The world marked World Cancer Day this month, on Feb 4. In Malaysia, the fight against the disease is still an uphill climb due to a lack of oncologists and other professionals as well as low health literacy among the rakyat.
IN the war against cancer, Malaysia is in urgent need of more “soldiers”.
Specifically, we need more oncologists, radiotherapists and other medical professionals to treat patients.
Currently, there are 110 oncologists in the Government and private sector nationwide. This number falls short of the recommended ratio of such specialist doctors to serve to the Malaysian population, which is expected to be an ageing society by 2035.
To reach that ratio, the number of oncologists needs to be at least doubled to 240.
As oncologists are the main doctors in treating cancer, Malaysian Oncological Society president Dr Matin Mellor Abdullah says an ideal ratio is eight to 10 of such specialists per one million citizens.
But with only 110 oncologists, this means the current ratio is only about four doctors to one million Malaysians.
“As of Jan 1 last year, the Malaysian population stood at 31 million. This means we will need to have between 240 and 300 oncologists,” he tells Sunday Star.
Previously, former Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin had said that Malaysia needs at least 280 oncologists if we are to follow a recommendation by Australian authorities to have 10 oncologists per one million people in 2010.
But it is still a long way to go compared to other countries, such as Britain, which recorded a ratio of 39 oncologists per one million inhabitants in 2014.
The lack of medical professionals involved in cancer treatment will be addressed in the Health Ministry’s updated cancer control plan, which is currently still being finalised.
In the mean time, though, the ministry is already taking measures to build capacity by increasing scholarships for students to take up oncology and by facilitating training programmes.
But the fight against cancer is also dependent on Malaysians themselves, who must realise that preventing cancer and other diseases lies in their own hands.
However, only a mere 6.6% of Malaysian adults aged 18 and above had adequate health literacy, or knowledge in maintaining good health, based on the Health Ministry’s National Health and Morbidity Survey in 2015.
And when it comes to cancer, more Malaysians need to realise that early diagnosis and detection can increase chances of survival and recovery.
With one in three cases of cancers being preventable, the ministry is also hoping Malaysians will choose healthier lifestyle options to strengthen their defence against the disease.
This is imperative because without any concrete action, the number of new cancer cases in Malaysia is expected to shoot up by 54% from 37,000 in 2012 to 56,932 in 2025, based on previous projections from Globocan, a cancer agency with the World Health Organisation.
Calling it a worrying and ongoing problem, Dr Matin, a consultant clinical oncologist and radiotherapist, acknowledges that training places are limited locally and even overseas.
“We have to look at various measures to improve the numbers of oncologists including inviting Malaysian oncologists overseas to come back to work in the country,” he says.
The quality of cancer treatment also varies, to some extent, depending on location, he points out.
“Oncologists are mostly located in the West Coast of Peninsular Malaysia and in Kuching and Kota Kinabalu. Therefore, it is possible that patients outside these areas may not be able to access treatment in a timely fashion,” Dr Matin says.
Oncology, he points out, is also “not a preferred specialty” as some say it can be a “depressing” field, especially if their patients are diagnosed with the disease in late stages.
To boost numbers of specialists in this area, Dr Matin says more effort needs to be taken to highlight the shortfall, seeing that cancer is a major cause of morbidity and mortality, and more specialists are needed to help tackle the problem.
“More promotional incentives and more senior positions should also be created for this field,” he suggests.
Describing the lack of oncologists as a huge burden for the country, Malaysian Medical Association president Dr John Chew says such doctors and supporting professionals are especially important with cancer becoming more prevalent with an ageing population.
“We do not have a social support network to look after this increased burden. Sure, we need to train more oncologists but this also means that more resources are needed.
“This includes setting up more centres and bigger budgets for chemotherapy, immunotherapy and diagnostics,” he says.
Dr Chew agrees that the most affordable and cost-effective strategy in combating cancer is prevention and using proven population screening to nip the disease in the bud.
“More effort to get smokers to quit should be taken. People should also be encouraged to screen regularly for cervical, breast and colon cancer,” he suggests.
As lifestyle choices also play a part, Dr Chew also urges Malaysians to eat a healthy, more plant-based diet, take up daily exercise, and maintain an ideal weight.
While noting that being an oncologist can be very demanding, National Cancer Society Malaysia president Dr Saunthari Somasundaram argues that the profession can be rewarding too.
“Some people find it depressing and it is not a field that they want to venture into.
“Cancer treatment can be a long term process. It isn’t just about treating the patients in a medical sense but also managing the families because it impacts them too,” she points out.
It becomes depressing in cases where patients are diagnosed in the late stages, but if they had come forward earlier, they could have been saved.
However, in advanced countries, the survival rate is high, at around 70% to 80%, thanks to increased awareness and strong support systems in place.
“Across all cancers, three out of five patients continue to live. So it isn’t all depressing and can be rewarding.
“But to make it even more rewarding, we have to spend more resources, time and effort in promoting prevention and early detection,” Dr Saunthari says.
Well aware of the situation, Health Ministry deputy director-general Datuk Dr Jeyaindran Sinnadurai says he won’t deny that Malaysia needs more oncologists, radiotherapists and palliative care doctors.
He reveals that the national plan to address cancer in the country is in its final stages of being drafted.
“The task force in charge of coming up with the plan has to present it to the director-general and minister once it is finalised for their endorsement before it can be rolled out,” Dr Jeyaindran explains.
He says the plan will include working towards increasing the number of medical professionals involved in the treatment of cancer, of which the country is wanting.
“We will build capacity to provide more oncologists, radiotherapists, palliative care doctors and support staff to be able to deliver care for cancer patients in a comprehensive and holistic manner,” he says.
Dr Jeyaindran points out that the ministry has already taken action in the battle against cancer by other means, including providing female Form One students with human papilloma virus (HPV) vaccines that protects against cervical cancer since 2010.
“The effects of such actions on cancer cases will only be seen in 15 to 20 years,” he says, adding that the ministry has also combined radiotherapy with traditional Chinese medicine to provide holistic treatment.
While the ministry has started promoting oncology by offering more scholarships in the field, it is also enabling an easier entry for aspiring doctors to get into training programmes and cutting the waiting time in securing places.
Also, the ministry’s proposed plan to have a cancer centre in every state hospital within the next five to 10 years is still on the cards, says Dr Jeyaindran.
“We want to deliver more accessible treatment to cancer patients. For now, we are looking at expanding services on the East Coast, the northern part of Peninsular Malaysia and in Kuching,” he says, adding that such locations are seeing an increase in patients and are of immediate concern.
However, Dr Jeyaindran says the setting up of cancer centres is still subject to the availability of funds.
At present, he says the ministry is doing its best with existing resources to deliver quality cancer care to people despite limitations.
“Medical professionals work as a team. These days, physicians also work together with oncologists and can dispense oral therapy in cancer treatment,” he says.
At any one time, it is estimated that there are about 90,000 to 100,000 people in Malaysia who are battling cancer.
Previous reports have said that a new national cancer control plan will be implemented to cover the period of between 2016 and 2020.
The new blueprint will be an update of the previous plan and will cover aspects such as prevention, screening, early detection, diagnosis, and treatment.
Health director-general Datuk Dr Noor Hisham Abdullah has said the plan would be implemented according to the Government’s capacity as there were only five government-owned cancer centres; they are in Johor, Kuala Lumpur, Putrajaya, Sabah, and Sarawak.
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