Essay: Concerns of terminally ill lung cancer patients living in developed countries

1. INTRODUCTION
1.1. Aim
This report aims to investigate the issues concerning terminally ill patients.
1.2. Parameters
This report will investigate the concerns of terminally ill lung cancer patients living in developed countries like Australia and Singapore. This report is limited to 2000 words.
1.3. Definition of ‘Cancer’
A disease that refers to the uncontrolled growth and multiplication of cells, caused by abnormalities in the DNA, that may eventually spread to other areas in the body (metastasis). These benign cell growths are generally harmless and will only become malignant when they spread to other areas in the body (Cancer Council Australia 2016; Australian Cancer Research Foundation n.d.).
1.4. Thesis
Despite major advances in medical technology, lung cancer is known to have poor prognosis and has claimed thousands of lives in developed countries such as Australia and Singapore each year, thus the government from these countries are obligated to derive a compassionate approach to ease the end of life journey for terminally ill patients.
2. BACKGROUND TO THE ISSUE:
2.1. Global Context
Lung cancer is known to have a poor prognosis and is the most common cause of cancer-related deaths worldwide, including developed countries such as Australia and Singapore, as it is also often detected at later stages where survival rate of patients is significantly reduced. According to Table 1a and Figure 1a, lung cancer was the number one killer for cancer, causing 1.59 million deaths worldwide in 2012 (World Cancer Report 2014, cited in World Health Organisation (WHO) 2015). In Table 1b and Figure 1a, approximately 1.8 million new cases of lung cancer and 1.59 million deaths from lung cancer were recorded worldwide in 2012, indicating high fatality in lung cancer patients (Ferlay et al. 2013). Although lung cancer is often associated to the act of smoking, other risks factors such as secondhand smoke exposure, family or personal cancer history, exposure to harmful radiation, asbestos or air pollution may also cause cancer in non-smokers (Cancer Australia 2015c).
Lung cancer patients may experience persistent coughing, breathlessness, pain in the chest, and show signs of weight loss (Cancer Council Australia (CCA) 2016; Lung Cancer Foundation of America (LCFA) n.d.). When these symptoms worsen and are detected at later stages, treatment options become limited which reduces the survival rate of the patient (LCFA n.d.). Lung cancer is known to have poor prognosis. The 5-year survival rate for non-small cell lung cancer at stage 1 and 4 are 58 to 73% and 2 to 13% respectively, while the 5-year survival rate for small cell lung cancer at stage 1 and 4 are about 40% and 1% respectively (Cancer Research UK 2014a). Patients have to undergo numerous procedures such as imaging tests and biopsy before being diagnosed with lung cancer and common treatment options include surgery, radiotherapy, chemotherapy or targeted therapy that can be expensive (Cancer Australia 2015a; 2015b). Without proper financial planning, these patients may not be able to afford receiving such treatments (Channel Newsasia 2015).
2.2. Australia
Based on 2012 data shown in Figure 2a and Table 2a, lung cancer is the fifth most common cancer and the number one cause of cancer-related deaths in Australia with 11,331 new cases and 8,232 deaths by lung cancer recorded in 2012 (Ferlay et al. 2013). In Table 2a and Figure 2b, 6,715 of the total new cases of lung cancer that were accounted in 2012 were males and the remaining 4,616 cases were females, and 4,964 of the deaths caused by lung cancer were males and 3,268 deaths were females (Ferlay et al. 2013). According to the Australian Institute of Health and Welfare (AIHW) (2016a), there is an estimated increase in lung cancer cases to 12,203 (7,130 were males and 5,073 were females) new cases and 8,839 (5,122 were males and 3,716 were females) deaths caused by lung cancer in 2016.
2.3. Singapore
According to Figure 3a and Table 3a, lung cancer is the third most common cancer and the most common cause of cancer-related deaths in Singapore as 1,974 new cases and 1,590 deaths from lung cancer were recorded in 2012 (Ferlay et al. 2013). In Table 3a and Figure 3b, 1,324 of the total new cases of lung cancer recorded in 2012 were males and the remaining 650 were females, and 1,083 of the deaths caused by cancer were males and 507 deaths were females (Ferlay et al. 2013). Based on data recorded by the National Registry of Diseases Office (NRDO) (2015) as shown in Table 3b and 3c, there has been an increase in new cases of lung cancer from 2005 to 2014, and although there is an increase in the survival rate of lung cancer patients, survival rates of five years after diagnosis remained low at 10.39% in males and 17.09% in females.
3. CURRENT ACTIONS
3.1. Actions in Australia
With the aim of reducing the concerns of medicine bills and to improve the quality of death of terminally ill patients, the government of Australia has implemented the ‘Pharmaceutical Benefits Scheme’ and funded the ‘Palliative Care Australia’.
3.1.1. Pharmaceutical Benefits Scheme (PBS)
Commenced in 1948, PBS was constantly revised to ensure that medicines remain affordable to every Australian resident who are Medicare cardholders, as it aims to meet the medication needs of Australians (Department of Health 2016a). Most of these medicines that are subsidized by the government can be purchased from any pharmacists, while other medicines such as chemotherapy drugs may require the help of medical professional to administer and can only be purchased from hospitals (Department of Health 2016a). As of 2016, the scheme requires individuals to only pay a maximum of AUD$38.30 (AUD$6.20 for concession cardholders) for most of its listed drugs, and patients will only be required to pay once for any original prescription and not on repeat prescriptions (Department of Health 2016a; 2016c).
3.1.2. Evaluation
Lung cancer patients can experience serious financial strain as they go through a series of scans and treatments without any financial planning (Lapso 2016). Although the PBS has ensured that old drugs are affordable, new specialized cancer drugs take too long to be added to its list, depriving its patients of possible better treatment methods (Ball et al. 2016).
3.1.3. Palliative Care Australia (PCA)
Started in 1998, PCA was previously known as ‘Australian Association for Hospice and Palliative Care Inc’ that was established in 1991 and it aims to provide palliative care of high quality for all Australians (Palliative Care Australia (PCA) n.d.). PCA is funded by the Australian Government in its operations and infrastructures as it continues to provide knowledge to improve on current palliative care policy, reaching out and educating the community on palliative care in Australia (Department of Health 2016b).
3.1.4. Evaluation
32,800 patients required palliative care in 2014 which was 4.1% more than the number of patients that required palliative care in 2013, and 80% of these patients were diagnosed with cancer (AIHW 2016b). According to Figure 2c, Australia was ranked 2nd worldwide in 2015 in providing quality palliative care to its patients, indicating resounding success in the support from the government in ensuring affordable quality palliative care in Australia (The Economist Intelligence Unit (EIU) 2015).
3.2. Actions in Singapore
In order to address the concerns over costly medical bills and to improve the quality of death of terminally ill patients, the government of Singapore has developed initiatives in place to ensure that these patients have access to affordable medical drugs and palliative care.
3.2.1. Drug subsidies
A list of drugs is subsidized by the government in accordance to the WHO’s list of essential medicines that is reviewed every year to ensure that these medicines are also affordable for patients who need long term medication (Ministry of Health (MOH) 2015b; Koh 2015). This list of drugs includes chemotherapy drugs such as carboplatin, cisplatin, docetaxel, paclitaxel, etc which are often used in treating lung cancer patients (MOH 2015a; Cancer Research UK 2014a).
3.2.2. Evaluation
According to doctors in Singapore, Gefitinib which is a pill that is taken orally, is a better alternative to chemotherapy treatment for lung cancer with Epidermal Growth Factor Receptor (EGFR) mutation, but was not added into the list of basic subsidised drugs (AsiaOne n.d.; MOH 2015a). Basic drug subsidies are only effective when specialised medicine that were not included in the list, can still be subsidised by the government through other schemes such as the Medication Assistance Fund (MAF) for low- and middle-income patients. (AsiaOne n.d.; MOH 2015b).
3.2.3. Palliative Care
Started in 1995, the Singapore Hospice Council (SHC) is a charitable organisation that represents all of the palliative care providers, coordinating the training and provision of palliative care services in Singapore (Singapore Hospice Council (SHC) n.d.). Most of the palliative care services in Singapore is funded by the government and donations from the public to keep its services at a low cost for its patients (MOH 2015c; SHC n.d.). The National Cancer Centre Singapore (NCCS) (n.d.) is one of the palliative care providers in a public hospital, providing symptomatic treatment and management of pain to its patients in the Singapore General Hospital.
3.2.4. Evaluation
Based on Figure 3c, Singapore was ranked 12th worldwide in providing affordable and quality palliative care services to its growing number of patients, indicating more can be done in better managing its resources, reaching out to the public and refining its policies (EIU 2015; Law 2015). According to Dr Cynthia Goh (cited in Law 2015), while there are a number of schemes that targeted acute care, hospices care is not covered by insurance companies and some of these schemes.
4. SUMMARY, CONCLUSION AND FUTURE RECOMMENDATIONS
4.1. Summary
Lung cancer has a poor prognosis due to late detection and the absence of a cure, resulting in high mortality rates. Beyond the excruciating physical pain of being terminally ill, lung cancer patients are often troubled by the financial load that is placed on their family and to overcome the emotional pain in the acceptance of being terminally ill. The government of developed countries like Australia and Singapore have provided financial assistance, supporting their patients through their end of life journey in the form of drug subsidies and the provision of affordable quality palliative care. In Australia, although the Pharmaceutical Benefits Scheme (PBS) is effective in providing a list of affordable medicines, new specialised drugs take too long to be added into the list. However, it is ranked 2nd worldwide in providing affordable quality palliative care to its patient. In Singapore, its drug subsidies are only effective with other schemes in placed to provide patients with access to new affordable specialised drugs. Singapore is ranked 12th worldwide in the quality of death index, indicating more can be done to improve the quality of death of its patients.
4.2. Conclusion
The government of Australia and Singapore have a similar holistic approach that is effective in alleviating the quality of death of its lung cancer patients through a number of initiatives to reduce their financial concerns and providing quality palliative care, at the same time, these initiatives should be reviewed regularly to optimise the use of its resources and strive to provide its patients with new affordable specialised drugs and quality palliative care.
4.3. Future Recommendations
While waiting for the discovery of a cure or better alternate treatment, the government can focus on educating the community on lung cancer, encouraging the community to show support for lung cancer patients to improve their quality of death through the use of media, community outreach programs or volunteering in any hospices. Concurrently, the government should also place more emphasis in preventive measures, promoting regular body check-ups to prevent the late detection of lung cancer. Lung cancer has claimed thousands of lives without any discrimination, affecting both the patients and their loved ones. Improving the quality of deaths of lung cancer patients, medical research and increasing awareness in communities will give mankind a shot at winning the battle against lung cancer.