Cancer care triage in Asia shows treatment options gap

A hard look at cancer treatment options in Asia highlighted the gap in treatment pathways for innovative therapies in developing economies with much of the focus now on either screening or palliative care.

While regional cancer hubs like the National Cancer Centre of Singapore (NCCS) offer cutting-edge services at its Proton Beam Therapy Centre, the only one in Southeast Asia and among a handful in Asia-Pacific, the regional demand is potentially too vast.

Soo Khee Chee, director of the NCCS, told FiercePharmaAsia on the sidelines of an Economist magazine sponsored forum dubbed the War on Cancer that regional treatment means making access decisions.

"Singapore is a small nation that punches above its weight in healthcare," Soo said at the March 17 event in Singapore. "But there are a lot of parameters to consider with public demand from Singaporeans and for private treatment. We weigh these all the time in access to medicines and to therapies like the proton beam."

National Cancer Centre of Singapore director Soo Khee Chee

Other speakers at the conference from government and multilateral agencies as well as leading companies in the oncology space said that the absence of insurance or related reimbursement options to pay for long-term oncology care can lead to many families to avoid screening checkups that could detect cases early--with the effect that discovery is usually in a later stage with few treatment options outside of palliative care.

That dynamic was a feature of keynote speakers, including from developing country Myanmar, which has made a so-far-successful transition to democracy that comes with expectations of better healthcare options that are hard to meet.

"There are 51 million people in Myanmar, and 70% of them live in rural areas," Myint Han, director-general of the Department of Medical Services in Myanmar's Ministry of Health, told the gathering.

"It is extremely important that we act fast to improve accessibility and affordability of healthcare services. In the past 5 years, we have increased national healthcare budget for cancer control to address the issues, specifically around prevention."

But as Soo points out, a hub-and-spoke system is one that may be the most practical now to bridge the divide on access to services and drugs in the oncology space.

He said one of the first steps by many countries should be a detailed registry of cancer cases. A second step would be to aim national policies directly at screening and palliative care until other facilities can be developed.

For treatment options, he said surgical oncology with radiation therapy available would anchor doctors to hospitals and public health programs, potentially bringing along cutting-edge drugs that need money and expertise not readily available.

"In Asia Pacific in cases where cancer is advanced the treatment options are limited. So this hub and spoke can act to provide assessment," he said.

Of particular concern to the speakers were rising incidences related to lifestyle changes seen in breast cancer--encapsulating the chances of survival through early detection compared to advanced treatment.

"If caught in its early stages, breast cancer can be treated very effectively, with extremely high survival rates," the report notes. "If caught late, though, it is often fatal. Accordingly, it is a disease that policymakers and health systems must address to prevent needless loss of life."

- here's the report on breast cancer