Improving cancer care for ASEAN patients

Like most developed and advanced developing countries, Malaysia is seeing an upward trend in the prevalence of non-communicable diseases (NCDs) such as cancer and cardiovascular disease. Cancer persists as one of the five main causes of national mortality over the past 20 years and the number of cases has since escalated. In 2015, cancer contributed to 13.6 percent of all deaths in Ministry of Health hospitals compared to 8.9 percent in 1996.

A need for access to innovative medicines

In Malaysia, there is good access to traditional cancer treatments such as surgery and chemotherapy. However, for patients who do not respond to these treatments, the access to cutting-edge, innovative cancer medicines including targeted therapy, precision therapy and other new treatment paradigms is limited, placing cost burden on patients and their families.

Liver cancer is the sixth most common cancer in Malaysia

The annual mortality rate for liver cancer per 100,000 people was 6.1 percent in the year 2013, an increase of 42.8 percent since 1990. This is due in part to a lack of understanding of the disease. Hepatitis B virus (HBV) remains the leading cause of HCC in Malaysia. However, Hepatitis C virus (HCV) infections are increasingly playing a role in the development of the disease and are expected to continue to rise in the coming years. One concern is that many of those infected with HBV or HCV are unaware of their status and, coupled with the limited availability of effective treatment options, could explain the rising numbers of patients presenting with HCC.

Slow reimbursement processes in Malaysia impede patient access

Even though treatment options are available in the earlier stages of HCC, the survival rate is generally very poor as the majority of patients present at a very advanced stage. For those patients who are waiting for liver cancer treatment in Malaysia, the therapies needed are not available in the official list of prescribable medicines, resulting in patients having to obtain the medication elsewhere via an extremely slow process. This unfortunately means that for many, the cancer advances too far to be treated – some patients even die before receiving their medication.

Thai health policy has a strong focus on the prevention and treatment of infectious diseases, despite the growing rate of patients suffering from cancer and other NCDs. NCDs account for 71 percent of mortality in Thailand, of which cancer accounts for the second largest proportion at around 17 percent. According to the World Health Organization (WHO), the cancer mortality rate in Thailand in 2012 was 127.8 per 100,000 for men and 82.6 per 100,000 for women- the fifth highest in the Southeast Asia region.

HCC liver cancer is the most common type of liver tumor in Thailand

Approximately 60 percent of the cancer burden in Thailand is due to five types of cancers and liver cancer is one of them. Half of Thai patients affected by HCC have a chronic HBV infection; cirrhosis is also a common underlying disease. Unfortunately, patients often present in the advanced stages of HCC and thus have mostly poor treatment outcomes.

Limited access to innovative medicines impedes treatment

Notably, Thailand has been successful in implementing a Universal Health Coverage (UHC) system. Since 2002, 98 percent of the Thai population is covered by health insurance and the country has seen significant improvements in health outcomes for patients. However, cancer patients still have limited access to innovative therapies, the majority of treatments being traditional treatments such as surgery or chemotherapy. Only a small number of Thai patients are eligible for the reimbursement of innovative medicines, meaning that most may need to pay entirely out-of-pocket for such treatments.

Although Thailand has a good medical infrastructure in place and specialists that are on-par with international standards, there remains inequitable access to oncologists and tertiary centers, with coverage dictated by payer scheme and geography. Even though there is a willingness to pursue new access mechanisms to increase patient access to innovative medicines with high clinical value, the current budget and policy priorities constitute substantial barriers to more widespread access.

Non-communicable diseases represented 47 percent of total mortality in Vietnam in 2002, with 8.2 percent due to cancer. The leading cancers are lung, liver, stomach, colorectal and nasopharynx for men, and breast, cervix, and stomach and liver for women. The country has implemented initiatives to help tackle the growing number of cancer incidences, addressing problems such as a lack of early screening and putting an emphasis on public knowledge of the disease.

Though the capacity for cancer diagnosis and treatment has been strengthened significantly in Vietnam, the effectiveness of treatment still needs greater support in term of guaranteeing access to medicine and advanced treatment techniques. The cost of cancer treatment is actually higher than the long-term ability to pay for the majority of Vietnamese population.

Reducing hepatitis B burden to help prevent liver cancer

In 2012, the WHO estimated that Vietnam was one of the countries with the highest mortality rates from liver cancer, which is mostly attributed to the sheer number of people infected with hepatitis B virus (HBV) and hepatitis C virus (HCV).

Thus far in Vietnam there has been no comprehensive nationwide approach to HBV and HCV-related liver diseases, including HCC. The universal HBV vaccination program for infants started in 2002 however, unfortunately, the coverage of HBV vaccination has fluctuated and in 2013 coverage was reported to have dropped to under 60 percent. Therefore, to reduce the burden of HBV and HCV-related liver diseases, it is crucial to increase the coverage of the universal HBV vaccination for infants as well as promote other preventive measures against horizontal transmission of both HBV and HCV.

Lack of reimbursement a prohibitive barrier to patient access and treatment

Though the capacity for cancer diagnosis and treatment has been strengthened significantly in Vietnam, treatment efficacy still needs greater support in terms of guaranteeing access to medicine and advanced treatment techniques. For the majority of Vietnamese, the cost of cancer treatment is actually higher than their long-term ability to pay. This calls for a widespread insurance policy to answer the need for more equitable access in the country.