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Colorectal Cancer: National Cancer Registry 2007-11

Colorectal Cancer (CRC) is the most common of cancer types among men and the second most common among women in Malaysia at a prevalence of 13.2 per cent, as reported in the Malaysian National Cancer Registry Report (2007 – 2011).

Statistics showed that the incidence of the disease is highest among the Chinese, followed by Malays and Indians. The figures also revealed that the mortality rate for males was 1.42 times higher as compared to females.

The most common symptoms of the disease are altered bowel habit (41.7 per cent) followed by blood in stool (35.5 per cent), abdominal pain, (31.5 per cent), weight loss (31.0 per cent), anaemia (9.8 per cent) and intestinal obstruction (9.3 per cent).

These alarming figures were revealed by Health Director General Datuk Dr Noor Hisham Abdullah at the launch of the Clinical Practice Guidelines (CPG), which is the first of its kind handbook on the management of colorectal carcinoma at Hospital Selayang.

“Unfortunately, a majority of patients are at stage three and four (54.36 per cent), while only 8.4 per cent are diagnosed at stage one when they seek medical assistance".

He said some of the main causes in the rise of the disease was due to the unhealthy Malaysian lifestyle, in particular, the consumption of too much red meat and processed food, as well as the low intake of fibre.

“Genetics, consuming alcohol, smoking and lack of exercise are also contributing risk factors,” Dr Noor warned.

He pointed out that with the ever increasing number of new cases detected every year, the economic burden of CRC management is escalating especially if the patients are at the advanced stage.

“Hence, the introduction of screening programmes should be undertaken for early detection of the cancer which can ultimately reduce the economic burden of CRC, to the individual, family and country.

“Today, the estimated societal cost of CRC management in government hospitals in Malaysia using conventional chemotherapy ranges between RM13,622 and RM27,163 based on different stages, with an average of RM21,377 per patient. Early detection will not only save lives but also ease financial burden.

Among those present at the launch were colorectal specialist and chairman of the CPG steering committee Dr Nil Amri Mohamed Kamil and Hospital Selayang director Dr Sakinah Alwi.

/NST 27-06-2018

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Cancer on the Rise: National Cancer Registry 2012-16

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Cancer cases in Malaysia have been increasing for the past 10 years, and it remains the second highest cause of death, based on the Malaysia National Cancer Registry Report (MNCRR) 2012-2016.

Health Director General Datuk Dr Noor Hisham Abdullah said cancer cases in the country had increased to 115,238 from 2012 to 2016, compared to 103,507 from 2007 to 2011.

“In 2018, cancer took 9.6 million lives worldwide, with 16,000 lives in Malaysia alone.”

He said 86 out of every 100,000 males and 102 out of every 100,000 females had cancer.

For the period 2012-2016, 10 types of cancer were detected among Malaysians. They were breast, colorectal, lung, lymphoma, nasopharynx, leukemia, prostate, liver, cervical and ovarian cancers.

It was discovered that men were mostly affected by lung and prostate cancer, while women are most affected by breast, colorectal and cervical cancer.

Meanwhile, the types of cancer usually detected among children aged 0 to 14 were leukemia and spinal cord cancer, while youngsters between the age of 15 and 24 were prone to lymphoma.

The rate of cervical cancer, however, is seeing a downward trend from eight to six cases for every 100,000 females in the country, and this is probably due to awareness campaigns involving early detection such as pap smear, according to the report.

“Nevertheless, there is a significant increase in breast and colorectal cancers.”

Dr Noor Hisham said analysis based on ethnicity found that the Chinese were more prone to cancer than the Malays and Indians.

For every 100,000 Chinese population, it was found that 106 men and 117 women had cancer.

However, if compared (this report) to the previous one, there is a downward trend in regard to cancer cases related to the Chinese and Indians, while it is increasing among the Malays.

“Late cases where there was only detection at the third and fourth stages is also increasing from 58.7 per cent from 2007 to 2011, to 63.7 per cent from 2012 to 2016,” he said.

/NST 03-01-2020

IHH to acquire Prince Court Medical Centre by Q1,2020

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IHH Healthcare Bhd is expected to complete the acquisition of Prince Court Medical Centre in the first quarter 2020 on near unanimous shareholder support.

The government-linked health care provider announced that an extraordinary general meeting today, more than 99.99 per cent of non-interested IHH shareholders and proxies voted in favour of the conditional share purchase agreement between IHH’s wholly-owned subsidiary, Pantai Holdings Sdn Bhd, and Pulau Memutik Ventures Sdn Bhd, a wholly-owned subsidiary of Khazanah Nasional Berhad, for the acquisition of the entire issued share capital of Prince Court Medical Centre, for RM1.02 billion cash.

“This moves the Group closer to strengthening its market position in Malaysia and allowing it to better serve patient needs in the country,” IHH said in a statement.

Once the transaction is completed, Prince Court Medical Centre will become IHH’s 16th hospital in Malaysia. IHH currently runs Pantai and Gleneagles Hospitals in Malaysia.

Strategically located in the “Golden Triangle” area of Kuala Lumpur, Malaysia, Prince Court Medical Centre is a 277-bed private hospital offering a wide range of services including, among others, burns management, cancer, gastrointestinal diseases, interventional cardiology, in vitro fertilisation, nephrology, occupational health, orthopaedic and rehabilitation medicine.

“Adding Prince Court Medical Centre will empower us to bring our best-in-class care and outcomes to even more patients in Malaysia and abroad. With a broader network and stronger cluster of specialised tertiary hospitals in the Klang Valley, supported by a deeper clinical talent pool, IHH can offer a wider array of services and take on more complex cases.

“This will make our facilities even more compelling for both local and foreign patients, and further reinforces Malaysia’s attractiveness as a medical travel destination,” said Joe Sim, CEO of Malaysia Operations Division at IHH.

Prince Court Medical Centre medical director Dr Kuljit Singh said: “As part of the IHH Group, Prince Court Medical Centre can leverage on its scale and track record to unlock greater synergies and enhance our suite of service offerings and delivery of value-based care.”

/CodeBlue 09-12-2019

Fee Deregulation, Doctors still oppose Dispensing Separation

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The Malaysian Medical Association (MMA) still does not support separating the prescribing and dispensing of medicines to doctors and pharmacists respectively, despite the deregulation of physicians’ professional charges.

The country’s largest association of doctors said various health stakeholders had agreed back in 2015 that dispensing separation could only come about in a national health financing system, or a single-payer system.

A single-payer system means health spending is primarily made by the government, rather than the current multi-payer system that sees health care payments made by the Health Ministry, the Education Ministry, other federal agencies, private insurance, corporations, and people’s own out-of-pocket payments, among others.

“It’s not only the consultation fees. We’re talking about government structure, how they’re going to do that. What about the restriction? What is the audit trail? Will there be a duplication? Will there be fraud in the prescription? Who’s going to audit that? So there are lots of factors involved.

“So MMA will only support only when we have a single-payer system, which was agreed upon by all parties,” MMA Honorary General Secretary Dr R. Arasu told radio station BFM today.

The physician also said there must first be an electronic medical record (EMR) system that integrates patients’ medical histories between public and private health facilities, pharmacies, and general practitioner (GP) clinics.

“We must make sure the building blocks are in place,” said Dr Arasu. “Until then, dispensing separation is not feasible.”

The Health Ministry recently tried to criminalise non-compliance of mandatory prescriptions upon request, but was forced to postpone subsequent readings of the Poisons (Amendment) Bill 2019 in Parliament to 2020 after physicians’ and dentists’ groups expressed outrage against proposals of incarceration and fines for rejecting patients’ prescription requests.

The Health Ministry made a surprise announcement recently that GPs, dentists and specialists in private clinics and hospitals would be free to set their own consultation fees, 13 years after the professional rates of private medical practitioners were first regulated by legislation.

Clinic GPs had long been demanding that their consultation charges of RM10 to RM35, a rate set since 1992, be increased to their hospital-based counterpart rates of RM30 to RM125.

Dr Arasu assured Malaysians today that the total encounter fee in private clinics would either remain the same or only see a “marginal increase”, despite the deregulation of family doctors’ professional charges.

“So what we foresee is that the medicine price will be reduced and the doctors will start charging appropriate consultation fees for the services they actually provide for the patients.

Dr Arasu also pointed out that the deregulation of family physicians’ consultation fees would encourage GPs to provide other health services, like preventive counseling.

/CodeBlue 12-12-2019

Proposed Health Activities for 2020

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Malaysia is expected to see a revamped Health Financing System (HFS) if the Cabinet approves the healthcare reform proposal by the Health Ministry.

Minister Datuk Seri Dr Dzulkefly Ahmad said he planned to bring the Sihat Bersama (Health Together) 2030 proposal to the Cabinet before the end of January 2020.

A sustainable (1) HFS (2) public sector transformation through corporatisation in order to become more empowered, agile and responsive and (3) private sector regulatory reform. These are the three pillars outlined in Sihat Bersama 2030 to transform the healthcare system.

“Unless you have the HFS in place, there’s no point in bringing reform in the government and private sector, ” Dzulkefly said. He said Sihat Bersama 2030, which is the health sector’s version of the Shared Prosperity Vision 2030, would enhance existing healthcare services and address issues such as the lack of funds, long waiting period, lack of medical staff, the burden of non-communicable diseases and an ageing population. It will be a comprehensive plan that will address the health systems and healthcare delivery issues in the country.

He said the purpose of the HFS was twofold – (1) to increase pooled and prepaid health financing in a sustainable, diversified manner that is equitable and affordable for households and employers and (2) to establish a well-governed health financing institution.

Once approved by the Cabinet, a task force would be set up to look into implementation studies and communication strategies.

In Sihat Bersama 2030, the electronic medical record (EMR) system that stores the records of patients in public health facilities nationwide would be introduced nationwide to cut down waiting times and enhance patient care and population health.

EMR would be made accessible to private medical centres too, and could be used for research and decision-making on public health issues, and that the ministry would request proposals from the private sector to undertake the project this year.

Meanwhile, the price control mechanism and pool procurement of medicine would be rolled out by mid-year, he said.

On other measures, Dzulkefly said housemanship training would be reduced from 24 months to 18 months, and there would be five postings for training instead of six.

He also hoped to address service delivery issues such as reducing the waiting time and congestion in public health facilities by setting up 20 clinics, having more clinics with extended hours and expanding the use of e-registration and e-wallet payments.

The government will also increase the number of virtual clinics from the current five, while selected follow-up cases could use the virtual clinics manned by the same doctors.

On the concern over polio, the ministry has discussed with its Filipino counterpart about addressing the issue of stateless children in Sabah and the Philippines has agreed to fund polio vaccination of the children, with Unicef providing the cheaper vaccine that will be administered by NGOs.

The ministry has put in place a real-time surveillance dashboard to monitor disease outbreaks, hotspots, as well as facilities and doctors available.

When needed, district health officers would go to the ground to immunise the population at the hotspots.

As mentioned in the Budget 2020 announcement, pneumococcal vaccination will be rolled out this year, though no specific date has been set.

Meanwhile, the government will also expand the Skim Peduli Kesihatan (Peka B40) coverage to include individuals aged 40 and above from the low-income (B40) group.

Peka B40 provides health screenings and early intervention for non-communicable diseases such as cancer and mental health problems, and currently covers those aged 50 to 60.

A National Strategic Action Plan on Mental Health (2020-2025) will also be launched this year.

/theSTAR 02-01-2020

Malaysia 2020: Expected GDP growth at 4.8%

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The government remains steadfast in the belief that Malaysia will achieve an economic growth of 4.8% in 2020 as it expects to see positive effects from its development spending latest by June 2020, according to Finance Minister, YB Lim Guan Eng.

“We are confident about maintaining the projection, supported by a rebound in the commodity prices, growth in investment spurred especially by government spending, as well as expectations of a positive outcome to the US-China trade war, ” he told Bernama.

He was commenting on the downward revisions of the 2020 growth projections by economists. Last month, the World Bank Group trimmed its forecast of the country’s gross domestic product (GDP) growth for this year to 4.5% from 4.6% previously on weakening investment and trade activity recorded in the third quarter of last year.

“There was no problem in terms of development expenditure for ongoing projects, but new projects would have to be brought forward to 2020 and added to Budget 2020 (for new developments), ” he pointed out.

On the US-China trade war, Lim said the end of the dispute would be a booster or catalyst to spur the economy.“As an exporting economy, Malaysia will benefit.

/theSTAR 01-01-2020

Dengue cases Unabated

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The total number of dengue cases this year has reached an all-time high with 120,871 cases recorded as of Wednesday, December 2019 This averages out to about 331 new cases reported every day.

The previous high was recorded in 2015, with 120,836 cases.

In August, Deputy Health Minister Lee Boon Chye cautioned that the number could hit 150,000 by year-end.

The latest numbers were published on the iDengue website, which is run by the Health Ministry in collaboration with the National Space Agency.

The website, which is updated daily, noted that there have been 164 dengue-related deaths up to Nov 30, 2019 which had surpassed the 147 fatalities recorded in the whole of last year.

However, this is an improvement compared to the 336 deaths recorded in 2015.

The iDengue website provides information on hot spots, preventive measures and contact numbers of operation rooms in every state.

/theSTAR 05-12-2019