Allow Telemedicine, Malaysia Urged, After Study Finds Higher Covid-19 Risk For Cancer Patients

By Boo Su-Lyn | 02 April 2020

An oncologist wants the government to amend legislation to allow teleconferencing and ensure that doctors’ medical indemnity covers telemedicine.

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KUALA LUMPUR, April 2 — Cancer patients are more than twice as likely of getting infected with coronavirus than the general community, according to a new study in Wuhan, China.

The study, which looked at 1,524 cancer patients who were admitted to Zhongnan Hospital in Wuhan from last December 30 to February 17, found that cancer patients had a 2.3 times risk of Covid-19 infection compared to the community, possibly due to their lower immunity.

The research published in JAMA Oncology on March 25, however, also found that fewer than half of those infected patients were undergoing active treatment for cancer. Patients above 60 years old and patients with lung cancer may be at risk of Covid-19, researchers said, though they also highlighted a population study of 1,099 coronavirus patients that did not show a link between age and infection susceptibility.

Researchers further highlighted a report on 138 hospitalised coronavirus patients at Zhongnan Hospital that found hospital-acquired transmission of Covid-19 comprised 41.3 per cent of these patients.

The study by Dr Jing Yu et al concluded that hospital admission and recurrent hospital visits may be potential risk factors for coronavirus infection.

“We propose that aggressive measures be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward. For patients who require treatment, proper isolation protocols must be in place to mitigate the risk of SARS-CoV-2 infection,” researchers said.

Consultant oncologist Dr Tho Lye Mun said cancer patients in Malaysia were still continuing therapy, like chemotherapy or radiotherapy, due to the urgency of lifesaving cancer treatments, amid the Covid-19 outbreak in Malaysia that has infected over 2,900 people.

Follow-up therapy, however, can be postponed if cancer patients are stable or even be done via teleconference to identify any problems, said Dr Tho, who is also co-founder of Lung Cancer Network Malaysia. But legislative hurdles prevent Malaysian oncologists from teleconferencing for routine follow-ups, even as the country has been placed under increasingly restrictive lockdowns during the coronavirus crisis.

A regulation by Health Minister Dr Adham Baba gazetted Tuesday now prohibits people from travelling beyond 10km from their residence to seek treatment or purchase medicine. Most cancer care centres are located in the Klang Valley.

According to a 2019 study, the average distance from the Malaysian population to the closest radiotherapy centre was 82.5km, with various travel times among the different regions. Even residents in the central region travel an average 14.4km to the nearest radiotherapy centre in Kuala Lumpur and Selangor.

“Some of my patients have to drive all the way from Johor and brave multiple roadblocks when it would suffice to teleconference them ([video conferencing app Zoom etc) and make sure they are okay — anything urgent or if they are unwell, only then drive to KL,” Dr Tho, who is based in Beacon Hospital in Petaling Jaya, told CodeBlue Tuesday, referring to his patients’ experience before the 10km-restriction was imposed.

His patients were let through police roadblocks with official hospital documentation.

“Health care has not embraced this technology yet, partly because the medicolegal framework is not in place.”

The Telemedicine Act 1997 does not clearly spell out the procedure for a local medical practitioner to practice telemedicine. Anyone who practices telemedicine in contravention of the 23-year-old law, however, is liable to a fine of not more than RM500,000, jail for not more than five years, or both.

“It would help the medical community if the Ministry of Health could make an announcement that telemedicine is permissible and our medical indemnity covers telemedicine,” said Dr Tho.

The oncologist also urged the government to amend legislation to allow teleconferencing, especially for outstation and overseas patients, pointing out that all private hospitals in Malaysia have international patients. Dr Tho said he himself has dozens, if not hundreds of international patients.

“Since Malaysia wants to expand the medical tourism sphere — we have to look into giving best care to our overseas patients too, some of whom won’t see us for the next few months,” he said.

“Malaysia should invest and have frameworks and legislation in place to facilitate more widespread telemedicine consultation, especially for cancer patients.”

Minister in the Prime Minister’s Department Takiyuddin Hassan announced yesterday that Parliament would resume sitting on May 18, but stressed that the government would ensure the safety of all Members of Parliament and Parliament staffers.

The Movement Control Order (MCO), which was imposed on March 18 and has been extended to April 14, prohibits all tourists and foreigners from entering Malaysia, except for foreign migrants working in essential services.

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