::.. College of Radiology - History of Radiotheraphy & Clinical Onclogy in Malaysia

Radiotherapy and Clinical Oncology in Malaysia – How it all began?
By Dr Gerard Lim Chin Chye, MBBS, FRCR, Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, Malaysia - Dec 2004

With acknowledgements to the following for their contributions:
Professor Dato’ Dr Tahir Azhar, Dato’ Dr S K Dharmalingam, Mr T Yogaratnam, Mr Khoo Boo Hock, Dr Beena Devi, Dr D Jayendran, Dr B M Biswal, Dr Perdamen Singh, Prof Dr Ismail Saad, Dr Fuad Ismail, Dr Anita Zarina Bustam, Dr Albert Lim Kok Hooi, Dr Mohd Roslan Haron, Mr Lee Kok San, Mr Mahfuz Mohd Yusop, Dr Richard Lim Boon Leong, Dr Ednin Hamzah

Note: This article is reproduced with some modifications and with permission from the Biomedical Imaging and Intervention Journal, Biomed Imaging Interv J 2006; 2(1):e18
doi: 10.2349/biij.2.1.e18, http://www.biij.org/2006/1/e18/default.asp

Cancer is an increasing health problem in Malaysia. The following relates the development of the discipline of Clinical Oncology, which was previously known as Radiotherapy and Oncology.

Radiotherapy and Oncology in Universities

The academic unit was started in University Hospital Kuala Lumpur (now called University of Malaya Medical Centre) in 1997, with state of the art equipment including linear accelerator with multileaf collimators, stereotactic radiotherapy, High Dose Rate and Low Dose Rate remote afterloading brachytherapy, and virtual simulation. The oncologists were Dr Ibrahim Wahid, Dr Matin Mellor Abdullah; physicists were Ms Nicky Whylde, Mr Khoo Boo Huat, Ms Prema Rassiah and the therapy radiographer was Mr T. Yogaratnam.

Other universities that had departments of radiotherapy and oncology were Hospital Universiti Kebangsaan Malaysia and Hospital University Sains Malaysia in Kubang Kerian, Kelantan.

The Department of Nuclear Medicine, Radiotherapy and Oncology of Universiti Sains Malaysia, Kubang Kerian Campus started the first Radiotherapy service in the east coast of Peninsular Malaysia. The Radiotherapy and Oncology division was added to the existing Nuclear Medicine department in December 1995. The Radiotherapy and Oncology service was started with the guidance of Professor Mustafa Embong (then Dean of Medical School) and collaboration of Associate Professor Ahmad Zakaria (Medical Physics). Ministry of Health seconded a clinical oncologist, Dr Jayendran Dharmaratnam, and two therapy radiographers, Miss Aishah Shaari and Mr Khorlid Hassan, to the Ministry of Education for this purpose. In 1999, the High Dose Rate brachytherapy service was operational with the collaboration of IAEA and now this department is the one of the departments offering HDR interstitial brachytherapy services in Malaysia. Subsequently state of art radiotherapy techniques like 3-dimensional conformal radiotherapy and X-knife radiosurgery service were added in 2001⁶.

Radiotherapy and Oncology in Penang

The service in Penang was upgraded in 1996 with the posting of Dr D Jayendran, a senior clinical oncologist from Ministry of Health who volunteered for this service. Chemotherapy and palliative care was provided at Penang Hospital while radiotherapy was planned and given to government patients at Mount Miriam Hospital initially, with the addition of Pantai Mutiara Medical Centre later. Oncology clinics were also run in Alor Star, Seberang Perai and Taiping.

Overview of Radiotherapy Services in Malaysia

As at 2004, there are 20 centres for Radiotherapy and Oncology in Malaysia comprising 5 government centres and 15 private centres. There are 25 linear accelerators, 7 cobalt-60 teletherapy machines, 15 brachytherapy units, 11 simulators and 4 CT simulation units.

A model of a modern Linear Accelerator

Upgrading of the radiotherapy equipment in 2000 was at a cost of RM 10 million, with the installation of linear accelerator, simulator and competerised treatment planner. The linear accelerator was equipped with multileaf collimator and capability for Intensity Modulated Radiotherapy.

Forty-one hospitals in the Ministry of Health are delivering chemotherapy besides universities and the private sector. Conventional chemotherapy is given in many general hospitals, district hospitals and private centres. High dose chemotherapy with bone marrow rescue has been carried out in University Hospital Kuala Lumpur since 1989 and in Hospital Kuala Lumpur since 1994.

In order to decrease the burden on the government centres, the Government has purchased private radiotherapy services from Mount Miriam Hospital, Pantai Mutiara Medical Centre, Mahkota Medical Centre, Pantai Ayer Keroh Medical Centre, Nilai Cancer Institute and Gleneagles Oncology Centre.

Work on the next Ministry of Health oncology centre at the Department of Radiotherapy and Oncology in Hospital Pandan, Johor. Construction would be at a cost of nearly RM558 million, with a Total Hospital Information System, 2 linear accelerators, a CT scan, operation theatres and other support services.

The Burden of Cancer

While the idea of a National Cancer Registry was first reported in the Star on 7^th April, 1978, the First Report of the National Cancer Registry was realized on 4^th July, 2003. For the first time, the real cancer burden in Malaysia was confidently estimated. A total of 26,098 cancers were diagnosed among all residents in Peninsular Malaysia in the year 2002. The corresponding figures for Sabah and Sarawak were 1748 and 2002 respectively. The cumulative risk of Malaysians getting cancer in their lifetime was 1 in 5. Taking into account the unregistered cases, the cumulative lifetime risk was 1 in 4⁷. Since then, the Second Report of the National Cancer Registry has been released in December 2004.

The Penang Cancer Registry in its Five Year Report from 1994-1998 demonstrated that 53.1% of cancers were in the advanced stages, i.e. Stage III or Stage IV. This was published on 15^th December 2003⁸

Tackling the Burden of Cancer

The role of public health cannot be underestimated. This includes public awareness, education, screening and early detection of disease, as well as rehabilitation and palliative care. The Ministry of Health launched its campaign against cancer as part of its ongoing Healthy Life Style approach to the prevention and control of some of our major public health problems in 1995⁹.

Decreasing the proportion of cancers presenting at a late stage would lead to increasing chances of cure or long term control of the cancer. In Sarawak, where the three commonest cancers present at an advanced stage in at least 70% of the cases¹⁰, efforts have been made at early detection. Allied health professionals, such as medical assistants and nurses have been trained on how to detect early signs and symptoms of cancers of the nasopharynx, breast and cervix.

Despite the awareness campaigns and public talks that have been given, the practice of screening for cancer is not widespread enough. The Second National Health and Morbidity Survey¹¹ revealed that the overall prevalence of Pap smear was only 26%. The overall prevalence for breast self examination is 46.8%¹⁰. Screening rate by Breast Self Examination was 34.1%, followed by Health Worker Examination (31.1%). Mammography was carried out only in 3.8% of women. Health education programmes have to target the population subgroups that would benefit from screening, including women in the older age groups.

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Thursday, 08 March 2012