LETTER | For decades, a cancer diagnosis was equated with a loss of hope and indeed, even described as a death sentence. Advances in drug therapies have changed this.
“Cancer survivor” is a term used to define people who had completed treatment successfully, and it has evolved to mean something more holistic. The National Coalition for Cancer Survivorship and the National Cancer Institute (NCI) in the United States state that "a person becomes a survivor from the time of diagnosis and continues to be a survivor for the rest of his/her life".
In Malaysia, we face two complex problems in the cancer landscape. One is that Malaysian patients are diagnosed in late stages of cancer compared to similar countries. Our national registry data shows that more than half of our survivors are diagnosed in advanced stages of cancer (Stage Three or Stage Four).
The other problem is that the age of diagnosis of most Malaysians is getting younger. Basically Malaysian survivors, although in advanced stages of disease, live longer, better quality lives. And this does not include those who actually go into extended remissions (which is for all purposes, a cure) and remain disease-free throughout their lives.
In Malaysia, resources (and availability of new, innovative treatment) are often focused on providing therapies for early stage cancer patients as they often have better chances to respond to these treatments. However, in some cancers, offering patients in later stages of the disease new and innovative treatments may yield equal rewards; with them living longer, better lives including some who remain disease-free for their entire survival period.
Breast cancer is a good example. Patients with breast cancer in early stages (Stage One and Two) who visit public hospitals have access to a drug therapy called “trastuzumab” which is highly effective for patients who express a specific protein (HER2+). With these drugs, they have better, longer survival and/or cure rates.
However, evidence shows now that for those with breast cancer in Stage Three and Four, trastuzumab also has huge benefits – increasing both survival periods and the quality of life of these patients. Unfortunately, it is unavailable for their use.
The economic and non-economic gains obtained by extending treatment to cancer survivors in late stages are enormous, especially for specific cancers such as breast cancer. The economic case needs to be assessed - by balancing the expenditure to pay for the costs of the drugs versus the savings in terms of less hospitalisation and care required for the survivor who remains well, and factoring in the economic productivity of this survivor (and family members) in terms of their ability to work.
There is also a humanitarian case to be made; in whether providing these drugs can improve the well-being of the survivor and his or her family in addition to providing them a better quality of life for longer periods of time. In these cases, they offset the monetary costs of providing treatment to these groups.
Merely asking for funds to be provided for the survivors’ treatment may seem unjust to the Health Ministry, what with our recent economic conditions.
However, the National Cancer Society of Malaysia, alongside other cancer control groups, would like to call on all stakeholders to work together on building new innovative strategies to ensure these patients can be given these innovative, highly effective therapies.
Foundations aiding patients across all cancers in different aspects may also be roped into partly funding patient purchase programmes; while pharmaceutical companies can aid by strategies such as assistance programs, in which they too partly contribute to provide these drugs at subsidised rates.
With other stakeholders pitching in with their part, the Health Ministry will only need to take a small funding step forward in order to ensure that the heart of the Malaysian healthcare system - our patients - are provided with the best care we can give them, in order to enable them to survive longer and live better.
DR MURALLITHARAN M is a public health physician and the director of the National Cancer Society of Malaysia. He can be contacted at [email protected]
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.