Despite advancements in cancer treatment, survival rates in Southeast Asia remain lower than in high-income countries (HICs) due to late diagnoses and limited access to innovative therapies.
Although there are more than 200 types of cancer, some of which are already curable, the survival rates for cancers in Southeast Asia are much lower when compared with high-income countries (HICs). Despite rapid advancements in cancer therapeutics, the cancer burden in the region is projected to reach 3.6 million new cases and 2.4 million deaths by the year 2040.
For instance, the latest Malaysia National Cancer Registry for 2017 to 2021 reported a total of 168,000 cases, a 46.5% increase from the previous report for 2012 to 2016 while in Thailand, over 180,000 new cases were diagnosed in 2022 with a predicted 50% increase in incidence by 2045.
The case fatality rates in Southeast Asian countries are higher primarily due to late-stage presentation and difficult access to treatment, with rapid socioeconomic development, associated lifestyle changes and increased exposure to risk factors increasing the cancer burden in Malaysia and Thailand.
Healthcare systems are unable to meet patients’ needs
Southeast Asia's accelerated industrialization and globalization has raised new challenges for the region's healthcare systems. The demand for better care is increasing in tandem with increasing educational levels, aging populations, and growing awareness of human rights in the recently developing democratic environment.
However, the rising incidence of noncommunicable diseases (NCDs) and a rapidly ageing population are putting financial strain on the healthcare system. This has forced the public healthcare system to focus more on primary and acute healthcare services, with treatment for chronic diseases often limited to generic medications, especially for rare diseases and cancers.
“People take more time to work through the public healthcare system, from getting registered, to seeing a doctor, and getting screened, which causes a significant delay in diagnosis,” says Dr Murallitharan Munisamy, Managing Director, National Cancer Society of Malaysia (NCSM).
Barriers to early diagnosis
Dr Tan Chih Kang, a consultant clinical oncologist at Picaso Hospital, Kuala Lumpur, believes that a lack of awareness is one of the main reasons patients delay their diagnosis and treatment. “Many patients do not realize that if detected and treated early, many common cancers have a good prognosis, with patients leading robust and healthy lives for decades to come.”
“Many people fear a cancer diagnosis as it carries the stigma of a ‘death sentence’. So, when they notice symptoms which could be caused by cancer, such as a lump in a breast, or a persistent cough, they experience fear and denial, which discourages them from discussing their symptoms or undergoing early screening,” Dr Muralli adds.
Dr Araya Adulbhan, a medical oncologist at Bangkok Hospital Siriroj and at the National Cancer Institute of Thailand explains, “In Thailand, patients often worry that the cancer diagnosis would be a burden to their family, especially if they are the breadwinners, so they would rather wait or try alternative treatments before seeking medical help. Often, they would only head to the hospital for treatment when their symptoms have worsened to the point they could no longer tolerate them.”
Dr Tan also highlights the low uptakes of screening programs, “People are also unaware of the available screening programs for common cancers such as breast, cervical and colorectal cancers. A survey showed that the uptake of subsidized mammogram screenings in Kuala Lumpur is only between 10.5% to 31.9% among the general population.”
Similarly, the Health and Welfare Survey of the Thai National Statistical Office (2021) revealed that 19.2% of women were unaware that breast cancer could be screened via mammography, while 22.7% believed that Pap smear screening for cervical cancer was unnecessary. Mammogram and Pap smear screenings uptakes were only at 13.8% and 54.0%, respectively.
Late diagnosis leads to higher cost
According to Malaysia’s latest National Cancer Registry from 2017 to 2021, 65% of cancers were detected in the advanced stages, i.e., Stages 3 and 4. Delayed diagnosis does not only limit a patient’s treatment options, but also worsens their prognosis, and reduces their quality of life.
Dr Tan elaborates, “As cancers progress, they become more complex, and require costlier innovative therapies to treat, which increases the financial burden on patients and the national healthcare system."
"Cancers which have metastasized tend to have worse outcomes than those which have been detected and treated in the earlier stages. More aggressive treatments of late-stage cancers have also been shown to reduce patients’ quality of life, and increase the physical and emotional toll of the disease.”
A 2015 study revealed that one in two cancer patients in Malaysia suffered from financial catastrophe within one year of diagnosis and treatment, where 46% of patients used up all their savings, 39% could not afford their medication, 22% could not afford their rent or mortgage, and 19% had to discontinue treatment.
Dr Muralli explains, “The direct cost of cancer, including innovative therapies, hospital stays, and other indirect medical costs can quickly add up, potentially leading to financial ruin for patients. Patients and their families are forced to make impossible choices between paying for life-saving treatments or meeting basic living expenses. Patients without health insurance may delay or forgo treatment altogether, which can quickly worsen their condition and impact quality of life. This financial burden underscores the critical need for accessible and affordable healthcare.”
Easing access to innovative therapies
For patients who want to circumvent the long wait lists and limited supply of innovative therapies in the public healthcare system, the private sector offers a wider range of, and often newer treatments and specialist services.
Unfortunately, in Malaysia the cost for the treatment of chronic diseases such as cancer can be prohibitively high even for middle-income patients with personal health insurance. Patients who may have purchased personal health insurance but have not periodically reviewed or updated their policies to cover the latest innovative cancer therapies, often find themselves in distress when they realize they have to pay for newer therapeutics out-of-pocket.
In Thailand, around 48 million citizens, or 75% of the Thai population are covered by the tax-funded Universal Coverage Scheme (UCS) offering free healthcare as a safety net for all income levels, but it has its limitations. “While the range of cancer therapies and services provided by UCS to Thai citizens has improved considerably since its inception, they are still limited by the available budget. UCS covers basic screening, radiology, and some chemotherapy but rarely any of the newer treatments such as targeted therapy and immunotherapy, which are often necessary to treat patients presenting with late-stage or rare cancers,” shares Dr Adulbhan.
He adds, “To manage the cost of medications, it is not uncommon for patients in Thailand to travel to other countries such as India to purchase their required medications, when it is not covered by the UCS. In fact, it is often less expensive to spend on the round trip to India than purchasing the drug locally in Thailand.”
Advancing equitable and accessible healthcare
Healthcare access companies such as Axios International have devised patient access programs to help patients pay for their treatments at a price they can afford.
Ms. Shahad Safaa, Global Head of Access Solutions, Axios International, states, “To help patients not only access but stay on treatment, we need to canvas for and consolidate various sources of funds and support; this has led to the development of Axios International’s cost-sharing model and patient access programs.” Axios International launched the world’s first patient access program (PAP) for cancer medications in Asia in 2008. To date, Axios International has supported over 100,000 patients across Asia through 15 specialized programs, including cancer.
She adds, “These programs have been designed to address barriers linked to affordability and accessibility, helping patients in low- and middle-income countries (LMICs) gain access to life-saving therapies that would otherwise be beyond their reach.”
Sometimes a patient is not able to access a drug simply because the drug is not yet available in the country. Dr Tan shares, “In Malaysia, physicians can help patients obtain faster access to drugs that are not yet approved in the country by applying for special permits through the National Pharmaceutical Regulatory Agency (NPRA), which typically takes a few months.”
Cancer patients require other kinds of support beyond medications. Dr Muralli explains, “There is a notable shortage of quality healthcare centers in remote parts of Malaysia. To address this, NCSM is collaborating with the Ministry of Health and other non-government organizations (NGOs) to facilitate and expedite the care of cancer patients from rural areas who are less able to afford care. We have set up transit homes all over the country for these patients, usually situated in close proximity to either government or private hospitals. This arrangement helps patients to reduce travel and accommodation costs while making it easier for them to be diagnosed and treated at earlier stages of the disease.”
Dr Adulbhan adds, “The cost and physical challenges of traveling often long distances between their homes and hospitals in the city can pose challenges to cancer patients. To address this, the Thai government has identified 13 public health centers across 13 provinces in Thailand, each equipped with the necessary medical resources and specialized equipment for cancer treatment, so patients who live in the surrounding areas need not travel all the way to Bangkok for treatment.”
NGOs also play a pivotal role in supporting cancer patients in Thailand. For instance, the Queen Sirikit Centre for Breast Cancer (QSCBC) Foundation actively organizes breast cancer screening for under-privileged women in the slums of Bangkok so they can have easier access to screening and diagnosis facilities. As well as providing psychological support services, the QSCBC Foundation has also built Pink Park Village which houses a convalescence center, a hospice, and day care center that provides low-income patients with a short-term home while they undergo treatment.
Shahad adds, “As well as medication delivery and administration to patients in underserved or remote areas, we work together with local NGOs to offer mental health support for cancer patients to cope with emotional challenges, manage stress, and improve their overall quality of life.”
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