Malaysia in dire need of oncologists

KUALA LUMPUR: A large number of cancer patients seeking treatment in public hospitals nationwide have never seen an oncologist in their lives, according to a medical practitioner.

In many government hospitals, there are no oncologists in-house and with an overwhelming number of patients, medical officers or specialists in smaller hospitals will email oncologists for them to prescribe the needed cancer treatment course, said one who declined to be named.

“Normally, a surgeon or a specialist will diagnose the patient and an oncologist decides on the treatment after seeing the patient in person.

“But in government hospitals, there are way too many patients. A large number of patients will not get to see an oncologist at all, ” said the medical practitioner who declined to be named.

She said most of the oncologists are in private hospitals. There are 33 oncologists in six government cancer treatment centres, 14 in university hospitals and 61 in private hospitals nationwide.

The 33 oncologists are stationed in Hospital Kuala Lumpur (HKL), National Cancer Institute (IKN), Hospital Pulau Pinang, Hospital Sultan Ismail in Johor, Likas Women and Children’s Hospital in Sabah and Sarawak General Hospital.

On top of their heavy workload, government oncologists also have to travel once every two months to other hospitals in other states that have no oncologists.

Many public sector oncologists are frustrated with the immense workload and have left the service for the private sector, worsening the brain drain, she said.

A clinical consultant oncologist who used to work in Universiti Malaya Medical Centre, Dr Mastura Md Yusof, said Terengganu, Pahang and Perlis do not have oncological services and in Kedah, there is only one private centre offering chemotherapy, but for radiotherapy the patients need to go to Penang.

“Delayed appointments for referral, diagnostic scan, biopsy and treatment such as surgery, chemotherapy and radiotherapy can take one to three months in public hospitals due to heavy patient load and lack of manpower, ” said Dr Mastura who now works in a private hospital.

The lack of oncologists and oncological services is one of the contributing factors to delayed diagnosis and treatment besides underdiagnosis, patients’ poor cancer knowledge and fears, and the lack of social and psycho-social support systems, she added.

The medical practitioner who declined to be named also said Terengganu gives very basic chemotherapy treatments with no visiting oncologists while Perlis does not have any services.

Hospitals in Kuantan, Ipoh, Slim River, Teluk Intan, Sri Manjung, Kuala Lipis and Temerloh treat very basic cancer cases while complicated ones are referred to HKL.

Patients from Pahang, Perak, Selangor and Kuala Lumpur are referred to HKL while those from Serdang, Kajang, Klang, Putrajaya, Negri Sembilan and Melaka go to IKN for treatment.

Visiting oncologists from HKL see patients in Kuantan, Ipoh and Kota Baru hospitals.

IKN oncologists visit only the Melaka Hospital, which does not have an oncologist or radiotherapy services.

The hospital gives basic chemotherapy for straightforward cancer cases, carried out by the surgical or gynaecology or ear, nose and throat department, depending on the tumour.

Visiting oncologists from Hospital Sultan Ismail will go to Batu Pahat and Muar, Johor, while oncologists from Likas Women and Children’s Hospital will visit Tawau and Sandakan in Sabah.

University hospitals UMMC, UKMMC and USM have oncologists and radiotherapy services but refer their own patients to one another.

UiTM has oncologists but no radiotherapy services and its specialists currently work in UKMMC.

While the medical practitioner said cancer needs were acute for the severe lack of facilities and manpower, Universiti Malaya Cancer Research Institute director Prof Dr Nur Aishah Mohd Taib (pic) said the cancer situation in the country is in a state of “national emergency”.“The delay in diagnosis and treatment is a serious concern because it determines patients’ survival rate, ” she said.

Overall, advanced-stages cancer cases detected – stages 3 and 4 – were found to have increased from 58.7% for 2007-2011 to 63.7% for 2012-2016, according to the latest National Cancer Registry Report 2012-2016 released by the National Cancer Institute last Friday.

Scrutinising the data in detail, Dr Nur Aishah said the number of men diagnosed with lung cancer Stage 4 went up from a high 66% to an even higher 78% for the two comparison periods, while for women, it was 71% to 81%.

Patients detected with colorectal cancer Stages 3 and 4 increased from 65.2% to 73.1% for women although for men, the figures went down from 65.9% to 62.4% for the two periods.

Patients detected with breast cancer Stages 3 and 4 increased from 43.2% to 47.9% for the two periods.

The top 10 most common cancers for 2012-2016 were breast, colorectal, lung, lymphoma, nasopharynx, leukaemia, prostate, liver, cervix and ovaries.

The cancer incidence rate was 86 cases for every 100,000 males and 102 cases for every 100,000 females.

The report showed that the number of new cancer cases in Malaysia also went up by 11.3% over two five-year periods.

A total of 115,238 new cases (44.7% among males and 55.3% females) were recorded from 2012 to 2016, versus 103,507 from 2007 to 2011.

While cancer care services need to be beefed up, Dr Nur Aishah said to achieve early diagnosis, communities and primary healthcare providers need to be trained to have better knowledge of symptoms of cancer and clear referral pathways.

While calling for a mandatory reporting of cancer cases and for the registry report to be published biennially or annually for cancer trends to be monitored, she said tracking timeliness in diagnosis and treatments must also be driven by data for continuous improvement.

Dr Mastura said a comprehensive, coordinated cancer care service in multi-sectors is also needed as there is a lack of communications and collaboration between doctors of various disciplines and hospitals on managing patients.

To better control cancer, health literacy should be taught in school while more funds are needed for cancer drugs and treatments, and for building a cancer centre in states that do not have any, she added. - Star