LETTER | Cancer does not take a break

Azrul Mohd Khalib


LETTER | It has been a month since World Cancer Day. This year's theme "together, all our actions matter" is a vivid reminder of the power of collective action, collaboration and solidarity. At no other time in our recent history has this mantra been more important for us to believe in and practise than during this period of crisis and disruption caused by the Covid-19 public health emergency.

For a year, the people in Malaysia and those in countries around the world have been told to limit their movement, and stay at home. Lockdowns, which have been seen to yield mixed results in addressing the spread of the coronavirus, have instead had a devastating impact on the management of non-communicable diseases such as cancer, the outcomes of which will likely be seen in the months and perhaps even years to come, well beyond the direct effects of Covid-19.

When the epidemic began last year and movement restrictions were put into place, thousands of screenings, such as mammogrammes, colorectal and cervical cancer screenings, and other related procedures were deferred or missed due to reprioritisation of health systems, and the need to limit the number of people at health facilities.

While patients have now begun coming back for regular cancer care for a number of months now, it is not yet fully understood how much harm caused by the epidemic response, particularly decisions to reduce or pause cancer care, has been inflicted onto the cancer-related health outcomes in Malaysia.

Last year, the Ministry of Health released the findings of the Malaysia National Cancer Registry Report 2012–2016 (MNCRR). The findings were bleak.

People with lung and liver cancers have a five-year relative survival rate of only 11 and 12.8 percent respectively. Most were diagnosed in either stage three or four. More people were found to have been diagnosed late with cancer. The percentage of cases detected in stages three and four rose from 58.7 percent (2007-2011) to 63.7 percent in the period 2012 to 2016. Unfortunately, late diagnosis of cancer often results in the disease becoming more advanced, and less treatable under currently available treatment options. With late diagnosis, fewer people will survive cancer.

When applied to the existing situation caused by the Covid-19 response with oncology screenings and cancer-related procedures previously deferred or disrupted, this will lead to missed and delayed diagnoses. it will also mean lost opportunities to treat cancers at an earlier stage of their progression. Months without detection will mean fewer options and worse outcomes. It will mean that there will be more deaths due to cancer.

While data on this issue has not yet become available for Malaysia, several countries have already reported an increase in newly-diagnosed breast and lung cancer patients arriving at a more advanced stage in recent months. There is no reason for Malaysia to not experience a similar situation. It is a disturbing and distressing thought.

While life for many took a pause several times this past year, cancer did not.

The current national cancer strategy must adapt to the stark reality that as a consequence of the responses to Covid-19, more people will be diagnosed late with cancer in Malaysia. There will be increases in incidence of late stage cancer.

We need studies to be carried out to fully understand the impact of the Covid-19 epidemic on cancer care.

More than ever before, we need to urgently promote early detection and timely diagnosis of the disease, and ensure good linkage with available treatments. We must also immediately evaluate the existing regimes for cancer care to ensure that we have the right life-saving therapies, necessary workforce, and technologies that reflect current and upcoming realities.

Just as we have re-purposed resources and manpower to respond to the coronavirus threat, we must now look to what we have available to ensure that people living with cancer in this country will be able to access life-saving treatment and care for them to survive. Lives can be saved.

AZRUL MOHD KHALIB is the head of Galen Centre for Health & Social Policy.

The centre is an independent public policy research and advocacy organisation based in Malaysia that is dedicated to discussing health and social issues through the lens of public policy. The full declaration of the 31 global think tanks can be seen at the Galen Centre website.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.