Can We Provide Urgent Intermediate Cancer Care Amidst COVID 19? – Dr Nur Aishah Mohd Taib

By CodeBlue | 26 March 2020

We need to work together to make sure timeliness to cancer diagnosis and treatments are done in the best way possible even under existing constraints.

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A fear among new or existing cancer patients is whether they will be able to get their diagnosis quickly in a rapid, equitable and high-quality manner. Whether there is a limited time frame in getting treated without compromising on outcomes.

An ongoing pandemic will affect immediate loss of life. But what about the future loss of lives?

The matter at hand is whether we can get access to equitable quality care during this period. Are there designated public cancer hospitals available right now that can diagnose and treat with the upmost quality?

The designation of major public hospitals for screening and treating Covid 19 patients are the same facilities that treat cancer patients in our beloved country.

Is there a strategy already in place to care for those in need of cancer care? Should we stop screening for cancer during this outbreak?

I believe we should. We need to reduce this activity so it can be channeled to other areas of priority. Thus, detection and treatment of early symptomatic cancers and metastatic cancers (cancers that have spread to other organs) should be the main focus.   People should be able to come forward  when they have symptoms.

To know more about symptoms of cancer, please refer here.

Where should you then go when you have symptoms? See your general practitioner (GP). The GP will refer you on as needed. If we have designated and clean public hospitals which can diagnose and treat cancers , the GPs need to know.

For those with access to employment and personal insurance, please use the private health sector facilities. Give way to those from the lower middle and lower income communities to access these public hospitals.

A large metanalysis found that should the time to surgery after a diagnosis for early breast cancer go beyond 60 days, survival rates were affected (Bleicher et al in JAMA Oncology in 2015).

Catastrophic problems experienced by patients with metastatic disease such as spinal cord compression, resulting from cancer that has spread to bones, require urgent treatments within hours.  Can we afford to delay chemotherapy at this time to ensure that our patients remain immune-competent ?

These questions need to be answered and a plan put into place.

We need to work together to make sure timeliness to cancer diagnosis and treatments are done in the best way possible even under existing constraints.

During a period of low resources in the public sector, would longer surgeries be ethical? For example, simple mastectomy and axillary surgery takes about 60-90 minutes, while an immediate reconstruction lasts between 4 to 6 hours.

Should we operate on one patient, when we could have operated on four?

Desperate times may require desperate measures. The good news is that there is a delayed reconstruction option for breast cancer patients needing a mastectomy.

Is the private sector able to respond and provide equitable access to the lower-income community? Are there non-covid designated public hospitals in either Ministry of Health or Ministry of Education available to treat those unable to access private hospitals? Is there a national platform for our first-liner GPs to get information quickly?

Many questions remain unanswered.

As a community, we need to organize ourselves to ensure equitable access to quality care. A national task force on cancer diagnosis and treatments needs to take up this challenge.

No doubt we have a pandemic, but we need to strategise on a plan to get ordinary Malaysians through it.

Prof Nur Aishah Mohd Taib
Head, UM Cancer Research Institute, Universiti Malaya
Vice President, Together Against Cancer

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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