KUALA LUMPUR, Sept 11 — Universiti Malaya Medical Centre (UMMC) said it provides advanced cancer therapies that are unavailable in other government hospitals, after research found the majority of their cancer patients suffered financial disaster.
The public university hospital noted that it provides the latest cancer treatments like immunotherapy that costs much more than chemotherapy, as well as HIPEC surgery for gastrointestinal cancer, both of which are not offered in Ministry of Health (MOH) hospitals.
“Survivorship relating to cost of treatment is an outcome that has a profound influence on the total cost,” UMMC director Dr Tunku Kamarul Zaman Tunku Zainol Abidin said in a statement to CodeBlue.
Dr Nirmala Bhoo Pathy, associate professor of clinical epidemiology and public health at Universiti Malaya, told a conference organised by the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) recently that cancer patients at UMMC were more likely than those at MOH hospitals to suffer financial disaster.
According to a 2019 study she authored on financial toxicity after cancer that was published in Journal of Oncology Practice, she found that 65.1 per cent of cancer patients at the public university hospital ran into “financial catastrophe” one year after their cancer diagnosis, compared to 33.4 per cent of cancer patients at MOH hospitals.
At the FPMPAM conference, Dr Nirmala had questioned why cancer patients at university hospitals incurred catastrophic expenditures that were not suffered by MOH hospital patients.
But UMMC said according to Dr Nirmala’s study sample, UMMC saw 229 (35.7 per cent) gastrointestinal cancer cases compared to only 87 (15.1 per cent) in MOH hospitals. For breast cancer studied in the research, UMMC treated 271 cases (42.2 per cent), higher than 116 cases (20.1 per cent) in MOH facilities.
“UMMC is a tertiary referral center that handles very complex cases and the treatment will undoubtedly be more advanced, and therefore more expensive.”Universiti Malaya Medical Centre (UMMC) director Dr Tunku Kamarul Zaman Tunku Zainol Abidin
“This may explain the reason for over twice the number of cases representing breast and gastrointestinal cases recruited in UMMC compared to the 12 MOH hospitals combined,” Dr Tunku Kamarul Zaman said.
He also pointed out that up to 45.2 per cent of the cancer cases sampled in MOH were haematological cancers that only comprised 2.3 per cent of UMMC’s sample cases.
Dr Tunku Kamarul Zaman noted that according to Dr Nirmala’s study, a sizeable number of those patients were recruited from a single MOH referral centre for hematological illnesses, where patients received expensive frontline drugs like tyrosine kinase inhibitors to treat chronic myeloid leukaemia for free.
This, Dr Tunku Kamarul Zaman said, “will certainly ensure that those with these types of cancers would not be affected financially as compared to all other cancers.”
The UMMC director also found sampling bias in Dr Nirmala’s study, noting that the MOH data was from 12 MOH hospitals, but their sample of 577 cancer patients was smaller than the UMMC sample of 642 patients. The study also sampled 75 patients from private hospitals.
“This itself, represents biasness in sampling, resulting in huge variations in the data analysis, since there would be differences in the care provided in different hospitals and variations in the standard of living as well as financial needs of the patients that needs to be taken into account.
“Therefore, in essence, the researchers have made the assumption that all MOH hospitals are the same, to the extent that MOH for the whole country is assumed to be just one big hospital, which again, is most certainly untrue,” Dr Tunku Kamarul Zaman said.
He stressed that the cost of cancer treatment depends on the complexity of cases and that costs differ for various cancers, stages, and presentations of the disease. Patients may also be prescribed different therapies and have various responses to treatment that subsequently affects cost.
“An important point to remember is that one cancer is not the same with another. In fact, a single cancer type, for example breast cancer, may have different sub-types, ranging from the invasive to non-invasive nature, stages of disease, histological types and sensitivity to receptors. All of these have varied treatment costs,” Dr Tunku Kamarul Zaman said.
“In essence, while UMMC is in agreement that there will be patients and their families who will face financial catastrophe and other financial difficulties due to the burden of the disease, the claim that patients in UMMC is financially worse than those in MOH hospitals is simply flawed since the study published by Nirmala et al. is not robust enough to answer this, and that the analysis leading to this conclusion is largely questionable.”