Cancer-free. It’s what every cancer patient yearns to hear after undergoing physically- and emotionally-draining treatments, however, the dreaded “C” isn’t always a one-time event.
Notable personalities have fallen victim to recurring and multiple brushes with the illness. The Greatest Showmanstar Hugh Jackman had skin cancer cut from his face for the sixth time in two years in February 2017. In the same year, singer Olivia Newton John revealed that her breast cancer had returned and spread to her back after being in remission for 25 years. And closer home, Prime Minister Lee Hsien Loong was diagnosed with malignant lymphoma in 1992 at the age of 40 and cleared of the cancer the following year but in 2015, doctors found he had prostate cancer.
Cancer is Singapore’s top cause of mortality, and perhaps more worrying, experts warn that about one in 10 people will get separate cancers in their lifetime1. Another leading cause of death here, heart disorders are increasingly known to strike again, too. According to Dr Peter Yan of Peter Yan Cardiology Clinic, about 18% of males and 35% of females will have a second heart attack in the next five years. “However, this figure may vary depending on the state-of-art treatment during and after a heart attack, the management of risk factors and optimisation of medical therapy for heart attack victims,” he notes.
1 When two or more cancers strike, Today Online, 2 Nov 2016
2 Singapore Cancer Registry Annual Registry Report 2015 National Registry of Diseases Office (NRDO)
3 Source: Monograph on Cancer Survival in Singapore 1973-2012, Singapore Cancer Registry, National Registry of Diseases Office, Ministry of Health, Singapore
- Cardiovascular Heart Disease Source: Dr Peter Yan of Peter Yan Cardiology Clinic
Why critical illnesses keep coming back
- Higher life expectancy and rapidly ageing population: Singaporeans’ life expectancy of 83.1 years partly accounts for the rise in critical illnesses such as cancer and heart disease, which tend to affect the elderly. Coupled with the fact that these illnesses are increasingly known to strike even younger individuals below 40 years, the possibility of recurring or multiple critical illnesses in one’s lifetime is very real — and a growing one.
- Higher survival rate: Advancements in invasive treatments as well as new drugs that help patients cope with symptoms better, lower their blood pressure or slow the heart rate, mean that patients with heart disease can have longer lives than before. Likewise with cancer, it has been observed that early screening and detection, advances in medical technology and improved cancer care will continue to increase survival rates. However, this presents more years in which a subsequent critical illness can strike.
- Compromised health: “Having damaged heart muscles, survivors of heart attack and stroke are at substantial risk of a subsequent heart attack, heart failure, stroke or sudden death,” says Dr Yan.
- Lifestyle habits, genetic defects and infections: Dr Akhil Chopra of OncoCare Cancer Centre says, “Smoking or excessive alcohol consumption, genetic susceptibility if cancer is related to inheritance of certain defective genes, environmental and occupational exposures, as well as certain infections like human immunodeficiency virus (HIV) and human papilloma virus (HPV) can all affect a survivor’s risk of a second cancer.”
- Severity of illness: Certain types of cancers or original tumours that are large can be more aggressive than others. Even after remaining free of recurrence for the first five years, there is a risk of the cancer recurring elsewhere from years five to 20. “Aggressive cancers such as triple negative breast cancer commonly recur within first five years, whereas some other cancers such as Estrogen receptor (ER) positive breast cancer can come back even 10 years later,” says Dr Chopra.
- Toxicity of treatments: Ironically, treatments such as chemotherapy and radiotherapy have a toxic effect that take a toll on the bodies of cancer survivors, making them more vulnerable to subsequent cancers. “This is especially true for young patients cured of aggressive cancers such as acute leukaemia, lymphoma and breast cancer. Some chemotherapy drugs can increase risk of blood cancers such as acute leukaemia within two to five years following treatment. Radiotherapy-induced secondary cancers are typically seen later, at least five to 10 years post-treatment,” Dr Chopra says. However, the overall risk is low and has been further reducing with improved anti-cancer therapies.
Coping with recurrent critical illness
While survivors should certainly celebrate being liberated from the grips of critical illness, they shouldn’t let their guard down. Here’s how to keep illness from striking again, and continue to live a fairly long life:
- Maintain a healthy lifestyle: Even after being given the all-clear, continue to eat sensibly by reducing intake of high saturated and transfat and increasing intake of fruits and vegetables; exercise regularly and maintain a healthy weight; limit alcohol intake; and stop smoking. Obesity has been associated with breast cancers of worse prognosis that are less sensitive to treatment.
- Keep cholesterol levels, blood pressure and diabetes mellitus under control: Keeping your health in check brings down your overall risk of disease. According to Dr Yan, diabetes mellitus is one of the highest single cardiovascular risk factor. “The overall lifetime risk at age 40 and surviving to age 70 of having a heart attack is 50% in males and about 33% in females. However, if an individual at age 50 has diabetes mellitus, surviving through 85 years old, the lifetime risk of a heart attack is 67% for males and 57% for females.”
- Re-examine your life and manage stress: Stay positive and re-evaluate your priorities including the importance of family and work. Individuals living in a pressure-cooker environment can look for stress management techniques that work for them or talk to someone they trust.
- Attend medical check-ups regularly: Three- to four-monthly visits are the norm for a few years up to five years or until the heart patient’s health stabilises. Dr Yan says, “Heart patients should see their heart specialist or neurologist regularly and have their blood biochemistry checked to ensure all coronary risk factors are appropriately controlled.” Continuing to see your doctor even past the five-year illness-free mark is a well-established way to facilitate detection of a new coronary risk factor or cancer early, while it’s still curable.
- Take appropriate medication: According to Dr Yan, long-term evidence-based medications such as anti-platelet therapy, statins, beta-blockers and ACE-inhibitors are known to prevent recurrent heart attack and stroke. Continuing medication indefinitely can help control the patient’s heart disease, provided this is in accordance with your doctor’s advice. There may be side effects, which the doctor can monitor during check-ups.
Meanwhile, Dr Chopra notes that recent studies have shown that extending hormonal therapy for ER positive high-risk breast cancer from five to 10 years, improves outcomes. However, the doctor will have to determine if any treatment should be extended in order to further suppress recurrence and mortality, as all anti-cancer treatments are associated with toxicities.
The implications of recurring critical illness
Individuals will not only have to work harder to protect their health and reduce their risk of critical illness while they’re young, but also be financially ready should the unfortunate happen to them. Aside from the costs of expensive screening tests, treatments, surgery, emergency care, hospitalisation and follow-ups, they’ll have to look into care-giving needs if they’re unable to carry out daily living activities on their own.
Having a sound financial plan in place will help manage these costs. Should there be a need to take an extended work break, there’s also no need to worry about being unable to live comfortably or provide for their dependants. In other words, they can focus on making a complete recovery.
A critical illness plan gives a lump sum payout upon diagnosis of a life-threatening illness such as cancer or heart disease. You are free to use the money as you wish, be it to cover the cost of surgery, or to continue paying the bills while you take a break from work to focus on recovery.
While many plans give a one-time payout for diagnosis of critical illness, Aviva’s My MultiPay Critical Illness Plan gives multiple payouts for different severities of critical illnesses and when specified critical illnesses recur, up to a total of 900%* of the Sum Assured. Premiums are waived when 300% of the Sum Assured or more is paid out for critical illnesses, so individuals don’t have to think about additional costs while they are on the road to recovery.
*Policy terms and conditions apply. Please refer to Product Brochure for more details
Updated on: November 2020