Cancer” is a scary word, one of the scariest in the world.
According to Roche Pharmaceuticals regional medical leader for oncology Dr. Sivabalan Sivanesan, PhD, who spoke during the Roche forum for Asia-Pacific journalists in Singapore recently, “Over 14 million people were diagnosed with cancer” in 2012. “This equates to more than 38,000” diagnoses “every day.”
That same year, Sivanesan added, “more than 8 million people died from cancer.” That translates into “over 20,000 deaths a day.”
“It is predicted that, by 2035, over 14 million people will die of cancer each year,” Sivanesan said.
That is a frighteningly high mortality rate for a disease that is preventable and treatable with high success rates if caught early.
TOO HIGH
He said the number of people diagnosed with cancer “is predicted to increase by almost 70% from 2012 to 2035.”
This projected increase in cancer morbidity isn’t the only worrisome statistic.
Sivanesan, citing data from the World Health Organization, said the number of people who die from cancer “is predicted to increase by nearly 75% from 2012 to 2035.”
Sivanesan also said that “researchers believe that over half of cancer cases–and up to half of all cancer deaths—are preventable. This means that there are between 2.4 million and 3.7 million avoidable deaths per year, 80% of which occur in low- and middle-income countries.”
Can cancer be beaten? Yes. “Cancer is not always a death sentence—particularly with the progress made in recent decades. Although the incidence of cancer is increasing, in many countries more people are surviving cancer than ever before,” he said, adding that 28 million people have survived cancer worldwide.
HEAVY BURDEN
The Economist Intelligence Unit (EIU) senior principal for health care Chee Hew told the Philippines Graphic that “cancer is ranked as the second leading cause of death and disability across the Asia-Pacific.”
“In Asia, non-communicable diseases account for 72% of all deaths and 63% of the total disease burden, i.e. Disability Adjusted Life Years (DALYs), serve as a composite measure of premature death and years lived with disability,” Hew said.
The Philippines ranks 10th of 12 countries across the Asia-Pacific region in terms of DALY burden, Hew said, citing the research she and her colleagues at The Economist have gathered.
The cancers with the highest incidence rates in the region, according to The EIU, are lung cancer (29 cases per 100,000 people), gastric cancer (22 cases per 100,000 people), liver cancer (21 cases per 100,000 people), colon cancer (21 cases per 100,000 people) and breast cancer (17 cases per 100,000 people).
The EIU looked into a per country breakdown of the cancers that plague the Asia-Pacific, and these are the top cancers by country: Australia – non-melanoma skin cancer, China – lung cancer, India and Indonesia – breast cancer, Japan – colon and rectum cancer, Malaysia – breast cancer, Myanmar – lung cancer, the Philippines – breast cancer, Singapore and South Korea – colon and rectum cancer, Thailand – liver cancer, and Vietnam – lung cancer.
Hew said the global regulatory frameworks for approving new drugs is “slow” and “drugs take much longer to be approved in the Asia-Pacific.”
All of these things, according to the EIU, place a “heavy burden on Asia-Pacific countries.” These things incur “higher financial costs to patients and their entire families.”
The nations and territories within the Asia-Pacific region face two strong roadblocks that make it harder to provide effective treatment for cancer patients.
“There is a lack of awareness in how to prevent cancer,” Hew said. “This contributes to late-stage cancer diagnosis because the patients don’t know what the early symptoms are, or have regular medical checkups that would detect cancer early.”
Hew also pointed out that late-stage cancer diagnoses can also be results of “misdiagnosis during cancer treatment.”
“Patients lack awareness or knowledge on how to get regular tests,” she said. “There is a lack of free screening programs in many countries, especially in China, India and Malaysia. There is an insufficient number of trained doctors and [medical] technicians, resulting in misdiagnosis. There is limited access to tests, instruments and methods [for diagnosis] in rural areas.”
The EIU quoted Dr. Sumadi Lukman Anwar of Indonesia’s Gadjah Mada University: “Only one in five Indonesian women are aware of cervical cancer screening.”
The earliest description of cancer was found in the Edwin Smith Papyrus dating back to 1600 BC. The document describes breast tumors removed by a tool called the “fire drill.” The same papyrus states that “there is no treatment.”
Cancer is not one disease. Over the last 10 years, medical experts and researchers have identified over 250 different types and subtypes of cancer–findings that have triggered a shift away from the “one-size-fits-all approach. The best way to provide medical care for cancer patients is by “tailored therapy.”
Only 5% to 10% of cancers are entirely hereditary: Most cancers develop through a combination of hereditary and environmental factors, including smoking, imbibing alcohol, obesity and poor diet.
PATIENT IN THE PICTURE
The biggest barrier between cancer patients and survival is delayed diagnosis.
“Either the patient is not aware of the disease or cannot afford diagnosis and treatment,” Durhane Wong-Rieger, PhD, chair of Rare Disease International and of the Canadian Organization for Rare Disorders, said. She also noted that other factors for diagnosis delay include “distrust in the screening process.”
“The patient or the health care system can also cause delays in treatment,” she added.
She quoted Hanoi, Vietnam-based K Hospital deputy director Dr. Tran Van Thuan: “Around 70% of patients diagnosed with cancer are already at stage three or four, leaving the percentage of those who can be effectively treated low.”
In Indonesia, he noted, more than 50% of patients diagnosed with kidney cancer are diagnosed in the disease’s advanced stages—and that this is the same case for patients diagnosed with prostate cancer.
“We have been talking about cancer and beating cancer and curing cancer and treating cancer—but where is the patient in all of these discussions?” Wong-Rieger posited this question during the forum. “The patient is who this is all about and the patient is the leader of the fight against the cancer that ails him or her.”
Wong-Rieger cited a 2015 press statement by the European Society for Medical Oncology on how cancer drives patients into poverty in Southeast Asia: “Up to 20% of patients did not attend their medical appointments or could not pay for medicines. Disadvantaged patients had an 80% higher risk of death within 12 months following diagnosis compared to those without economic difficulties at baseline.”
She also noted that most health insurance products do not cover critical illnesses like cancer, while some comprehensive health insurance policies that do come with limits that may or may not cover the entire cost of treatment.
“This is something where the patient must participate and be heard,” Wong-Rieger said. “Patients can raise awareness, support the value of screening, provide testimonials to engage others.”
“They can advocate for their right to health care and timely specialty care,” Wong-Rieger said. “We talk about human rights, like the right to free speech all the time. Now, can we talk about our right to good health with as much fervor and power?”
“Patients can advocate for improved treatment options and access,” she noted, “as well as collaborate to engage community and support care systems.”
“Patients are your best partners for improving health care programs and health policy,” Wong-Rieger said.
WHY SO SERIOUS?
The key challenges the EIU found insofar as dealing with cancer is concerned include this: “Aging and richer populations have higher cancer prevalence.” In Japan, China, Singapore and Taiwan, rapid aging is a factor in the increase in the cancer morbidity rate.
Moreover, “inefficiencies in the treatment of late stage diagnosis” has been a huge roadblock in the fight against cancer. Hew said that many patients “lack awareness of cancer,” its symptoms and the treatments that are available, especially in rural areas. These rural areas, Hew noted, also lack experienced doctors, and that doctors deployed to rural areas “lack sufficient training, especially in complex cases.”
Hew expressed concern over the fact that “cancer care is concentrated in larger hospitals in urban cities” and that the region has an “inadequate number of specialized hospitals” for cancer treatment.
Cancer is an expensive burden, and Hew noted that there is a lack of sufficient funding for cancer diagnosis and treatment. “Health insurance is increasing, but there is still only limited coverage. While health insurance is particularly strong in reimbursement [of treatment costs] in countries like Japan and Taiwan,” she also said that the “lack of sustainable funding for reimbursement limits cancer coverage in countries like the Philippines.”
TRANSFORMATION
Key transformations to reshape oncology care in the Asia-Pacific include the integration of cancer care in public health care policy and health insurance policies; innovative funding for education campaigns, screening, diagnosis and treatment; the expansion of cancer care providers and digital health care for cancer that harnesses computer and mobile internet technology to give patients greater access to accurate information on cancer, health care providers, and means by which they can afford the treatment they need.
Digital means of both safeguarding and transmitting patient information will also shorten the time between diagnosis and treatment.
Disease management covers prevention, early detection, the delivery of acute care and ongoing monitoring—end to end resources that are designed to save both time and lives without sacrificing accuracy of diagnosis.
According to the EIU research, the new approaches to cancer prevention include “population-wide prevention that addresses the common risk factors, patient awareness of risk factors and healthy living, and targeted pharmacological intervention for patients with an elevated disease risk.
The EIU also noted that “raising disease awareness among [health care] providers and the public” and “early diagnosis via screening programs, particularly for breast cancer,” are key to ensuring better early detection and diagnosis of cancer—which will offer the people diagnosed with the ailment better chances of surviving the disease.
For the people already diagnosed with cancer, the EIU researchers recommended “continuous, comprehensive, person-centered cancer care and specialist coordination.” They also recommended using linkages of technology, such as biomarkers, “for more personalized care and more precise biopsies.” These approaches the EIU recommended “aim to reduce the disease burden and costs, as well as complications.”
The Asia-Pacific also needs these to fight cancer, according to the EIU: “Infrastructure and expertise to address the ongoing monitoring of cancer patients,” as well as “affordable access to acute care and treatment via health insurance systems.”
All these improvements are well and good, but how good are they if the patients cannot afford them?
What the EIU’s research shows is that partnership-driven patient assistance programs (PAPs) are developing in the Asia-Pacific region, with some of them available in the Philippines—but which are still underused.
PAPs bridge the affordability and accessibility gaps between patients and improved diagnosis and treatment for cancer.
“Both governments and industries have been promoting prevention care and early diagnosis to ease the cancer burdens on society and families,” Hew said. “Some specialized cancer treatment hospitals, including those targeting medical tourists, emerged to provide more personalized care.”
“Pharmaceutical companies, government organizations and non-government organizations all launched PAPs to further expand patient accessibility. Private insurance companies also innovate with dedicated products, providing favorable terms for cancer customers,” she added. “Traditional health care providers work with new AI providers to offer personalized treatment, including diagnostics, monitoring and treatment.”
She also noted that “the future of cancer care requires integration of the health care ecosystem.”
“Medical technology players must provide tighter integration with pharmaceutical firms–such as in terms of biopsy and companion diagnostics technology,” Hew said. “Pharmaceutical [companies] need to change from traditional to integrated care. They need to develop partnerships with government for PAPs, etc.”
She also noted that high tech players like IBM and Google can tap the emerging market for medical analytics and bring their best tech into the fight against cancer.
It will be recalled that in mid-2017, IBM shared data with the Philippines Graphic on its Watson supercomputer, which is now being leveraged for several purposes, including its use in key cancer specialist hospitals for case comparison to help doctors improve their diagnosis and treatment of cancer.
CUSTOMIZATION
Sivanesan said, “Every person with cancer is different. At Roche, we have gained unique biological insights into how different cancers develop and we are working on specific molecular tests to help assess cancer in clinical practice.”
He also predicted that “new cancer treatments will be tailored to specific groups of patients defined by diagnostic markers (biomarkers). This will help to target treatment to patients that have the most chance of benefitting.”
The tailored approach, Sivanesan said, “has enormous potential to make healthcare better, safer and more effective, with benefits for patients, physicians, payers and society at large.”
Biomarkers work this way, Sivanesan said: Toxicity biomarkers “verify the impact of new drugs on targets and pathways. Patient biomarkers “achieve the role of personalized health care.” Efficacy and disease biomarkers help medical personnel “treat diseases more effectively.
Roche has embarked on new approaches to clinical endpoints and trial designs, according to Sivanesan: “We have new study designs called ‘basket trials’ and ‘umbrella trials.’ We have new clinical endpoints.” These endpoints cover all possible bases, from cancers detected early to the cancers that have turned metastatic, or spread beyond the original infection area.
“Roche is uniquely positioned to drive personalized healthcare,” Sivanesan said, citing the company’s “combined strengths of pharmaceuticals and diagnostics, its synergies in research and development and its unique global network of alliances in poineering personalized medicine.” G
