In 2020 alone, the number of new cancer cases reported in Malaysia was 48,639 while the number of people living with cancer (five years) was a whooping 128,018 (Globocan, 2020).

Presently, the top three most common cancers among Malaysian males are colorectal, lung and prostate cancers whereas for females, they comprise of breast, colorectal and cervical cancers.

Central to this discussion is that the pandemic has led to the reallocation of healthcare resources to cater to the influx in Covid-19-related hospitalisations.

Particularly, during the first Movement Control Order (MCO), cancer-screening services were limited, cancer surgeries were postponed, and clinical visits and imaging appointments were deferred.

While these measures were taken to ensure that we had enough medical personnel, hospital beds (ICU and non-ICU) and personal protective equipment (PPE) to accommodate the high number of Covid-19 admissions, they resulted in widespread disruptions to cancer care service delivery in the nation, especially so given that some tertiary hospitals were also hybrid Covid-19 hospitals.

Our cancer survivors were also torn between having to leave their homes to attend hospital appointments, or postponing their hospital visits to a later date for fear of exposing themselves to the coronavirus.

Now that MCO 2.0 is back, we would like to remind Malaysians at large that cancer patients may again be facing similar problems and that it is no longer ethical to let them (and also patients with other chronic diseases) suffer due to the pandemic.

While fighting the invisible virus remains the utmost priority currently, cancer care cannot be delayed.

Here, we would like to propose several measures that can be taken to maintain the continuity of cancer care in Malaysia.

General public:

• Anyone with new cancer symptoms (lumps, pain at specific areas, unexplained bleeding) should seek medical advice promptly. Do not brush off any persistent symptoms.

Cancer survivors:

• Check with respective clinics if your appointment has been rescheduled due to MCO 2.0.
• Take note of your appointment time slots so that physical distancing can be maintained in the waiting area of the healthcare facility.
• Obtain a travel permit if your healthcare facility is further than the 10 km radius from your home. Take along your hospital appointment books as proof to the police station.
• If you are receiving chemotherapy, radiotherapy or any other cancer therapy, you should comply with the treatment. Discuss any concerns with your doctor.
• Those with personal medical insurance and who wish to fast-track their treatment may want to explore treatment options at private hospitals. This also serves as a reminder to the general public to review your existing insurance policies to ensure sufficient coverage for rainy days.
• Always practise good preventive measures – wearing of mask, physical distancing and hand hygiene whenever you leave your home. Carry a hand sanitizer and carry along an extra face mask if possible.
• During this difficult time, get in touch with cancer support groups and NGOs such MAKNA, National Cancer Society of Malaysia (NCSM), Breast Cancer Welfare Association (BCWA), Lung Cancer Network Malaysia (LCNM), Colorectal Cancer Survivorship Society Malaysia (CORUM) and Hospis Malaysia for your psychosocial needs.

Healthcare providers:

• Establish a clear referral pathway from primary care to receiving hospitals. Communication is vital to ensure that the receiving hospitals have the capacity to take in new referrals.
• Reach out to patients who stay further than the 10 km radius from the hospital (especially tertiary referral centres). Clear communication with patients on the necessary SOPs is needed to ensure that they can continue to access treatment in a timely manner.
• Establish good coordination of cancer services between various departments in the hospital so that patients need not go for different appointments on different days.
• Have a clear workflow for patients whose care has been deferred. Ensure a working hotline is ready for them to call if they experience symptoms.
• In the event that the hospital is unable to manage the patient in a timely manner, direct them to a nearby hospital to ensure continuity of care. This however must be done after counselling the patients adequately and ensuring that individual patients have been passed over to a dedicated team in the receiving hospital.
• Consider migrating stable patients to tele-consult services via a proper workflow.

The Covid-19 pandemic has superseded all other health-related urgencies. Cancer is a disease which can take a heavy toll on the country’s health resources, particularly advanced stage cancers which require more complicated and expensive therapies.

Therefore, cancer care, which comprises screening and early diagnosis, treatment, surveillance as well as supportive and palliative care, should be re-strategised according to the new norm so that the continuity and quality of care are not compromised.

Teoh Soo Peng is a candidate of the Doctor of Public Health (Drph), while Nirmala Bhoo-Pathy is a public health medicine specialist and associate professor of epidemiology at the Dept of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya.

The views expressed are those of the writers and do not necessarily reflect those of FMT.