KUALA LUMPUR, Oct 5 — The Covid-19 pandemic has transformed lung cancer management on several fronts at many hospitals from screening to diagnosis and treatment.
As hospitals across the country are forced to delay or cancel certain medical procedures in response to Covid-19 cases, those hard choices are disrupting care for cancer patients.
Cancer patients in general and those suffering from lung cancer are particularly vulnerable because of their many intrinsic characteristics and care needs.
However, Lung Cancer Network Malaysia Vice President Dr Tho Lye Mun said, in this age of medical advancement and innovation, cancer is no longer a death sentence as an innovative approach to cancer treatment is available.
“By studying each patient carefully, we are able to match the right treatment to each patient and move away from a trial-and-error approach,” he said at a virtual media forum on ‘No Patient Left Behind: Improving Lung Cancer Care in Malaysia’ organised by the National Cancer Society of Malaysia (NCSM) recently.
“For example, immunotherapy. It is a new innovative way we use to harness the patient’s own immune system to enhance it to fight cancer,” he added.
Dr Tho said a study has shown that patients who received immunotherapy upfront, achieved a 32 per cent survival rate at five years.
“This represents a paradigm change and not only that, but these patients are also able to maintain a good quality of life and spend many productive years with loved ones and family.
“Certain drugs may require a high expenditure upfront, but then you may get long-term benefits,” he added.
Noting that access to immunotherapy can be limited, Dr Tho called on the public and private sector to come together and do a “painstaking evaluation” of the cost-benefit of each treatment to make sure it prolongs life, but not at the expense of quality of life.
According to the Malaysian Study on Cancer Survival (MySCan), the five-year survival for lung cancer is only at 11 per cent compared to prostate cancer (73 per cent) while it is 67 per cent for breast cancer.
“A major factor behind this is late diagnosis. About 80 per cent of lung cancer patients are diagnosed at stage four, which is a complete reverse from breast cancer which is mostly diagnosed at an early stage.
“Covid-19 plays a major role in late diagnosis of cancer in Malaysia, as public health care facilities were forced to redeploy resources to treat Covid-19 patients”, added Dr Tho, who is also a clinical oncologist.
“Elective surgeries that need to be referred to other hospitals are deferred, and certainly, the existing cancer units have come under a lot of pressure.
“Many cases which have not been diagnosed have delayed access to biopsies and diagnostic scans,” he lamented.
Dr Tho said although some of the cancer patients were decanted to private hospitals to ease the burden of public health care facilities, these patients still remain as ‘minority’ as many of them are still unable to access the right treatment platforms.
“The cancer patients, or patients who depict cancer symptoms, can be reluctant to seek medical care for fear of contracting the Covid-19 in hospital settings.
“I think, in some way, this leads to missed opportunities to detect and treat cancers, especially at an early stage,” he said, adding that among the early symptoms of lung cancer are persistent cough, coughing up blood, weight loss, chest pain, and recurrent chest infection.
He said the National Cancer Patient Registry (NCPR)’s report may not provide the Covid-19’s impact on cancer patients for another few years as the data were presented every five years.
“Perhaps more patients are now presenting to us with even more advanced disease than what we used to see in pre-Covid-19,” he said.
NCSM medical director Dr M. Murallitharan said the current epidemic acts as a major barrier for cancer or potential cancer patients to access hospital services in order to be diagnosed earlier.
“Surgery is almost non-existent in most public hospitals at this point in time, simply because almost all the operating theatres are being used as intensive care units (ICUs) for Covid-19 cases.
“If they don’t reopen operating theatres, there is never going to be an opportunity to cut out lung cancer, and it stops right there,” he said.
According to Dr Murallitharan, the early symptoms of lung cancer might be confused for Covid-19 symptoms during the pandemic which contributed to the late diagnosis of lung cancer.
“The symptoms of lung cancer could be similar to Covid-19, they think about ‘Oh, I have some funny symptoms’ and took the polymerase chain reaction (PCR) test and when it comes back negative, they are very happy and life goes on.
“But underneath that, it may be one of the symptoms in lung cancer and for the next three to four years, they are going to see the late diagnosis (of lung cancer) back again after all the hard work they have done. “This is going to be something we are going to be dealing with for quite a few years,” he said.
Dr Murallitharan said, however, very few patients would be able to benefit from innovative treatments, such as immunotherapy in Malaysia due to the high cost and limited resources in healthcare service.
“Only those with good insurance coverage and being treated in private hospitals will have access to these treatments, but in the government hospitals, there is very limited access and a lot of it is due to the financial issue,” he said.
Galen Centre for Health and Social Policy Head, Azrul Mohd Khalib said the late presentation will not only prevent cancer patients from obtaining effective treatment but also limits treatment options as they develop the disease.
Thus, he said the public sector must invest in innovative cancer treatment given that 70 per cent of the Malaysian population have access to the public health system.
For instance, during the pandemic, both public and private health sectors have been working together in fighting Covid-19 by minimising bureaucracy and sharing resources, he said.
“In order for us to be able to move forward, we have to find ways to look at how we can improve on how we can finance our healthcare system, and also how we can make sure everyone is contributing so that we can all benefit.
“So, the public and private health sectors shouldn’t be two systems in competition with each other. It needs to be able to work together to address gaps within the services that are being provided,” he lamented.