Governments should form strategies to control cancer

Conclusion

If cancer is not prioritized and not seen as a national issue involving both national and local governments, it would not only affect the patients’ household but also the society and the economy.

This was stressed by Prof. Mark Woodmark, MSc, from the George Institute for Good Health, during a recent media briefing on the human cost of cancer held in Bali, Indonesia.

“In lower- and lower-middle-income countries, there is a need to create social safety nets that support the poorest, especially when there is an early diagnosis,” Woodmark said.

According to the Asean CosTs In ONcology (Action) study, nearly 88 percent of cancer patients were diagnosed for the first time at the second to the fourth stage of cancer while only 12 percent of the patients were diagnosed at the first stage. Therefore efforts to increase earlier detection of cancer can improve the survival rate and reduce the economic burden attributed to cancer. This can be achieved by governments implementing high-quality screening programs, covering large numbers of the population.

Largest sample size

Among the eight countries that participated in the study, Indonesia had the largest sample size, almost 25 percent of the total number of patients involved in the study. First started in 2012, the Action study in Indonesia involved 12 major hospitals which monitored 2,335 patients. Southeast Asian countries would need to implement a national cancer control program with theirs existing health systems to fight cancer effectively.

A lecturer of public health policy at the University of Indonesia, Prof. Hasbullah Thabrany, MPH, PhD, explained: “In line with the Action study’s recommendation, the Indonesian government has implemented early cancer detection programs at the local health clinic level and at primary healthcare service providers. Last year, it launched the universal healthcare coverage program. This has helped open access to healthcare services for patients greatly and is a good start toward taking care of cancer patients.”

Highly appreciative of this government program was Melati, a 52-year-old breast patient residing in Jakarta. With the increasing number of cancer patients though, she said the conditions in the ward were often crowded with long queues.

Melati shared: “Patients need to be proactive when speaking with their doctor and should not just stay silent. Doctors have to take care of a lot of patients so if we want something explained, we need to ask. They would be happy to explain. If not, then they would move to the next patient.”

Financial catastrophe

The cost for breast cancer treatment could reach up to $15,000 per year, according to Prof. Nirmala Bhon-Pathy, MD, PhD, cancer epidemiologist at the University of Malaya. She said patients whose income was $1,000 a month or lower would have a very difficult time to pay for their treatment.

With average gross domestic product per capita in 2014 for the eight countries being $3,553.75, she added that most cancer patients had to use money from their savings and experienced financial catastrophe in maintaining the quality of life. By financial catastrophe, we mean having to spend 30 percent or more of the household income on out-of-pocket expenses for cancer treatment.

Fortunate to have a health insurance was Mei, 32, a breast cancer patient living in Malaysia. Although her insurance covered the costs of her expensive treatment, the cost of health supplements and other out-of-pocket expenses to strengthen her immune system to fight off the cancer had an impact on her household income.

“I’m glad that the bulk of the treatment costs was covered, but the extra expenses for buying health supplements and other health needs really took a toll on our monthly household income,” she remarked.

Financial risk protection

Bhoo-Pathy explained that though it was said that Malaysia had achieved universal health coverage, this study revealed that the government needs to improve financial risk protection for cancer patients. This includes not just improvements in quality access and use of cancer screening programs and cancer care services, especially in the public health sector, but also a reexamination of the country’s health financing system to ensure public funds are being channeled to those who need them most.

Woodward concluded: “We hope with the result and findings from the Action study, governments are able to form strategies to control cancer and maintain the productivity of the people and economy. Establishing safety nets do not only support economic growth but more importantly provide hope for the people in fighting this terrible disease, giving them the access to the best treatment available.”