Govt needs to foster long term planning for cancer care doctors — Mastura Md Yusof

MAY 22 — I refer to the recent Cabinet decision to turn down the request to harmonise General Practitioner (GP)’s fees and for approving the drug price controls.

I can’t help feeling saddened to hear that the plight of our health professionals were not given due consideration by our policy makers.

If I may bring their attention to my practice in cancer care which is a multiprofessional field, in which oncologists, other site-specific specialists and GPs all play a role,, especially in resource limited country such as ours.

Cancer management is a huge undertaking and a continuous public health challenge in Malaysia. While a shortage of oncologists looms, the demand for oncology services in our country is increasing.

With a population of 34 million, the current ratio stands at 3.4 oncologists per one million Malaysian people.

Optimum cancer health services can only be delivered via good policies and governance, integrated infrastructure and systems for awareness, prevention and early detection besides efficient and timely diagnosis, treatment and supportive care.

Malaysian patients with cancer frequently present late with poor outcome. Lack of nationwide effective prevention, poor accesses to specialized investigation and treatment as well as use of un-proven alternative medications in cancer have been commonly highlighted.

 However, non-adequately tapped primary healthcare systems deserve a mention if we are serious about improving cancer care in the country.

Whenever the context of a growing cancer burden in our resource-limited country is discussed, the need to implement an integrated and multidisciplinary approach to cancer cares must be given priority. This is where the role of the GPs lies.

Sadly the need for a better understanding of the involvement of primary care physicians or GP in cancer care is lacking.

GPs’ tasks within the broad cancer care spectrum may range from prevention, cancer screening and diagnosis, treatment of side-effects during definitive cancer therapy, shared follow-up and survivorship care, to bereavement and end-of-life care. These are the work of a professional and the value of which should not be overlooked.

Let’s take a look at the simplest example. One key aspect of the national strategic plan for cancer control is to promote healthy lifestyle, prevention and early detection.

The levels of cancer prevention effort ,broadly classified into primary, secondary, and tertiary prevention lies within the realm of public health.

Various health education programmes, health awareness campaigns, and vaccination are the basics in primary prevention, followed by secondary prevention with health screening and early detection of cancer with prompt initiation of treatment as the goal. In established cancer diagnosis, tertiary prevention focuses on reducing the impact of the disease with rehabilitation and improvement of patients’ quality of life.

The GP plays a huge role in implementing secondary prevention and they can be instrumental in the initial decision making by the patient to go on the clinical pathway rather than the unproven treatment pathway.

Their clinical skills and rapport with patients built over years may help patients to navigate through the healthcare system, especially when the patients go through one treatment phase to the other.

 If the GPs are not remunerated accordingly for their roles, a lack of continuity in cancer care may result and erode the quality of a holistic cancer care process.

Early detection of cancers require recognition of common symptoms and early warning signs of cancer. Not all patients have access to tertiary care in the urban areas. In most corners within our country, the subsequent steps to be taken lie within the scope of the GPs.

Mobilising appropriate resources in order to reduce the impact of cancer on the physical, social and psychological burden of individual patients cannot be carried out with community pharmacist or be tasked only to healthcare professional within public health facilities.

The ‘first-contact, continuous, comprehensive and co-ordinating care’ by the GPs is indeed a challenge and this is definitely a role worth to be invested on. Not only that , in the future for cancer, GPs may do follow-up of patients after completion of treatment in cooperation with the oncologist and provide support for families and carers of cancer patients, including during bereavement.

Recognising their value and fostering a long term planning for these primary care doctors to deliver efficient cancer care that is interconnected with us in the oncology field will ensure that patients’ needs are met throughout the cancer trajectory.

* Dr Mastura Md Yusof is a consultant oncologist at Pantai Hospital Kuala Lumpur.

**  This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.

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