Disease Burden and Screening Policy for CRC in Vietnam

Vo V.Thang1,2., Le D.Duong1,2,  Nguyen TK Cuong, Nguyen Xuan Chi3, Nguyen Minh Quan3    

1 Institute for Community Health Research, Hue University of Medicine and Pharmacy, Vietnam.2 Faculty of Public Health, Hue University of Medicine and Pharmacy, Vietnam.3 Thu Duc Hospital, Ho Chi Minh city, Vietnam

ABSTRACT

Colorectal cancer (CRC) was currently considered as the fourth leading cause of cancer worldwide. In Asia, the incidence and mortality of CRC have been increasing and becoming a big concern of healthcare policy at national level.

Cancer was predicted to be the leading disease burden in Vietnam in the next decades. The 5-year prevalence of CRC is 27.3 per 100,000, also is the fifth common cause of cancer – related incidence. CRC account for approximately 9% of all new cancer cases in both sexes as well as the second most common cancer in female and the fourth most common cancer in male (IACR, 2018). Regarding newly diagnosed patients, there was 67.8% CRC that presented with stages III and IV at diagnosis (Bui Dieu et al 2015). Therefore, Vietnam has been ranked in the list of countries with the highest rate of cancer fatalities (WHO, 2016).

The economic burden of CRC of the whole society was estimated about 14,268.3 billion VND. The values fluctuated sharply from stage I to stage IV, accounted for 6.9 billion VND; 5,731.2 billion VND; 3,564.5 billion VND and 4,965.7 billion VND, respectively. Majority of CRC patients were not affordable to pursue their treatment because of health insurance was not coverable enough to pay for all treatment costs, especially targeted drugs and high –tech equipment and other indirect costs. It was nationally reported that in all stages except stage I, the economic burden related to patient care was higher than that of medical services (Phan T. 2015). This problem led to quite high rates of treatment abandonment that resulted in seeking alternative or traditional treatments or patients not being admitted to hospital for treatment until the cancer was so late that they could only receive palliative care (T. V. Thuan et al 2018).

The National Cancer Control Plan (NCCP) was firstly started in 2008 and continued to implement in a new period (2015-2025) in efforts to provide effective diagnosis and treatment. However, there was no comprehensive programme for CRC screening and early detection cover nationwide and also lacking hospital specialized and palliative care in oncology. In additional, other challenges were still limited in policy development, resources and partnership development for CRC control at national and international level.

It’s very necessary to intensify evidence based planning and management of CRC early diagnosis and treatment (SBIRT approach). CRC screening, capacity building of health personnel and improved monitoring and CRC registry should be paid more attention at NCCP’s direction in Vietnam. A pilot community based CRC cohort study will be feasible for conducting in either the central or southern Vietnam.

Key words: Colorectal cancer (CRC), International Agency for Research on Cancer (IACR), National Cancer Control Plan (NCCP), Disease burden, Screening.