Local Voices: Discussing cancer in Hong Kong and Macao
An oncology resident at Prince of Wales Hospital, Dr David Johnson explains how doctors make decisions:
“As a health care provider, we are balancing the benefits and risks of our treatments. From clinical experience and research we know that some patients may be at risk of major complications and, in such cases, treatments such as surgery and chemotherapy may not be suitable for them. This does not mean that we have given up on the patient. It means that we have taken the patient’s quality of life as a higher priority.
“The patient should always weigh the pros and cons of each treatment [ie is it curative or palliative]. The benefits may not actually be that significant, and this should always been seen in the context of the known side effects [in case they could be life-threatening].”
Hong Kong’s public hospitals are often backed up with months-long waits for care. Clement Chan, chairman of the Cancer Patient Alliance and a leukaemia survivor, offers a solution:
“We believe there should be more cooperation between public and private providers. With incentives from the government, the private sector could offer a discount for initial tests to ease the burden on the healthcare system and ensure a quicker diagnosis.
“If private hospital doctors can run the preliminary tests first, public hospital doctors can provide a second opinion, then pick up the case. This way, you’ll have the scans and the diagnosis completed, and a doctor’s second opinion within 14 days.”
In 2018, the government announced plans to vaccinate 11- and 12-year-old girls against the Human Papillomavirus (HPV), the leading cause of cervical cancer. The Karen Leung Foundation, which raises awareness about gynaecological cancers, has identified gaps in the policy. Executive Director Katharina Reimer explains:
“What’s lacking is the coverage for the older girls … from 13 to 25. It’s also not [administered to] boys. There are now more and more studies showing that HPV causes a variety of male-dominated cancers, such as throat, oropharyngeal, anal and tongue cancers.
One of our doctors who works with the foundation always reminds us that people aren’t just having vaginal sex. There’s oral sex and anal sex to consider, too. Ultimately, 70 per cent of throat cancers and 90 per cent of anal cancers are HPV-related – both types of cancer are on the rise in both sexes.”
Harriet Stuart-Clarke, a general Practitioner at Central Health, shares advice on how to make life easier for cancer patients:
“It should be up to the person with cancer to decide how much or little they want friends, family and their work to know. Patients may feel that all they do is talk about cancer, so it may be a relief for them to talk about the latest TV programme, politics or even what nail colour they’ll choose at their next manicure. Just because they have been diagnosed with cancer, it doesn’t change who they are.
“It’s natural to want to help a friend or family member going through a tough time. It’s helpful to be aware that a person having cancer treatments may experience changes in their sense of taste and smell, and they may have a sore mouth or sensitive skin, so be mindful when you bring gifts or food. Practical help – like childcare during hospitals stays or meals – is also an effective way to show support. To coordinate efforts with a group, Meal Train (www.mealtrain.com) can help you to stay organised.”
Myths and Misconceptions
Dr Gregory Cheng, an oncologist at the Macau University of Science and Technology hospital, debunks
“The most common myth is that cancer cannot be cured. Nowadays, some cancers such as leukaemia and lymphoma are potentially curable, even in late stages. Another common misunderstanding is that chemotherapy is very bad for the body, making patients worse. Actually, chemotherapy is still very useful for certain types of cancer. The side effects, such as severe nausea, vomiting, and the risk of infection can be controlled nowadays.
“One other misconception is about pain medication. People tend to think they should avoid strong pain medications for fear of dependence or addictions. Some cancer patients will avoid taking any pain medication unless the pain becomes absolutely intolerable. At that stage, they would usually require high doses of very powerful medications to control the pain; whereas, smaller regular doses would provide better pain control.”
Macao resident Ricardo César de Sá, a caregiver for his mother with glioblastoma multiforme, shares his thoughts on what families should know during the treatment process:
“Families should educate themselves: What is the prognosis of the disease? What are the treatment options and side effects? Which innovative new treatments have shown promise? The patient and family should read up as much as they can to make an informed decision with their doctors. Get several second opinions and ask for the success rate of each potential treatment.
“Friends and family should know that the situation may or may not improve, and the current diagnosis might change in an instant. Cancer is a very unpredictable disease and, despite the best standard of care, it might not be curable. There are good days and bad days during treatment, and it’s no easy ride.”
Michelle Sio, 59, underwent a mastectomy and chemotherapy in 2014. That same year, she co-founded a cancer support group called Association of Happy Paradise. Sio is now cancer-free.
“It’s important to have a good start. First, you should consult at least two to three doctors to let more professionals analyse your disease. Sometimes, the doctors may talk you into doing surgery because they want more business, but other doctors may suggest a milder approach. Moreover, if a doctor is very negative about your situation, this may kill your will [to fight cancer]. That’s why you cannot just listen to one doctor.
“You should also bring your family members to the first consultation, because when you get too nervous, you may not be able to digest all the professional opinions. But at the end of the day, both the patients and their family members have to stay calm, so that they can learn and ask about everything they should know. Cancer can impact the whole family; if one person loses control, the whole family can be affected.”
Perspectives on Pain
Lei Kam Cheng was diagnosed with stage 4 breast cancer about six years ago. The doctor predicted that Cheng had around 2.5 years to live. She subsequently underwent chemotherapy, electrotherapy, and targeted therapy to suppress the disease. Today, she is in the first stage of recovery.
“When I was having chemotherapy, the doctor told me not to touch anything with a chemical composition because my body was full of ‘poisons’. I could not use detergents or shower gels with fragrances. I could not touch seafood, because if their shells cut my hands it could cause inflammation.
“To keep my spirits up, my doctor often told me not to treat myself like a cancer patient. I am 73 now. My body will decline inevitably, so I take [cancer] as a process of ageing. Of course there will be pain, but who hasn’t been through pain in life?”