KUALA LUMPUR, June 16 — A cancer group has projected a delay in cancer surgeries in Malaysia amid a surge of Covid-19 cases filling up intensive care unit (ICU) beds in hospitals.
Health Minister Dr Adham Baba told a press conference Monday that Covid-19 ICU bed occupancy nationwide has reached 97 per cent, with 1,161 patients filling 1,767 beds.
“In an extensive breast surgery, for example, or actually, thyroid surgery, the patient probably needs an ICU bed. But if I lock up that ICU bed, when I suddenly get an admission into the emergency department with low oxygen, I know this person is not going to compete for my ventilator,” National Cancer Society Malaysia (NCSM) medical director Dr M. Murallitharan said last month at a roundtable discussion on cancer care amid the Covid-19 crisis, organised by Galen Centre for Health and Social Policy, supported by the Pharmaceutical Association of Malaysia (PhAMA).
“How am I going to have the face to do elective surgery? It is something very unreasonable to expect from the public centres as well.”
Elective surgery means an operation that can be safely postponed without major adverse consequences to the patient. Former Health director-general Dr Ismail Merican said in April last year — during the first Movement Control Order (MCO) — that cancer surgeries should not be deemed “elective”, as life-threatening diseases should be diagnosed and treated urgently.
During the current new wave of the coronavirus epidemic in Malaysia that is seeing greater proportions of severe Covid-19 cases, up to 31 per cent this month, the Ministry of Health (MOH) has yet to reveal non-Covid mortality statistics on deaths indirectly caused by the epidemic due to lack of access to treatment, among others.
Dr Benedict Sim Lim Heng from Sungai Buloh Hospital told a webinar last April that non-Covid patients who needed surgery, among other treatments, were forced to be diverted from Sungai Buloh Hospital when it converted into a full Covid-19 hospital, some of whom died.
Dr Murallitharan said that strong political will is the key to drive for better resource allocation for cancer patients in the country. Besides the costs incurred for treatment, effective cancer management requires consent, oversight and regulations, he said.
“Immediately by one stroke of the pen, the emergency ordinance allows the government to seize and use hospitals for Covid-19. So when the government has the political will, when they see that urgency, they can do it.
“So all we are asking for is to look at things, you see the relevance of using it in Covid-19, why not then use it in a semi-emergency setting? However, it is what you call it subsequently for years to come,” Dr Murallitharan added.
Dr Feisul Idzwan Mustapha, deputy director (non-communicable diseases) of the disease control division in the MOH pointed out that although public health facilities are strained with the Covid-19 epidemic, not all hospitals are affected.
“So it’s not like that throughout the country, but now the government has to make that difficult decision of resource allocation because we are looking at the current trajectories of other countries as well, requiring specialised ICU support and definitely, we are in a very difficult position now,” said Dr Feisul.
At the same time, Dr Feisul also mentioned that the government should communicate effectively to gain the public’s trust in order to manage cancer care effectively during the harsh impact of the Covid-19 epidemic.
“For me, strategic communication is something that we can control, in terms of trying to modify the public’s perception and build that trust. There is a strong trust deficit right now — from the public towards the government as a whole.
“Some hospitals are open, they are available for diagnostic procedures, but we don’t see people coming through to get this type of diagnosis.”
At the same time, Dr Murallitharan also mentioned that cancer care in Malaysia is multidimensional and does not include clinical aspects only.
Dr Murallitharan said that currently the National Cancer Control Programmes (NCCP) does not include aspects to protect the social welfare of cancer patients, as he highlighted the plight of affected patients during the Covid-19 crisis.
“The clinical aspects of cancer management is just one one aspect. There’s all these other aspects — the social aspect, the political aspect, the economic aspect — which are much wider than it can ever be encompassed into this one single document of the NCCP.”
According to Dr Murallitharan, apart from clinical management of the disease, there are also other unaddressed underlying aspects of cancer.
“In the first few weeks, I think the concern for most of our cancer patients, besides not getting appointments, difficulties to travel, was actually a very basic issue of food. Many of them didn’t know where the next meal was going to come from. So we actually had to spend quite a lot of time and energy working on the ground, and put something simple as food on the table,” Dr Murallitharan added.
Dr Murallitharan emphasised that “a whole-of-government, whole-of-society approach” is needed for cancer patients in the country. Although he strongly agreed with the need to increase clinical facilities, such as inpatient beds and building new cancer centres, he also mentioned that clinical demand will always exceed the supply of services.
Dr Feisul, who concurred with Dr Murallitharan, stated that the current cancer-related policies in the country are focusing more on cancer service delivery, like diagnosis and treatment procedures, but not a holistic approach to tackle the multidimensional issues that cancer patients are facing.
Malaysia’s National Strategic Plan for Cancer Control Programme (NSPCCP) from 2016 to 2020 was designed mainly to address the cancer care and management from a holistic viewpoint that spans across primary prevention, screening, early detection, diagnosis, treatment, rehabilitation, palliative care, as well as traditional and complementary medicine and research.
“For me, it is work in progress, a balance between what resources we have and what’s the political buy-in and a lot of focus is very much on the service delivery,” said Dr Feisul.
“We talked about cancer prevention and control the whole continuum — from health education and prevention from early detection, which includes some screening, then you have your management.
“Management is what people most often talk about. Then you have your rehab, your palliative care. So that’s the whole continuum. The other aspect about cancer is the social and economic aspect as well. So it’s not just a health issue, it is also a social and economic issue.”
According to Dr Feisul, as a country develops economically, its cancer incidence rises too. Malaysia is facing a similar trajectory like many other developing countries that record more cancer cases than patients with cardiovascular diseases.
“As our management becomes better, we have more survivors, right? So cancer survivors are also faced with different challenges, not just from the health domain, but also from the social and work domains.”