Late Cancer Diagnosis During Pandemic May Cut Survival, Increase Treatment Cost: Experts

Undiagnosed cancer cases suffered delayed access to biopsies and diagnostic scans in Malaysia during the Covid-19 pandemic, while outpatient appointments were cancelled and elective surgeries deferred, says an oncologist.

KUALA LUMPUR, August 30 — Late diagnosis of lung cancer due to the Covid-19 epidemic will eventually lead to a reduction in survival years, productivity, and higher treatment cost, experts said.

They also noted that the real impact of Covid-19 on lung cancer patients can only be seen after a few years, as there is a high tendency for patients to be presented at a much later stage.

Covid-19 played a major role in late diagnosis of cancer in Malaysia, as public health care facilities were forced to redeploy resources, including health care workers and hospital beds to treat coronavirus patients, said Dr Tho Lye Mun, a clinical oncologist and vice president of Lung Cancer Network Malaysia.

“Outpatient appointments have been cancelled. Elective surgeries that needed to be referred to other hospitals are deferred, and certainly, the existing cancer units have come under a lot of pressure,” Dr Tho mentioned in a virtual media forum last Thursday titled “No Patient Left Behind: Improving Lung Cancer Care in Malaysia during Covid-19”.

“So, cases which have not been diagnosed have delayed access to biopsies and diagnostic scans,” he added in the forum organised by the National Cancer Society of Malaysia (NCSM).

Although some of the cancer patients were decanted to private hospitals to ease the burden of public health care facilities in the country, these patients still remain a “minority” as a large pool of lung cancer patients are still unable to access the right treatment platforms.

At the same time, Dr Tho also noted that cancer patients, or patients who depict cancer symptoms, can be reluctant to seek medical care for fear of contracting the coronavirus in hospital settings.

“I think, in some way, this leads to missed opportunities to detect and treat cancers, especially at an early stage.”

Dr Tho also highlighted that the National Cancer Patient Registry (NCPR) report, presented every five years, may not provide the impact of Covid-19 on cancer patients for “another few years”.

“Anecdotally, I would say, perhaps more patients are now presenting to us with even more advanced disease than what we used to see pre Covid-19.”

He added that the five-year survival rate for lung cancer patients lags behind at 11 per cent, compared to 73 per cent for prostate cancer and 67 per cent for breast cancer.

NCSM medical director Dr M. Murallitharan also mentioned that early symptoms of lung cancer can be mistaken for Covid-19 symptoms during the pandemic, which also contributes to late detection of lung cancer.

So when a person exhibits lung cancer symptoms, he or she tends to go for a Covid-19 test and feels “normal” after testing negative, without realising the possibility of lung cancer.

“For the next three or four years you’re going to see the late diagnosis of lung cancer back again after all the hard work you’ve done,” Dr Murallitharan said in the virtual forum.

“People will be stuck in this mindset of, if the respiratory symptoms did not mean Covid-19,  they will feel it’s all good. This is going to be something we’re going to be dealing with for quite a few years.”

He pointed out that the current epidemic acts as a major barrier for cancer or potential cancer patients to access hospital services in order to be diagnosed earlier. 

The challenges include poor access to tertiary hospitals and consultant physicians and inability to undergo scans and bronchoscopy procedures, which are the key to promote recovery of lung cancer at a much earlier stage.

“Even if I get diagnosed with lung cancer, we still face a lot of troubles. Surgery is almost non-existent in most public centres at this point in time, simply because almost all the operating theatres are being used as intensive care units (ICU).

“If you don’t reopen operating theatres, there’s never going to be an opportunity to cut out lung cancer, and it stops right there.”

In addition, late presentation of cancer will eventually reduce opportunities for treatment, subsequently cutting cancer patients’ survival rates, according to Azrul Mohd Khalib, head of the Galen Centre for Health & Social Policy.

Late presentation will not only prevent cancer patients from obtaining effective treatment, but also limits treatment options as they develop the disease.

“There are going to be fewer people who’ll be able to be treated effectively because many are going to be presenting later on and we’re not going to see the impacts right now. It could be in a couple of years from now,” said Azrul.

Azrul stressed that new strategies should be crafted to cater to cancer patients in late stages, especially in terms of “in terms of investment in what’s going to be needed.”

“We can’t leave these people behind because they are coming in late. They’re going to come in stage three, stage four, and what are we going to do with them?”

“That’s going to be the question that’s going to be asked, not tomorrow but what we need to start asking today, what can we do to help those who are going to be presenting, later on, as a result of Covid-19.”

Azrul also firmly pointed out that public health financing is an extremely important determinant of cancer treatments in public health care facilities.

Thus, a fair and transparent national budget for the Ministry of Health should be presented, he said.

“Last year we suddenly were told that everything had been absorbed into this one budget line that contains everyone’s allocation. So we weren’t able to track the allocation for oncology, radiology last year and also related services, and we can only assume that a lot of it was cut back simply because it needed reprioritisation for Covid-19 response,” said Azrul.

“So, what we think our savings today is actually going to be expensive for us in the future. I think the planners need to think about that.

“MOH needs to advise the government. What does it mean when it comes to cutting down these budgets and most importantly, what does it translate to in terms of health outcomes.”

Azrul highlighted that what is being considered as “savings” now are actually huge losses in terms of years of productivity, with limited treatment options for cancer patients.

Lessons From Covid-19 Epidemic

Dr Murallitharan however noted that the Covid-19 epidemic has paved the way for better and improved public-private partnerships, and even among civil societies, to come together to handle and manage the virus.

He said that a similar model can be adapted to treat cancer patients in the country as the method can act as a bridge which connects patients to access better cancer therapeutics.

Dr Murallitharan, who reiterated the decanting process of cancer patients from public to private hospitals, said: “Many patients would benefit from getting consultations from doctors in the private setting.”

“For the first time, we’ve seen private physicians, eminent professionals, senior consultants from the private sector, being able to work within the government setting. All this has been miracles that we’ve dreamed about.”

Azrul, who concurred with Dr Murallitharan, said that public and private health sectors managed to engage on Covid-19 together by cutting bureaucracy and sharing resources. 

“We’ve never really seen this before, and that’s going to be a model that we have to learn from. The reforms that we need to put into place must really be meaningful reforms that actually change the way we use our health care system,” Azrul added.

“So, it 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.”

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