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Geriatric Oncology: Multidisciplinary Approach in a Global Environment

Current Status in China

Dr. Janice Tsang

MBBS, MRCP(UK), FRCP(Lond.), FRCP (Edin.), FHKCP, FHKAM(Medicine)

Specialist in Medical Oncology

Hon. Clinical Assistant Professor

Li Ka Shing Faculty of Medicine, The University of Hong Kong

Founding Convenor

Hong Kong Breast Oncology Group

Hon. Secretary

Hong Kong Cancer Therapy Society

18th November, 2016

Disclosure.

Consultant or Advisory Role:

AstraZeneca, Aptus, Eisai, GlaxoSmithKline,

Foundation Medicine, Novartis & Pfizer

Geriatric Oncology - Unique Environment in China

• From population perspective

• From cultural perspective

• From health care system perspective

• From patient and family perspective

Geriatric Oncology - Unique Environment in China

• From population perspective

• From cultural perspective

• From health care system perspective

• From patient and family perspective

Massive population: 1.38 billion

Cancer – leading cause of death

Major public health problem

An estimated 4292,000 new

cancer cases and 2814,000

cancer deaths would occur in

China in 2015

Cancer in China

Geriatric Oncology - Population Perspective

• Urban vs Rural Areas

– Lung, CRC and Breast vs Lung, Stomach, Esophagus

• Different ethnic groups

– Stomach cancer in N. Chinese vs NPC in S. Chinese

• Liver cancer (HBV-related HCC) and NPC

• National Central Cancer Registry– Made up from different local registries

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Cancer statistics in China, 2015

CA: A Cancer Journal for Clinicians

Volume 66, Issue 2, pages 115-132, 25 JAN 2016 DOI: 10.3322/caac.21338

http://onlinelibrary.wiley.com/doi/10.3322/caac.21338/full#caac21338-fig-0001

Maps of the 2 Sets of Contributing Cancer

Registries and Geographic Regions in

China.

Dots indicate the locations of the cancer

registries.

(A) This is a map for 22 cancer registries

(data from 2000 to 2011).

(B) This is a map for 72 cancer registries

(data from 2009 to 2011).

Previous national incidence and

mortality estimates have been

limited to small samples of the

population using data from the

1990s or based on a specific year.

With high-quality data from an

additional number of population-

based registries now available

through the National Central

Cancer Registry of China.

Data from 72 local, population-

based cancer registries (2009-2011),

representing 6.5% of the

population, to estimate the

number of new cases and cancer

deaths for 2015.

Data from 22 registries were used

for trend analyses (2000-2011). CA CANCER J CLIN 2016;

66:115–132

Estimated New Cancer Incidence & Deaths (Thousands)

For Selected Cancer by Age groups, China 2015

Male >=60:

1. Stomch

2. Lung

3. Esophagus

4. Liver

5. CRC

Female >=60:

1. Lung

2. Stomach

3. CRC

4. Breast

5. Cervix

9

Macau Cancer Registry….2003-2007 only…

Geriatric Oncology - Unique Environment in China

• From population perspective

• From cultural perspective

• From health care system perspective

• From patient and family perspective

Geriatric Oncology - Cultural Perspective

• The family as a basic unit for the Chinese community

• Family decision on MDT management

• Cancer still a “taboo” in the Chinese culture

• Elderly tend to delay their presentation to medical consultation

• Obligations in the family

– Home maker, attended wedding of children or grannies

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Geriatric Oncology - Unique Environment in China

• From population perspective

• From cultural perspective

• From health care system perspective

• From patient and family perspective

Multidisciplinary Team Cancer Care (MDT Model)…

OR

Public/Private Public/Private Public/Private/Medical Insurance

Self-financed items Anti-cancer drugs mostly supported by Govt Red Packets / Biosimilar

For most cancers, but not GO

Geriatric Oncology – Healthcare System Perspective

• China – Geographic Difference

– Urban vs Rural Area – differential access to cancer diagnosis and treatment

– Different systems among mainland, Hong Kong SAR and Macau SAR

• China FDA (or State FDA – SFDA, CFDA)

– Lack of access to FDA & EMA approved drugs

– Lag time of 4-5 years at least (lag time of 2-3 years in Hong Kong)

• Matching Science with affordability

– HKSAR – self-financed items (SFI)

– Macau – supported by government

– Mainland – red packets vs generic drugs vs modified molecules

• Intravenous fluid vs “immunotherapy”

Geriatric Oncology - Unique Environment in China

• From population perspective

• From cultural perspective

• From health care system perspective

• From patient and family perspective

Geriatric Oncology – Patient & Family’s Perspective

• Taboo to the senior elderly patients

• Worried of negative effect or emotions to the patient

• Patient perceives as “death sentences” and taking “age” as a factor to deter intensity of cancer treatment

• Patient worried about side effects of treatment, esp medical treatment s.a. chemotherapy, targeted therapy, immunotherapy or surgery or RT

• Patient perceives himself/herself as a physical burden and financial burden to the family

• Family sharing same internal feelings and misconceptions/perceptions

• Patient’s autonomy and patient’s right sometimes compromised

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Possible Solutions to Overcome the Unmet Needs & Challenges of

Multidisciplinary Team Cancer Care (MDT Model) in Chinese

Elderly Cancer Patients

Medical

OncologistsSupporting

Staff

Surgeons

Pathologists

Nurse

Specialists

Clinical

Psychologists

Medical

Social Workers

Physiotherapists

Occupational

Therapists

Dietitians

Clinical

Oncologists

Population Perspective

-Public Health Policy

-Early detection

-Prioritize clinical research and

resources priorities

-Environmental protection

Cultural Perspective

-Public Health Education

-Exchange with regional and global

KOLs

-International, regional and local consensus

-Self-help groups and support groups

Healthcare System Perspective

-Public health education & public policy

-Health reform

- Cancer Hospital/Cancer Centre

- CFDA accredited centres in HK

- Leadership and Exchange

Patient & Family Perspective

-Distress – 6th vital signs (IPOS)

-Identify psychosocial unmet needs

-Patient factors

-Biological factors (molecular

genomic profiling)

-Family dynamics and support

Acknowledgements

The University of Hong Kong

The Hong Kong Cancer Therapy Society

The Hong Kong Breast Oncology Group (HKBOG)

The Hong Kong Breast Cancer Foundation

All the breast and non-breast elderly patients and collaborators

Geriatric Oncology: Multidisciplinary Approach in a Global Environment

Current Status in China

Dr. Janice Tsang

MBBS, MRCP(UK), FRCP(Lond.), FRCP (Edin.), FHKCP, FHKAM(Medicine)

Specialist in Medical Oncology

Hon. Clinical Assistant Professor

Li Ka Shing Faculty of Medicine, The University of Hong Kong

Founding Convenor

Hong Kong Breast Oncology Group

Hon. Secretary

Hong Kong Cancer Therapy Society

18th November, 2016