WHEN it comes to cancer, many healthcare
professionals advocate early detection as this can greatly increase the chances
of the treatment being successful.
Although
there are no Malaysia-centric statistics on the number of patients whose cancer
is diagnosed late, research has shown that almost 50 per cent of patients in
the United Kingdom who get cancer are diagnosed late, making treatment less
likely to succeed and reducing their chances of survival.
What this
means is besides a greater need for education on early detection and screening,
we need to ensure that patients with late diagnoses can access treatment and
that their quality of life following diagnosis is not compromised. An example
of a cancer that is often diagnosed late is renal cell carcinoma (RCC), also
known as kidney cancer.
This is
because the symptoms for RCC — such as loin pain, fever, weight loss and even
bleeding in urine — are similar to that of other diseases and may surface only
in the late stages of RCC. In fact, 49 per cent of patients in Malaysia are
diagnosed with RCC when the cancer is at the final stage (Stage IV).
A study
conducted at the University Malaya Medical Centre showed that the five-year
survival rate of patients with Stage IV RCC was only 13 per cent. Kidney cancer
is among the 10 most frequently occurring cancers in Western communities.
Globally,
about 271,000 cases of kidney cancer are diagnosed yearly and 116,000 people
die from it. According to the Malaysia National Cancer Registry Report
published in 2007, the incidence of RCC is 0.6 per cent in Malaysian females
and 1.7 per cent in males. RCC accounts for 43.8 per cent of new kidney cancers
reported in Malaysia in 2007.
However,
these statistics present limitations as it has been nine years since the data
was collected for the registry. In addition, the actual statistics might be
higher as data collection and reporting for RCC in rural areas can be
challenging and lead to under-reporting.
Oncologists
estimate that the incidence is most probably higher based on the increased
number of RCC patients they have been consulting.
Despite
the doom and gloom of cancer statistics, all is not lost. Advancements in
medical research have led to new forms of treatment being developed for
patients.
In the
past, treatments with chemotherapy have not been effective and led to
disappointing results. New treatment options, in the form of targeted therapy,
emerged as a tool to fight cancer cells with more precision and potentially
fewer side effects.
Revisions
in healthcare policy should ideally be aligned with innovation in cancer
treatment. Despite new targeted therapies being approved for use by the
authorities in the United States and Europe, these are still limited in most
parts of Southeast Asia, including Malaysia.
Even if
they are available in the market, patients have to buy the drugs from private
medical facilities as not all of them are funded by the government. This
excludes a large number of Malaysians from accessing it in the public or
government sector.
According
to the National Health and Morbidity Survey 2015 (NHMS 2015), more than
two-thirds of the adult population preferred government to private facilities
when seeking healthcare services for major health problems, minor and major
surgery, dental treatment and for child delivery.
Furthermore,
a higher proportion of those in rural areas, the lower socio-economic groups
and the aged population (above 75) preferred government healthcare facilities.
When it comes to seeking treatment for major illnesses, the proportion of
respondents preferring government hospitals increased to 75 per cent.
Thus,
there is a pressing need for more drug options to be made available in public
hospitals so that more patients benefit from the treatments. In the case of
treatment for RCC or kidney cancer, there is only one drug approved and listed
in the government formulary.
More
options are needed by patients and clinicians because a single drug may not be
suitable as every individual has different needs.
For
patients who are not able to respond to this particular treatment, access to an
alternative drug will allow them to continue treatment.
However,
access to an alternative drug is often a lengthy and uncertain process. For
some patients, the options that are available are so dismal that it is almost a
case of no option at all. This is a grave injustice to patients because it is
not available at the facility where they seek treatment. This can force
patients to pick treatments that merely address the symptoms and not the cause
of their condition or seek treatment at healthcare facilities that may be
priced out of their reach (that is, private hospitals) just to obtain the right
drug and treatment.
In
Western or developed countries, the options to these drugs are fully funded by
the government, leading to patients having equal access to treatment drugs that
best suit them. However, in Malaysia, drug choices are limited and patients are
left with limited or no options.
Patients
may have to pay out-of-pocket expenses to access other treatment but this will
put them in a difficult financial dilemma of cost versus survival. In fact, a
recent study showed that five per cent of cancer patients and their families
were pushed i nto poverty in Southeast Asia between March 2012 and September
2013. The study, which was published by Dr Nirmala Bhoo-Pathy from Universiti
Malaya’s Faculty of Medicine, evaluated data collected in eight low- and
middle-income Southeast Asian countries, including Malaysia.
The study
also showed that cancer resulted in “financial catastrophe” for almost half of
the patients who suffered from economic hardship at the time of diagnosis. The
policy of approving new drugs is based on an analysis of the quality of life
years patients gain versus the cost of the drug.
Unfortunately,
drug affordability is determined by pharmaceutical companies based in developed
countries such as the US and Europe. This leads to a mismatch in drug
affordability in a country like Malaysia, where people have a diverse range of
economic situations.
Therefore,
no matter how clinically effective a drug is touted to be, due to a mismatch in
affordability criteria, no drugs have been approved in the government formulary
in recent years. In the foreseeable future, cancer is set to be a major burden
worldwide and become the leading cause of morbidity and mortality.
Although
the good news is that there are new innovative products being approved by
health authorities, cost still remains a major issue. Patients are often
tormented with the choice between survival and cost, something that patients in
Western countries do not have to contemplate as their treatments are fully
funded by their health authorities.
Thus, it
is imperative for policy- makers to review and update the targeted cancer
therapy treatments in the national formulary. The last time an innovative drug
indicated for solid tumours was listed was in 2013. The formulary is updated and
made available at least three times a year and we urge the health authorities
to provide similar targeted treatments for kidney cancer patients.
These
targeted treatments may have higher costs but they have been proven to be
efficacious and improve survival rates of patients. For better treatment
outcomes in patients, the Health Ministry should ensure that medicines with
proven efficacies are accessible to the majority of the population.
We hope
that more funding will be made available to assist patients in their treatment
so that they can live longer with better quality of life without putting them
at risk of financial catastrophe. Malaysia’s healthcare system has been
recognised by the World Health Organisation as one of the best among the 37
member states.
While the
public delivery system continues to undergo transformation to meet the needs of
a growing and ageing population as well as alarming rate of non-communicable
diseases, let us be aware of the imperative need for Malaysia to keep abreast
of breakthrough therapies that impact patient survival and quality of life and
to champion for these therapies to be accessible in public hospitals.
Cancer
does not discriminate. Every patient, regardless of economic status or whether
he or she is at the early or end stage, deserves access to treatment.
Datuk Dr
Mohd Ibrahim Abdul Wahid
Datuk Dr Mohd Ibrahim Abdul Wahid, medical
director, Beacon International Medical Centre, and vice-president, College of
Radiology, Malaysia
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