KUALA LUMPUR, Feb 28 — Oncologists suggest introducing copayments, in which payments are shared between the government and patient, to increase access to innovative drugs for breast cancer in the public sector.
Dr Mastura Md Yusof, a consultant clinical oncologist and radiotherapist at Pantai Hospital Kuala Lumpur and Picaso Hospital, stressed however that access to innovative therapies alone won’t make the cut for best fit for optimum care.
“Patient selection and streamlining of care are important. Who are the patients that truly require that extra care? Accurate and rapid diagnosis and staging as well as molecular subtyping are key to understanding why early diagnosis saves lives and money because we treat the cancers at earlier stages or lesser risk for recurrence and mortality,” Dr Mastura told CodeBlue recently.
“A great multidisciplinary team effort between oncologists and surgeons is equally important. After all that is satisfied, that leaves us with possibly a smaller proportion of patients that require that extra treatment.”
For these patients, Dr Mastura suggested the following measures: a drug fund allocated in the federal government’s annual budget; collaboration with local or international philanthropist individuals or companies, or non-governmental organisations (NGOs), to offer copayments on behalf of patients; as well as copayments of between 30 per cent and 50 per cent from patients.
The oncologist said copayments from patients can be assisted through a memorandum of understanding (MOU) with the Employees’ Provident Fund (EPF), for example, to allow withdrawals or regular deductions at intervals for treatment from the patient or the patient’s employers.
Dr Mastura explained that various new targeted therapies and immunotherapies are increasingly showing promise, especially for early-stage breast cancer.
“Women diagnosed with breast cancer each year are treated according to the cancer subtype. Major advances in treatment of the disease spanning from a hormone positive to HER2 positive subtypes have been well established since the past decade,” she said.
“Hormone positive breast cancer patients now have the additional treatment with targeted therapy after they have completed surgery, radiotherapy, and chemotherapy that reduce the chance of cancer coming back and prolonged their lives while HER2 positive cancers are treated with a sequential therapy utilising dual anti-HER targeted therapy and antibody drug conjugates.”
For women with triple-negative breast cancer (TNBC), an aggressive form of breast cancer associated with a lower survival rate, treatment was solely limited to chemotherapy until immunotherapies emerged in 2021.
“Initially showing promise in advanced stage cancer, the use has shown benefits when given together with standard chemotherapy prior to surgery as a stand-alone therapy up to one year after surgery in early stage triple negative breast cancer. There are ongoing efforts to make them even more effective with other combined or sequential strategies with newer innovative therapies. So now we have created much hope for our TNBC patients,” Dr Mastura said.
Studies conducted and published by the European Society of Medical Oncology last year indicate that combination therapies involving chemotherapy and immunotherapy had a 5.1 per cent increase in overall survival rates and a 9 per cent increase in event-free survival rates. Yet, access to these life-saving therapies are still locked behind fiscal constraints and extensive red tape.
When asked if major innovative therapies for breast cancer have been listed on the Ministry of Health’s (MOH) formulary, Dr Mastura said a few drugs were added this year. Accessing non-formulary therapies requires special approval from the Health Director-General under the special approvals system (Ubat Kelulusan Khas).
When asked about the process to get special approvals from the Health director-general to access therapies that are not on the MOH formulary, Dr Mastura said if a patient requires a drug after failing all other avenues, their attending oncologist may apply for approval by the Health DG to approve the import of the drug that isn’t on the formulary.
“The process of applying isn’t difficult at all, but usually there will be a list of patients waiting for such approval and the list can be very long! And agonising for the doctors who are on the ground explaining to the incessant queries from patients about their drugs’ approval. At times, patients can’t wait and drop from the list.”
Remove Red Tape If Public Patients Are Willing To Pay For Innovative Treatment
Prof Dr Ho Gwo Fuang, a senior consultant clinical oncologist at Curie Oncology KL, urged the MOH to reduce bureaucracy for patients in government hospitals who are willing to pay for innovative treatment themselves, noting that their specialist must still apply to the Health DG for permission just to prescribe the medication.
“This layer of red tape should be removed and specialists should be allowed to exercise his/her own judgment if the MOH coffer is not involved, so patients can get the medicine in a timely manner,” Dr Ho told CodeBlue.
“The MOH payment system is very rigid – either they pay for you for everything (which is a very limited quota), or you don’t get anything. They should expand the access and allow many more patients to get access with a copay system, say, MOH pays half the bill (whilst keeping the existing full-pay quota).
“In this way, many more patients can get some access. The government should negotiate on behalf of all the hospitals in Malaysia with regards to drug price. Although Malaysia’s market is not as big as that of China, negotiating purchases in bulk tends to lead to some price reduction. In this case, the private and public health care sector should unite and speak with one voice.”
MAKNA: Make Innovative Cancer Therapies Available
Breast cancer incidence among Malaysian women has been rising over the years, from 31.1 per 100,000 population (2007-2011) to 38.9 per 100,000 (2017-2021).
According to the Malaysia National Cancer Registry Report 2017-2021, the age-standardised rate (ASR) of 38.9 for female breast cancer is nearly triple the 13.7 incidence rate for female colorectal cancer, the second most common cancer among women in Malaysia.
Yet, the MOH’s oncology budget remains limited, despite a 15 per cent increase for radiotherapy and oncology to RM168.4 million for 2025 from RM146.3 million this year.
“MOH should make these therapies available to achieve better cure rates,” the National Cancer Council (MAKNA) told CodeBlue, referring to innovative therapies for breast cancer.
“Treating early-stage cancer to achieve a higher cure rate will improve survival and ultimately save the government health care cost.”
When asked if the MOH should list major innovative therapies for breast cancer in its formulary, the patient group said: “It has to be evidence-based from clinical studies.”
“MAKNA would support efforts made by MOH to make the treatment available. Access/ affordability and equitability will also be an issue. Good to consider all aspects too.”
According to the Malaysia National Cancer Registry Report 2017-2021, female breast cancer incidence rates were higher starting from age 40 in 2017-2021 compared to 2012-2016, particularly in the 65-69 age group (149.8 ASR in 2017-2021 versus 117.9 ASR in 2012-2016).
About half of breast cancer cases among Malaysian women were diagnosed at the late stages of three and four in 2017-2021. Slightly fewer cases were diagnosed at Stage Four (22.2 per cent in 2017-2021 vs 22.8 per cent in 2012-2016), while the proportion of Stage Three cases increased about three percentage points to 28.3 per cent in 2017-2021 from 25.2 per cent in 2012-2016.
The likelihood of successful treatment at the late stage is far less than if cancer were diagnosed early.
Cancer Research Malaysia, a non-profit cancer research organisation, previously said in 2022 that Malaysia has a much lower five-year survival rate for breast cancer (67 per cent) compared to other Asian countries, like South Korea (92 per cent) and Singapore (80 per cent).
Malaysia’s 67 per cent five-year survival rate for breast cancer is also one of the worst in the Asia Pacific region, according to the Galen Centre’s 2021 White Paper on cancer care challenges, gaps, and opportunities in Malaysia.
