Cancer Treatment in Singapore: Side Effects, Costs, Subsidies

In Singapore, there are about 235 cancer cases per 100,000 population – a rising statistic as compared to 1972, where cases were about 189 cases per 100,000 population. Thankfully, the increase in cancer cases over the years have been followed by advancements in medical technology and treatments for cancer. There is now a lower mortality rate (78 deaths per 100,000 population) as compared to data from 1972 (93 deaths per 100,000 population). Knowing that cancer can be better treated now is reassuring, but what are the treatment costs, side effects and other considerations? Read on to find out more.

How are the different stages of cancer diagnosed by a doctor?

What accompanies a cancer diagnosis is the stage of progression of the cancer. Cancer occurs when the body continues making cells in excess, and when old or abnormal cells do not die off as they should. These extra or abnormal cells overcrowd the normal cells in the body, impeding the body’s ability to function normally. Though there are many different types of cancers, doctors have common ways to mark the progression of cancer by using staging. Knowing what stage of cancer that someone is at is important for planning treatment. Moreover, it can inform the doctor of the severity of the cancer and likelihood of survival for the patient as well. 

To identify the stage of disease, the doctor may order x-rays, laboratory tests, and other tests or procedures. If the patient has had surgery for the cancer, the doctor may also examine the tumour specimen. The stage of cancer is first determined before any treatment is done. However, sometimes restaging of cancer is also done, when the cancer appears to have recurred or relapsed. This helps doctors to revisit and review the plans for treatment, and make changes if necessary. 

Most cancers can be broadly classified into five stages, depending on the severity of the spread of cancer: 

• Stage 0 – Cancer that has not yet become invasive (i.e. carcinoma-in-situ). Patients at this stage have good prognosis, and can often be cured with just surgery alone.
• Stage 1 – Usually a small tumour that is growing only at a single area 
• Stage 2 – Usually a bigger tumour at a single area, sometimes with involvement of nearby lymph nodes
• Stage 3 – A much larger tumour with more extensive involvement of either the adjacent tissue or lymph nodes, but is still confined to a single area and has not spread to other parts of the body
• Stage 4 – Cancer that has spread to distant parts of the body

How is cancer treated?

Some of the common approaches to treat cancer include surgery, chemotherapy, immunotherapy, and radiation therapy. Some people with cancer will have only one treatment, but most people have a combination of treatments, such as surgery with chemotherapy and radiation therapy. Below are some of the common treatment options for cancer: 

Chemotherapy

Chemotherapy is a type of cancer treatment that uses drugs to kill cancer cells. It works against cancer by stopping or slowing the growth of cancer cells.

Surgery

When used to treat cancer, surgery is a procedure in which a surgeon removes cancer cells from the body.

Radiation therapy

Radiation therapy uses high doses of radiation to kill cancer cells and shrink tumours.

Immunotherapy

Immunotherapy helps your immune system fight cancer by aiding the immune system in better acting against the cancer. It is a type of biological therapy, which refers to treatment that uses substances made from living organisms to treat cancer.  

Stem cell transplant

Stem cell transplants help to restore stem cells in people who have had their stem cells destroyed by high doses of chemotherapy or radiation therapy. These stem cells eventually grow into healthy blood cells. 

Hormone therapy

Hormone therapy is a treatment that slows or stops the growth of some cancers which propagate by using hormones in the body, such as breast or prostate cancers. 

Photodynamic therapy

Photodynamic therapy uses a drug that is activated by light to kill cancer cells.

The choice of treatment may depend on the careful consideration of various factors which have the potential to affect treatment. Some factors are:

Type of cancer

Each type of cancer has different characteristics, which would imply they require different treatment options. For example, hormone therapy may be selected in the case of breast cancer, due to the nature of hormone involvement in the growth of the cancer. 

Goal of treatment

Is the goal to abolish cancer completely? Or is the goal to keep the cancer under watchful control? Maybe the goal of treatment is to prioritise the patient’s comfort and ease the pain of treatment. The goal of treatment will help to inform the type of treatment to be undertaken.

Personal factors

In considering treatment, how and where the patient is at the point of treatment can affect the type of treatment selected. Some of these include the patient’s age, risk tolerance for treatment, existing medical conditions like diabetes or other health issues, life circumstances, values and beliefs.

Environmental factors

Are there existing family members who can care for the patient while he or she undergoes treatment? Is the patient presently being employed? These factors can affect treatment decisions as well.

What are the side effects of cancer treatment?

As treatment is individual to each patient, side effects can vary from person to person. Generally, the more intensive the treatment, the more side effects there may be for the patient. The most common side effects of treatment, and their treatment options, include: 

Pain

‘Pain’ refers to a broad category of symptoms, and is an underlying commonality amongst all cancers and cancer treatments. Pain can take a toll on a patient’s quality of life, making sleeping, eating, and going out with loved ones a challenge. It is important to know that the patient does not have to live with pain – there are options to reduce pain with various therapies and medications.

• Treatment options: Pain medication and other therapies like acupuncture, massage therapy, and physiotherapy can be taken.

Nausea and vomiting

Nausea and vomiting are usually linked to Immunotherapy, radiation therapy to the abdomen, and chemotherapy treatments. It can cause weight changes, dehydration, and malnutrition, which can worsen the overall symptoms of the side effects

• Treatment options: Nausea and vomiting can be treated with anti-nausea medication through various means which can be discussed with the medical provider. If there are additional weight concerns after this means of intervention, a dietician could be called in to help with weight management.  

Fatigue

Commonly tied with chemotherapy, cancer-related fatigue (CRF) is a severe form of fatigue accompanied with overwhelming tiredness, exhaustion, and weakness that does not improve with sleep and rest. A common symptom of cancer treatment, fatigue can be debilitating to the individual experiencing it. 

• Treatment options: If the fatigue severely interferes with the patient’s ability to carry out daily activities, treatment options could be discussed with the doctor in charge to see if it can be alleviated. 

Anaemia

Red blood cells in the body assist to carry and circulate oxygen throughout the body. Anaemia occurs when there is insufficient red blood cells to carry oxygen throughout the body. This can cause dizziness, weakness, faintness, and a racing sensation in the heart. Anaemia is thought to be caused by chemotherapy, radiation therapy, and some immunotherapies. 

• Treatment options: These normally include blood transfusions, or taking certain medications. Careful monitoring of blood is required as well.

Problems with the mouth

Anticancer drugs and radiation to the head and neck can cause damage to salivary glands and tissues in the mouth, throat, and lips. These can result in difficulties swallowing, changes in taste, dry mouth, infections in the mouth, mouth sores, tooth decay and sensitivity to hot and cold food.

• Treatment options: Good oral hygiene should help to reduce mouth problems as a side effect of cancer treatment. If mouth problems occur due to infection, these can be treated with medication. Nutritionists and speech therapists can help with swallowing strategies, and ensuring adequate nutrients can be taken in for recovery.

Hair, skin, and nail problems

Radiation and chemotherapy can bring about hair loss on the head and other parts of the body, if targeted for treatment. Skin-related side effects of treatments for cancer include dryness, itchiness, redness, and swelling. Nails may also darken or turn yellow, or crack even. 

• Treatment options: Hair loss usually recovers naturally, as regrowth of hair can begin while the treatment is still happening. One can expect for hair loss to be at its worst over the first two months of treatment. Simple beauty techniques on skin care, makeup, and nail care can help with these problems. When more care is needed, an onco-dermatologist can help prescribe medications to help manage dermatitis (skin irritation), sores, and nail changes to help you continue with your cancer treatment.

What are the costs of cancer treatment in Singapore?

The costs of cancer treatment vary from patient to patient, as it depends on the types of treatment and tests done to treat the cancer. There are factors which affect the cost of cancer treatment: 

• Stage of cancer: Later stages of cancer usually come with a higher cost of treatment, as a more aggressive approach or alternative treatment methods might be needed. 

• Potential for complications: If the cancer is at a location in the body which poses an elevated risk for complications, treatment will be more costly as well. 

• Preference for hospital and ward type: Some patients may want to choose a particular doctor, and also may opt for a more comfortable ward. This affects costs of treatment.

• Treatments needed: The earlier cancer is detected, the greater the possibility that less treatment is required, hence making treatment more affordable. 

There are various treatment options which the doctor may suggest to the patient. Here are some of the therapies which may be recommended, and their costs: 

Biopsies

During a biopsy, a small tissue sample is taken from the patient’s body for further examination to investigate the cancer. The average cost of a biopsy for the most common types of cancers is S$1,044 in public and subsidised hospital wards and clinics. At private hospitals and clinics, you can expect to pay S$5,833 for a biopsy in private hospitals and clinics. Private hospital biopsies typically cost about two to five times more than subsidised public hospital biopsies. 

Surgery

The average cost of surgery for the five most common cancers ranges between S$2,810 in a public subsidised ward. In a private hospital, the costs of surgery can go up to S$18,525 to S$32,663.

Chemotherapy

The average cost of chemotherapy in Singapore is around S$1,500 per cycle. The cost per year depends on how many cycles and how frequent chemotherapy is. 

Radiation Therapy

The average cost of radiation therapy in Singapore is approximately S$25,000 to S$30,000. The total cost of radiation therapy also depends on the number of sessions required. 

Immunotherapy

Immunotherapy drugs cost an average of S$9,000 per dose. One dose is administered every two to three weeks, and the average cost for a year’s worth of treatment ranges between S$156,000 and S$234,000.

Also, if arrangements need to be made to care for the patient, there are the extra costs of hiring help, be it a helper or caregiver. 

Generally, the average cost of later-stage cancer treatment in a year can add up to $100,000 to $200,000 per year. 

How can you reduce the cost of your cancer treatment?

Financial help to alleviate the burden of cancer treatment costs is available. Here are some of the following options: 

Medisave: 

• Medisave can be used for inpatient and outpatient treatment, which chemotherapy and radiation therapy fall under. 
• MediShield Life, which is Singapore’s health insurance scheme, can also help offset some of the costs. S$3,000 of coverage for chemotherapy treatment and between S$140 and S$1,800 of coverage per session of radiotherapy treatment is covered by MediShield Life.  It also offers between S$200 and S$2,000 for surgical procedures. 

Insurance: 

Integrated Shield Plan

If there is an Integrated Shield Plan (IP) tagged to the MediShield account, there is higher coverage for costs. The IP will cover your hospital stay, pre-hospital and post-hospital treatments and most types of cancer treatment up to 95% of the cost of your bill. It is important to note that if the patient already has cancer, it will be difficult to obtain insurance. 

Critical Illness Plans

A critical illness plan can be considered, whereby this type of insurance provides a lump sum payment upon a cancer diagnosis. This sum can be used however the individual wants to, be it to pay for bills not covered by insurance or daily living expenses. Similar to IP plans, it is much more beneficial for you to get the plan while you are still healthy.

Government and other financial assistance: 

Medifund

MediFund helps patients who face difficulties paying a bill even after receiving a government subsidy and using their insurance. Patients can submit their applications and the amount of aid given will be considered and approved on a case-by-case basis.

Medication Assistance Fund

For the Medication Assistance Fund, eligible Singaporeans can receive further subsidies for expensive drugs that are not in the Standard Drug List but have been accessed to medically require it.

Other organisations

Some organisations like the Singapore Cancer Society offer financial assistance as well.

Considering packages with care providers could also be a way to cut costs off your cancer bill as well. 

After the cancer treatment

With successful treatment of cancers, doctors also recommend changes in lifestyle habits for the patient, to aid in maximising the period of remission long-term for the patient. Lifestyle changes doctors may suggest would be:

Adopting a healthy diet

A healthy diet can help to manage the side effects of cancer, recover quicker, and improve health. It could also reduce the future risk of cancer. Some general healthy habits include eating more fruits and vegetables, reducing the amount of simple sugars and alcohol from the individual’s diet, and having lean meats. 

Exercising regularly

Exercise can be as simple as taking a walk in the day, and is important during and after cancer treatment. This can help reduce fatigue, weight gain, and loss of strength. 

Finding emotional and social support

Having a network of supportive people can help with emotional coping and stress reduction, which are typically what cancer survivors or patients require most. Studies have compared people with cancer who had the most and least social support and found that those with the most social support had better quality of life and lived longer.

Getting enough sleep

The ideal amount of sleep for adults is seven to eight hours of sleep each night. This improves health, coping ability, mood, weight control, memory and attention, and more.

Key Takeaways

Taking care of a loved one with cancer can be an overwhelming process. If you are struggling to look after your loved one while juggling your other roles, Homage can help to alleviate your caregiving worries. Our trained care professionals are able to provide companionship, nursing care, night caregiving, home therapy and more, to keep your loved one active and engaged. 

Provide the best care to your loved one today! Fill up the form below for a free consultation with our Care Advisory team.