I APPLAUD The Star for highlighting the need for more oncologists to serve our country in the report: “Wanted, oncologists and specialist docs who treat cancer” (Sunday Star, Feb 26).
We learnt from the report that our country needs to double the current number of about 110 oncologists to fulfil the recommended ratio of 10 oncologists to one million population.
A healthcare system with inadequate number of oncologists results in long waiting times, treatment delays, unequal access to care and, ultimately, increased cost.
The WHO has predicted that incidence of cancer will increase to 21.3 million new cases every year up to 2030, and approximately 70% will be from low- and middle-income countries.
A comprehensive national cancer programme that encompasses different aspects of prevention, detection and treatment is currently being planned in the latest national blueprint in an effort to develop efficient, sustainable cancer care programmes to meet the projected rise in cancer incidence.
The Institute of Medicine states, “Cancer is such a prevalent set of conditions and so costly, it magnifies what we know to be true about the totality of the healthcare system. It exposes all of its strengths and weaknesses.”
Cancer treatment has improved tremendously over the past three decades. Progress achieved in prevention, screening, early diagnosis, and treatment have led to lower mortalities and morbidities from the disease.
However, a new burden from these treatments is now emerging – “financial toxicity” from increasing cancer expenditures.
Cancer expenses are rising due to four main reasons: aging population, more patients with access to treatment, innovations, and treatment over-utilisation.
Our population is aging and older patients are at greater risk of developing cancer, resulting in them becoming candidates for anticancer therapy due to current less toxic treatment and optimised supportive care. This increases the proportion of cancer patients receiving therapies.
In many parts of the world, oncology is broadly divided into surgical and non-surgical oncology. The majority of non-surgical oncologists working in our country’s public and private sectors are clinical oncologists who are trained to deliver both systemic and radiation therapies, including brachytherapy and radioiodine therapy.
In contrast, non-surgical oncologists working in the health set-up in developed countries are divided into two categories: medical oncologists who deliver drug therapies, and radiation oncologists who deliver radiation therapies.
More than half of cancer patients require radiotherapy at some stage during their cancer trajectory, achieving various benefits like cure, symptoms relief, prevention of recurrence as well as avoiding mutilating surgery.
Majority of the most common cancers in Malaysia require multimodality management, including radiotherapy, surgery and chemotherapy.
Scholarships offered for training programmes should accord greater consideration to clinical oncology specialisation as the dual training has the potential for not only addressing the shortage in the workforce but also provide an opportunity for more efficient resource utility and cost-effective service delivery.
This model of working eliminates the need to consult different specialists, facilitates co-ordination and continuity of care and efficient healthcare delivery. Malaysia risks facing a catastrophic impact from higher average burden of cancer, advanced disease at presentation and poor access to care or varying quality of healthcare delivery.
Greater emphasis must be placed on practices or measures to prevent wastage by optimising prescription and dispensing practices as well as wider usage of generic drugs of the same quality to that of innovators, and less use of expensive medicines.
Radiation techniques such as giving hypofractionated radiotherapy (shorter duration of radiotherapy sessions while maintaining effective dose), brachytherapy, and combination chemoradiotherapy provide potentially cost-effective radiotherapy treatment options.
This will encourage shorter in-patient stays and reduce hospital costs. Prevention measures such as public health campaigns on prevalent risk factors like obesity, sedentary lifestyles and smoking have been pursued.
Obesity has to be tackled from pre-school level with broad educational initiatives, strict policies on food sold in school and regulations on food advertisement.
Preventive measures against the HPV (human papillomavirus) infection in cervical cancer offered to lower secondary school girls can be extended to school-going boys to prevent the risk of other HPV-related cancers such as oral and anogenital cancers in men.
Adequate financing of the public health system is integral to the success in improving the value of cancer treatment in our country.
A universal healthcare coverage for ensuring that our populations are protected from ill health from cancer can be initiated. In addition, the fee for treatment should be determined based on their ability to pay and not their risk for cancer.
As the number of public oncology facilities serving the greater proportion of patients within the country is few, more often than not the specialists serving the facility are overworked and are tempted to leave for other tenures.
We should consider assigning funds to adequately compensate cancer healthcare professionals in public hospitals to maintain an adequate number of specialists in the public sector.
Finally, we need to increase research efforts and spending in treatment areas relevant to our patient population. Only by focusing on our unique needs and challenges can we enable and plan beneficial and cost-effective treatment pathways with highly significant outcomes in the future.
DR MASTURA MD YUSOF
Clinical Oncologist
SJMC
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