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In the new normal, cancer threat remains

By LAI S. REYES, The Philippine STAR Published Dec 14, 2020 3:00 pm

Cancer isn’t waiting for things to go back to normal. Why should you?

Research suggests that a one-month delay in treatment can result in a six-percent increase in risk of death, underscoring the need for patients to get the care they require as soon as possible.

COVID-19 has created a dangerous “new normal” for cancer patients where delayed preventive care, skipped well visits and postponed surgical procedures, chemotherapy and radiotherapy sessions have become commonplace.

Cancer isn’t waiting for things to go back to normal. Why should you?

This was the concern raised by a coalition of leading Asian oncologists in a virtual press briefing held recently via Zoom as there has been a significant drop in the number of patients accessing cancer services in the region brought about by the pandemic.

“The global pandemic has turned our world upside down,” lamented Dr. Fong Pei-Chieh, medical director, Asia Area, AstraZeneca. “So much so that other life-threatening diseases like cancer have taken a backseat.”

Since the onset of the pandemic, many cancer patients have delayed their treatments and those who have symptoms have been too afraid to seek medical help. This has resulted in a 40-percent drop in the number of patients that could be diagnosed with cancer this year.

“In Asia, a study projected 59.7 percent of cancer surgeries in India will be postponed, affecting over 50,000 patients,” noted Dr. Chieh.

In Indonesia, hospital data suggests a drop of 20 to 30 percent in cancer patient appointments.

There was a nine-percent drop in first-visit consultations and a 30-percent drop in follow-up consultations at the National University Cancer Institute, Singapore (NCIS) between February and March 2020, although these numbers have recovered.

 For cancer patients, access to care is very important.

In a survey of 480 onco-surgeons across India, it is estimated that 92,000 patients are likely to have delays in the timely diagnosis of cancer. Free annual Pap smear screening appointments also fell by 75 percent.

Here in the Philippines, 74 percent of medical oncologists had cancer patients whose health deteriorated, while some died because they were not able to seek urgent care in hospitals.

Alarmed by these figures, the leading oncologists from Singapore, Indonesia, India, Malaysia and the Philippines, together with AstraZeneca, call on cancer patients to access cancer services without delay as part of the “New Normal, Same Cancer” campaign.

The message is clear: Patients whose care has been interrupted need to be reengaged within the healthcare system.

“And people with suspected symptoms or those who missed their cancer screening should seek help in a safe way,” added Dr. Chieh. “Because early diagnosis and intervention improves their chances of survival and cure.”

Here in the Philippines, 74 percent of medical oncologists had cancer patients whose health deteriorated, while some died because they were not able to seek urgent care in hospitals.

FINDING THE RIGHT BALANCE

For cancer patients, access to care is important because cancer doesn’t wait. But because of the COVID-19 pandemic, most patients delay treatment for fear of contracting the deadly virus.

“Because of their condition and the kind of treatment cancer patients receive, their immune system is already compromised,” noted Prof. Cheng Wee Joo of the National University Cancer Institute, Singapore. “And if they get infected with the coronavirus, they may have the worst outcome.”

To ensure the safety of the patients and frontliners, most healthcare facilities around the globe implement stricter hospital policies, safety protocols and new models of managing cancer patients.

“In Singapore, we used our experience from SARS. We quickly adapted some of the safety protocols, like having split teams so that we can minimize the potential spread of the virus in our care team,” said Prof. Joo.

He added that the National University Cancer Institute, Singapore, ensures infection control right from the patient’s entry into the hospital.

“Every step of the way, there is strong infection control. Suspected cases are managed in cancer center isolation rooms,” he added. “So we keep on telling our patients to continue their treatment in the hospital when necessary. However, our care team also looked at the indications to determine whether some of them can manage their conditions at home to minimize their risk of contracting COVID-19.”

Some of these patients can opt for a telemedicine consult. Medications can also be delivered to the patients’ homes.

“But for others who require chemotherapy and radiotherapy, they have to come to the hospital for treatment,” Prof. Joo explained. “For some patients, we convert their intravenous treatments to oral to reduce the need for them to go to the hospital.”

But not all countries are as successful as Singapore in flattening the curve. And so, through the “New Normal, Same Cancer” campaign, AstraZeneca is calling on healthcare leaders and policymakers across the globe to ensure low-COVID-risk pathways are available for patients, and make sure there’s efficient diagnostics and treatment capacities to meet the projected needs of today’s and tomorrow’s patients.

To focus on overcoming barriers that limit access to diagnostic tools to support early lung cancer detection, AstraZeneca has a partnership, through its Emerging Markets Health Innovation Hubs program, with Qure.ai (developers of deep learning algorithms for interpretation of lung radiology images) to integrate innovative artificial intelligence solutions for early detection of lung cancer in patients across AstraZeneca’s Emerging Markets region, which covers Asia (Philippines, Malaysia and Thailand in 2020 and India, Indonesia and Vietnam in 2021).

The partnership aims to harness and scale up use of this technology to improve early-stage detection of lung cancer in the markets involved, to reduce mortality rates and improve patient outcomes.

In the Philippines, AstraZeneca has also partnered with Hi-Precision for the early lung cancer detection being offered in their sites nationwide.

‘WE ARE READY TO TAKE CARE OF YOU — AGAIN’

Cancer has become a significant problem in Asia with 8.2 million new cancer cases diagnosed in 2018 and 5.2 million cancer deaths.

Based on the Philippine Health Statistics data from 2018, cancer is the second leading cause of death in the Philippines next to ischemic heart disease.

 Dr. Frederic Ting, medical oncologist

“So, looking at the specific numbers based on Globocan 2018, the total population in the country as of 2018 is 106,512,067. And the total number of new cancer cases logged was 141,021. And the number of deaths was tallied at 86,337,” noted Dr. Frederic Ting of UP-PGH.

And the numbers are expected to rise with the delay in cancer care due to the pandemic.

“For chemotherapy pre-COVID, the Lung Center of the Philippines had more than 1,000 OPD consults per month,” shared Dr. Antonio Ramos, a thoracic surgeon and manager, Administration Services Department of the Lung Center of the Philippines. “We also have an outpatient chemotherapy area, which used to accommodate 500 chemotherapy treatments every month.”

But during the hard lockdown, the Lung Center of the Philippines, which was has been designated as a COVID referral center, had zero consultations in its outpatient clinic because its outpatient building was used to triage COVID-19 patients.

“We maintained our chemotherapy facility, but it was down to 40-percent capacity mainly because patients were afraid, and access was really limited,” said Dr. Ramos.

 Dr. Antonio Ramos, thoracic surgeon

When the quarantine eased up a bit, the hospital had about 100 consults per month. But the chemo sessions are still down. As far as radiotherapy is concerned, Dr. Ramos said pre-COVID they were doing 3,300 treatments per month.

“In June, it was down to 300 patients per month. Now we’re up to 66 percent. We are doing 1,900 a month as of last count and we are happy that the patients are coming back.”

Although the long-term impact on patients is not fully known yet, recent research suggests that a one-month delay in treatment can result in a six-percent increase in risk of death, underscoring the urgent need for patients to get the care they require as soon as possible.

“We encourage our cancer patients not to delay treatment, because we are ready to take care of you again,” enthused Dr. Ramos.