The Prospects of Cancer Care in Asia

Integrated services

Yew Oo TAN, Specialist in Medical Oncology, Farrer Park Medical Clinic

In Asia, the incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030 due to ageing and growing populations, lifestyle and socioeconomic changes. While there has been significant innovations in cancer treatment that help prolong a patient’s life and their quality of life, how can patients be supported at every stage of their journey?

Asia is the world's most diverse and populous continent; 4.5 billion of the world’s 7.6 billion people live there, and the population will increase to 5.2 billion by 2050 – with China and India alone accounting for 37 per cent of the worldwide population.

As a consequence of continuing socioeconomic development and increasing control of communicable diseases, life expectancy in all Asian countries has significantly increased. The proportion of people aged 65 years and above is likely to double from the current 7 per cent by 2030. It is well-known that cancer risk increases with age. Changing lifestyles, increasing urbanisation, changes in reproductive patterns and diet, obesity, tobacco use, alcohol, chronic infection and increasing lifespans contribute to an ever-increasing cancer burden and changing cancer pattern in Asian countries.

Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. It is estimated that 6.7million new cancer cases—39 per cent of new cases worldwide—were diagnosed among 4.5 billion persons (48 per cent of the world population) living in the fifteen most highly developed countries in South, East, South-Central and Southeast Asia: Japan, Taiwan, Singapore, South Korea, Malaysia, Thailand, China, Philippines, Sri Lanka, Vietnam, Indonesia, Mongolia, Pakistan, Laos, and Cambodia.

The striking variations in ethnicity, social norms, sociocultural practices and traditions, socioeconomic development and habits and dietary customs there are reflected in the patterns and burdens of cancer in different regions of Asia. The pattern and incidence of various cancers in different Asian countries vary significantly.

1. How has cancer care in Asia evolved over the last decade?

The healthcare systems across Asia are diverse and can vary from very rudimentary to very sophisticated. Likewise, the quality of cancer care is also highly variable. However, with increasing wealth and a growing economy, across many Asian countries, the quality of healthcare delivery  has improved in the past decade. Likewise, cancer care across many Asian countries has improved. Many new cancer treatment facilities have been built and an increasing number of cancer specialists and paramedical personnel are being trained. There are still many populations where access to good quality cancer services are not possible or affordable.

2. What does it mean to have integrated or holistic cancer care services?

Integrated or holistic cancer services are the key to successful management of many cancers today.  With the advent of new surgical techniques, development of sophisticated radiation oncology technology and therapies, as well as new drug treatments, cancer treatments today require multidisciplinary teamwork to achieve the best outcome for patients. The role of other paramedical personnel to improve the quality of life and psychological support is now an integral component of good quality cancer care.

3. When it comes to cancer care – from diagnosis to treatment to monitoring – how does the standard of care in Asia compare to that in other regions?

There is no Asian ‘standard of care’ since it is such a diverse continent, but in developed economies such as  Japan, China, South Korea, Taiwan, Hong Kong and Singapore there are national guidelines or internationally accepted guidelines for many cancer specialists. These are used for managing cancers from diagnosis through to treatment and monitoring. In fact, in these countries, there are many established centres of excellence where international clinical trials are conducted. The outcome of these trials has changed the treatment practice of many cancers, such as lung, liver and stomach cancers.

4. How do you see integrated or holistic cancer care services benefiting the entire spectrum of users – from patients to caregivers to healthcare providers to the overall healthcare system?

Many cancers among Asians, especially East Asians, have different incidences, causation and molecular profile. The outcome of treatment has shown distinct differences in responses and it is increasingly important to perform certain diagnostic tests on the tumour to show the differences. The healthcare providers and system must be geared to support these important diagnostic tests, in order to obtain the best outcome for the patients. In line with this, there must be integration of the various healthcare providers in approaching the treatment decision.

We are seeing the changing burden of cancer in Asia, along with appropriate management strategies. Many Asian countries should plan strategies that promote healthy ageing via living healthy lifestyles, tobacco and alcohol control measures, Hepatitis B Virus (HBV) and Human Papillomavirus (HPV) vaccination, cancer screening services, and vertical investments in strengthening cancer healthcare infrastructure to improve equitable access to services.

5. What about rural areas in Asia? How can they equally benefit from having access to integrated cancer care services?

With improving economies, many cancer patients living in rural areas of Asia have better access to modern diagnostic and treatment facilities. With better transport and communication, many cancer patients in various Asian countries are expecting more accurate diagnosis and treatment for their cancers. A few patients with economic means are travelling to regional cancer centres across national borders to seek better treatment for their cancers. This trend of medical tourism will continue as long as these centres of excellence provide prompt, accurate, state-of-the-art care at affordable prices.

6.What is the future of personalised cancer care?

Today, many cancers such as breast, lung, stomach, colorectal, lymphomas and leukemias require precise histopathological and often molecular or genomic profiling to offer precision medicine. Personalised cancer care should now be called ‘Precision Medicine’ as new drugs are prescribed to stop cancer growth based on certain molecular targets found in the tumour or blood. With the explosion in genomic medicine, the future of Precision Medicine looks bright and promising. The well-known side effects of cytotoxic drug therapies such as nausea, vomiting, hair loss and low blood counts that many patients fear, may become a thing of the past

7. What are the main factors in providing successful integrated cancer care services and can the healthcare industry support this?

For any integrated cancer care progrmme to be successful, the main ingredient is the collaboration and cooperation between the patient, healthcare providers and industry. The industry can be the companies that make the instruments or the equipment for the healthcare providers or pharmaceutical companies. A symbiotic relationship between the healthcare providers and industry will ensure better integration and holistic care for the cancer patients. With rapid advances in technology and better understanding of cancer biology, more sophisticated instruments and equipment, as well as targeted drugs or immunotherapy, are required to increase the survival of many advanced cancers. The tremendous advances in cancer therapies in the past two decades have been unprecedented and this is in no small measure due to the collaboration between healthcare providers and healthcare industry.

--Issue 38--

Author Bio

Yew Oo TAN

Yew OoTan has been practising as a specialist medical oncologist at Icon SOC Farrer Park Medical Clinic in Singapore for more than 15 months. Prior to that, he was Professor of Medicine at National University of Singapore and he has been practising medical oncology for more than 40 years.