have long lasting consequences.
There is an incentive to relook at how investments are measured. Effective interventions in cancer prevention, timely diagnosis, advances in therapies and care delivery models which have reduced the number of cancer deaths, improved survivorship, and quality of life for those living with the disease, need serious consideration.
Cuts or reductions in treatment and care would undoubtedly set back years of progress for cancer patients, especially those accessing and depending on services and treatment in public healthcare services. Safeguarding the cancer budget will ensure continuity, efficiency, and sustainability of cancer care for those who depend on it.
People who are healthier and able to survive cancer, can carry on working to help rebuild their lives, the economy, and this country. Ignoring cancer care now may turn one public health crisis into many others. We must act now.