Pandemic Forces Choice Between Cancer Treatment And Food

A study found that Malaysian breast cancer survivors experienced workplace discrimination, such as being forced to resign from their jobs.

KUALA LUMPUR, Dec 21 — Cancer survivors financially hit hard by the Covid-19 pandemic may have to choose between paying for treatment or supporting their families, a regional study found.

The study published last month on the ecancer journal — which was conducted by the Centre of Epidemiology and Evidence-Based Practice, University Malaya, and King’s College, London titled “Cancer and Covid-19: Economic impact on households in Southeast Asia” — found that unemployment rates increased during the Covid-19 pandemic.

Currently, Malaysia has the highest unemployment rate since 1989, as it is estimated that 830,000 people are currently out of jobs.

In the ASEAN region, the Covid-19 economic impact has affected a large proportion of those working in the informal sectors. These include daily wage workers, temporary contract workers, or small family-run businesses who are often one paycheque or one episode of illness away from financial catastrophe.

“More worryingly, the lack of a robust social security system in many Southeast Asian countries, especially in terms of income protection, could ultimately force many cancer survivors to choose between paying for their treatments, or to forego treatments and feed their families,” wrote the authors of the study by Kong Yek-Ching et al.

A qualitative inquiry in a multiethnic population of Malaysian women with breast cancer also revealed that patients from high-income groups, including those with health insurance, faced unmet financial needs related to cancer treatment and health care, said researchers.

Movement Restrictions Slowed Down Cancer Treatment

A police roadblock at Rawang-Kuala Lumpur on October 14, 2020, during the Conditional Movement Control Order. Picture by the Malaysian Armed Forces.

Besides the economic impact that caused a delay in treatment that cancer patients could no longer afford, movement control restrictions that were implemented nationwide in many Southeast Asian countries — such as Malaysia, Singapore, Thailand, and the Philippines — to reduce the spread of Covid-19 infection has also slowed down the treatment process for cancer patients.

The study found that because of movement restrictions, accessibility to hospitals and treatment may be a challenge for underprivileged patients, including those from the rural areas and low-income groups.

During the first Movement Control Order (MCO) in Malaysia, CodeBlue reported how cancer patients were turned around at police checkpoints despite having letters for treatment, amid a 10km travel limit. Following that, Health Minister Dr Adham Baba said that patients are allowed to travel beyond 10km if needed for health care.

Moreover, the same study by University Malaya and King’s College found that because the health care system had to accommodate Covid-19 patients, many non-urgent treatments, elective surgeries, hospital admissions, and follow-up appointments in Malaysia were either delayed or cancelled.

The oncology departments in major public hospitals in Malaysia, which are mostly Covid-19 hospitals, scaled down their elective surgeries to two days a week, shortened their clinical hours, and prioritised radiotherapy and chemotherapy administrations based on the magnitude of potential treatments benefits. Besides that, imaging procedures to monitor tumour growth were also postponed for these patients.

With a delay in treatment due to various reasons, the study stated that patients’ conditions may just worsen to advanced cancer stages, by which the options for treatment would be costlier.

Due to the delay and postponement in receiving treatment, follow-ups, or even diagnosis because of rising unemployment and economic strain on household income, many cancer patients may turn to traditional, alternative, or complementary medicines.

Malaysian Cancer Patients Suffer Workplace Discrimination

The study also found that Malaysian breast cancer patients faced discrimination at their workplace because of their disease, including being forced to resign from their jobs.

During the coronavirus pandemic, researchers believed that many employers would be forced to weigh in their organisational goals against the individual sufferings of employees with cancer.

The study said discrimination and stigma surrounding cancer can further drive people with cancer to hide their cancer diagnosis from their employers, or avoid seeking treatments at the hospital just to retain their jobs.

Comprehensive Financial Navigation Programmes To Combat Financial Impact Of Cancer And Covid-19

The study suggested the use of a Comprehensive Score of Financial Toxicity (COST) questionnaire as a screening instrument in identifying patients who are at greater risk of financial toxicity, who then can be adequately referred to appropriate support groups to assist in managing their financial strains.

Researchers described financial toxicity as a harmful financial burden experienced by people with cancer, encompassing both the objective financial burden and subjective financial distress.

COST is an 11-item measure of financial toxicity that includes financial expenditure, financial resources, and the psychological response of cancer patients.

The study also suggested the introduction of a financial navigation programme to help combat the financial impact of cancer and Covid-19.

According to the study, the existing financial counselling or assistance programmes for cancer patients, which may be already present in certain settings in Southeast Asia, are usually focused on specific episodes of cancer care, rather than on the patient’s overall treatment plan.

On the other hand, a financial navigation programme would proactively reach out and develop comprehensive plans to meet each cancer patient’s unique financial needs. For example, the financial navigation programmes in the United States provide support for patients in areas such as monetary management, disability, employment, insurance coverage, and psychosocial assistance.

Through this same financial navigation programme in the US, patients have reported savings of up to US$12,000 (RM48,888), with non-monetary benefits, improved emotional well-being, and high patient satisfaction.

Hence, it is suggested that countries in Southeast Asia should have financial navigation programmes that focus on increasing financial literacy, assessing the risk of financial toxicity, optimising health insurance, connecting patients to available financial resources, and helping with needed paperwork to apply for financial assistance.

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