“Hospitals are expanding radiotherapy services and actively seeking staff, yet too few young Malaysians are entering the profession and some of the country’s best graduates are being recruited overseas.”
EVERY DAY, approximately 110 Malaysians are diagnosed with cancer.
Figures highlighted by the National Cancer Institute show that 40,198 new cancer cases were recorded in 2024. Cancer was also Malaysia’s third leading cause of death that year, claiming 19,180 lives. Behind these numbers are thousands of patients who will require surgery, chemotherapy, radiotherapy or a combination of treatments. According to the World Health Organization and International Atomic Energy Agency, more than half of all cancer patients require radiotherapy at some point during their care.
That potentially translates into tens of thousands of Malaysian patients requiring radiotherapy each year. Yet one of the most important professions delivering this treatment remains largely invisible: the radiation therapy technologist, also known as the radiation therapist or therapeutic radiographer.
Radiation therapists are not ordinary X-ray technicians. They are specialised allied health professionals who operate sophisticated treatment equipment, position patients accurately, verify treatment fields and deliver prescribed radiation doses. They also monitor patients, maintain safety standards and work closely with clinical oncologists, medical physicists and nurses. A small error in positioning or treatment delivery can have serious consequences. The profession therefore demands scientific knowledge, technical precision, compassion and a strong safety culture.
Despite that responsibility, Malaysian hospitals are struggling to recruit enough qualified radiation therapists. A vacancy snapshot shared through the Malaysian RTT leaders’ network recently identified at least 26 vacancies across 15 hospitals and cancer centres. This was not a formal national census. It was simply a real-time professional network update. Therefore, 26 should be regarded as the minimum number of known vacancies at that moment, rather than the complete national figure. Several employers were specifically looking for diploma holders, junior staff or fresh graduates. This demonstrates that the shortage is not limited to highly experienced specialists. Hospitals are waiting for new entrants as well.
Meanwhile, Malaysia’s radiotherapy infrastructure has been expanding.
In the late 1990s, Malaysia had approximately 17 radiotherapy centres. A national accessibility study found that by February 2019, the country had 30 centres operating 58 megavoltage treatment machines. More recent studies and equipment inventories report between 35 and 41 centres, depending on whether specialised, brachytherapy-only and other facilities are included. Although the definitions vary, the overall direction is unmistakable: Malaysia’s radiotherapy network has roughly doubled since the late 1990s.
However, growth has not been distributed equally. The 2019 study found that approximately one-quarter of Malaysians had to travel more than 100km to reach the nearest radiotherapy facility. Patients in East Malaysia and the East Coast faced particularly long journeys. Malaysia may therefore need not only more machines in existing centres, but also new centres in underserved regions.
A recent regional planning project using Malaysian public-sector data estimated that the country would require an additional 20 linear accelerators and five radiotherapy departments. It also reported an actual radiotherapy utilisation rate of approximately 25 per cent, compared with an estimated optimal rate of 52 per cent. These projections require updating because they were based substantially on 2018 data. Nevertheless, they show the scale of the potential gap.
New machines cannot treat patients by themselves. Every linear accelerator requires radiation therapists, medical physicists, oncologists, engineers and support staff. Using international staffing benchmarks, another 20 treatment machines could require approximately 40 to 80 additional radiation therapists for machine operation alone. This excludes simulation, treatment planning, brachytherapy, management, training and leave coverage.
Why, then, are too few young Malaysians choosing radiotherapy?
First, the profession has a visibility problem. Students and parents recognise medicine, nursing, pharmacy and physiotherapy, but many have never met a radiation therapist. Some confuse the profession with diagnostic radiography or radiology.
Second, radiotherapy appears academically and emotionally demanding. Students must learn anatomy, oncology, physics, radiation safety and patient care while supporting people experiencing cancer.
Third, the financial proposition may not reflect the profession’s responsibilities. The official public-sector starting basic salary is RM1,974 for diploma-qualified appointments and RM2,580 for degree-qualified appointments. Allowances may increase total remuneration, but these figures can appear modest for a specialised and safety-critical career.
Malaysia also faces international competition. Singapore’s Allied Health Professions Council specifically recognises UKM’s Bachelor of Diagnostic Imaging and Radiotherapy. This creates a relatively accessible pathway for UKM graduates to enter the Singaporean workforce, where employers may offer higher salaries, structured development and relocation support.
Malaysia cannot solve this problem merely by asking graduates to be patriotic. Retention must be made professionally and financially attractive. A national response should begin with a comprehensive radiotherapy workforce plan. Malaysia needs reliable annual data covering student intake, graduates, vacancies, resignations, migration, treatment machines, patient workload and projected retirements.
Hospitals could jointly offer scholarships, training allowances and conditional employment before students enrol. Schools need outreach programmes showing radiotherapy as a career combining cancer care, advanced technology and meaningful patient contact. Clear diploma-to-degree pathways and opportunities in dosimetry, education, research, management and advanced practice should also be promoted. Most importantly, employers must improve retention through competitive salaries, transparent promotion pathways, professional development and manageable workloads.
Malaysia’s cancer burden is growing. Its radiotherapy infrastructure is expanding. The missing component is the workforce. Unless the country starts recruiting, educating and retaining more radiation therapists now, tomorrow’s cancer patients may find that Malaysia has invested in advanced treatment machines but does not have enough qualified people to operate them.
Dr Muhammad Afiq Khairil Anuar is a senior lecturer in the Radiotherapy Department of Healthcare Professional, Faculty of Health and Life Sciences, Management and Science University (MSU).
