::.. 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.

Palliative Care

Efforts at improving palliative care services throughout the country are being actively undertaken by governmental and non-governmental agencies.

Palliative Care was introduced by non-governmental organizations (NGO) in Kuala Lumpur and Penang in 1991, by Ministry of Health in Sabah in 1995. In 2000 a National policy was launched. Palliative care continues to be NGO driven. Most training programmes in Palliative Care are still run by NGOs. The NGOs continue to work closely with Palliative Care Units where they can. The setting up of Rumah Hospis in Penang would enhance palliative care in Penang. Home care nursing by some government general hospitals serve to enhance continuity of care of terminally ill patients after discharge from hospital, for example, in Hospital Kuala Lumpur, which was started in 1995 for patients within a 10 kilometer radius of the hospital.

In the East Malaysia, Palliative Care Programmes have been started with Palliative Care Units as well as Hospice Home Care as part of a community-based service. The programmes include the training of doctors, nurses, medical assistants and lay volunteers in the palliative care of terminally ill cancer patients. Palliative Care Units have been set up in several government hospitals, for example in Queen Elizabeth Hospital in Kota Kinabalu in 1995 and have undertaken training of Ministry of Health personnel.

There are now 11 Palliative Care Units and 48 Palliative Care Teams in various hospitals in the Ministry of Health, and 17 hospice organizations (NGOs) under an umbrella organization called the National Hospice Council that was formed in June 1998.

The palliative care unit of Hospital Selayang was started in December 2002 as part of the Ministry of Health’s policy to support palliative care services in all government hospitals throughout Malaysia. As Hospital Kuala Lumpur was largely overcrowded and there was no space for the development of a new ward, it was decided that this new palliative care unit and service be started in Hospital Selayang which is also a regional centre for pain control.

Non-governmental organizations (NGOs) have been actively involved in various aspects of cancer welfare, such as in cancer education, cancer counselling services, moral support to cancer patients, welfare services, organizing national and international symposia, providing therapeutic facilities.

Training

Training is an integral part of any cancer programme. The number of specialists in cancer treatment and the facilities available need to be increased in order to cope with the workload. There are 32 clinical oncologists in Malaysia of whom 21 are in the private sector. Physicists number 26, while there are 104 therapy radiographers, 2 medical technologists dan 45 nurses who have undergone post-basic oncology training.

In 1971, it was reported that there were about 30 radiotherapists and radiologists in West Malaysia, and the Ministry of Health at that time was doing all it could to increase the number of these specialists. An immediate measure was recruitment from Pakistan and Egypt, while the long term plan was to send more Malaysians overseas for training¹².

School of Radiography was started at the General Hospital Kuala Lumpur in 1963. Dato’ Dr Dharmalingam initiated the establishment of the School of Radiotherapy at the Kuala Lumpur General Hospital. With Mr A R Hutchinson as the Radiotherapy Advisor, the first five student radiotherapy radiographers commenced training in 1969¹.

Post basic course for Oncology Nursing was started at the School of Nursing in Kuala Lumpur on 1^st October, 1996.

The First ASEAN Association of Radiologists Scientific Meeting was held from 30 October 1980 to 1 November 1980 at the Faculty of Medicine, University of Malaya. Invited speakers included Professor J G Bloom from the Royal Marsden Hospital, London.

The International Atomic Energy Agency (IAEA) organised the IAEA Regional Training Course on Brachytherapy of uterine cancer using Manual and Remote After-loading Techniques at the Faculty of Medicine, National University Hospital and General Hospital of Kuala Lumpur from 6 to 26^th October 1986. It was organised in cooperation with the Government of Malaysia and National University of Malaysia, in collaboration with General Hospital Kuala Lumpur and the Nuclear Energy Unit of the Prime Minister’s Department. The Organising Committee was chaired by Professor Ismail Saad, co-chaired by Dr Perdamen Singh, while the Secretary was Dr Md Tahir Azhar, Assistant Secretary Dr Albert Lim, and the Technical and Scientific Committee included Mr Wong Jin Tin and Mr T Yogaratnam. Lecturers included Mr Hirohiko Tsujii, Dr S Ganesan and Dr M K Tan. Participants comprised 23 representatives from 10 countries and one representative from the Middle East. The Ralstron B 20 (Shimadzu) which was generously donated by the Government of Japan and channeled through the IAEA to Malaysia, was an essential component of the training course¹³ and was the first remote afterloading brachytherapy machine installed in Malaysia.

Regional cancer meetings in which Malaysia has taken part included Asian Oceanian Congress of Radiology (June 1995), Asia Pacific Cancer Congress (October 1996)¹⁴.

The First Malaysia /IAEA Brachytherapy Course was jointly organized by the Ministry of Health Malaysia and Hospital Universiti Kebangsaan Malaysia from 24-27^th February 2004, with cooperation from Malaysian Institute of Nuclear Technology (MINT). The foreign expert was Professor Subir Nag. The participation and cooperation between the government, university and private sector was remarkable throughout the organization and conduct of the course, which was attended by 93 participants.

Our Own Malaysian Clinical Oncology Training Began in 2002

While post-graduate training in radiotherapy and oncology had traditionally been in the United Kingdom / Ireland, the Malaysian Government sent two trainees to Hong Kong for the first time in 2002. This was due to the increasing difficulties encountered by our trainees in pursuing post-graduate training in the United Kingdom. The local Master in Clinical Oncology was started in University of Malaya Medical Centre in November 2002, with strong support from the Ministry of Health. The first professional examination was held in November 2003, with Professor Michael Barton and Professor Dato Dr Tahir Azhar as external examiners from Sydney and International Islamic University respectively. The external examiners gave favourable and encouraging reports regarding the standards and conduct of the examination.

As evidenced by the publications of the First and Second Reports of the National Cancer Registry of Malaysia, it cannot be overemphasized that the optimal number of oncologists needed must be much higher than the number available at the moment. Both overseas training and a local post-graduate courses for clinical oncology are being supported simultaneously by the Government in order to train more clinical oncologists as quickly as possible.

Conclusion

Much has been achieved in oncology in the past 40 years. Good and comprehensive cancer treatment is the right of all. Cancer care services must be accessible and affordable throughout the entire health system, from the primary care level up to the centres for tertiary care.

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