Why HTAR Only Has One Breast Cancer Patient Quitting Treatment

Cancer Research Malaysia’s patient navigation programme at HTAR also cuts waiting time for cancer diagnosis from 3-6 months to just 14 days.

KUALA LUMPUR, Dec 18 — By helping cancer patients at the Klang public hospital navigate a complicated system, Cancer Research Malaysia (CRM) has successfully reduced the number of patients skipping treatment.

The non-profit cancer research organisation said its patient navigation programme at Hospital Tengku Ampuan Rahimah Klang (HTAR), which piloted in 2015, cut the treatment default rate from 11 per cent to 4 per cent, dropping to just one defaulting patient out of all breast cancer patients at the government hospital last year.

“Due to the success we had in Klang, we successfully opened another three centres. Beginning this year, we started off in Sabah, then Seremban, and I’m the only one here from CRM because my team is launching a centre in Kuching tomorrow,” CRM head of community programmes Dr Jananezwary Kanapathy told a forum organised by the Galen Centre for Health & Social Policy here last October titled “One Year After The World Cancer Congress”.

CRM’s patient navigation programme helps patients navigate the complicated public health care system by tackling whatever challenges that hinder them from continuing treatment, whether it’s not understanding their doctors, or non-medical issues like financial problems, staying far away from the hospital, or busyness in caring for young children.

By working with the Health Ministry and other community partners like insurance agents, banks, Employees Provident Fund (EPF), the Social Security Organisation (Socso), and Tenaga Nasional Bhd (TNB), CRM’s patient navigation programme sorts out issues from helping cancer patients pass their small inheritance to their relatives, to buying them groceries or teaching their caregivers how to treat wounds.

“If you don’t turn up in hospital, patient navigators turn up in your house,” said Dr Jananezwary.

CRM’s patient navigation programme at HTAR has improved timeliness of cancer diagnosis, according to Dr Jananezwary, cutting the typical waiting time of three to six months in government hospitals, to just 14 days between a patient walking in upon presentation of the disease and diagnosis.

“In other hospitals, between the time of presentation and diagnosis, it can take, the mean is 40 days. Forty days and 14 days is significantly different,” she said.

Although cancer patients are getting screened, a whopping half of those whose tests detected problems disappeared from the health care system after the screenings.

“They’ll come back to you much later when it’s at Stage 3 or 4. We have a rapid referral system at primary care so they don’t disappear,” said Dr Jananezwary.

Although CRM’s patient navigation programme has improved on timely diagnosis and treatment default rates, Dr Jananezwary said the programme has yet to boost survival rates because cancer patients were still presenting their disease in the late stages, past the point of lumps.

“It’s a fumigating wound, a hole in your body, why won’t you turn up?”

Among the top reasons why Malaysians only turn up in the health care system at Stage 3 or 4 of their cancer are fear of hospitalisation and treatment, choosing alternative treatment, living far from the hospital, being in denial, or a lack of support from family members or key decision makers in medical issues.

“If you’re doing screening outside, you’re possibly hitting the same population again and again, hitting the population who wants to get screened. You’re still not hitting the populations who don’t want to be screened,” Dr Jananezwary said.

“Behavioural research very much needed,” she said. “What is the factor that would have nudged you to turn up earlier in hospital?”

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