An Expert Explains What Many People Tend to Misunderstand about Palliative Care

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HAYATI YAAKUB
Consultant General Physician
Sunway Medical Centre

Palliative care is often misunderstood. Many think it’s only for those nearing the end of life, but that couldn’t be further from the truth.

“Palliative care isn’t just about managing physical pain,” Dr Hayati Yaakub explains. “It provides emotional and psychological support to both patients and their families throughout their entire journey.”

THE DIFFERENCE BETWEEN HOSPICE CARE AND PALLIATIVE CARE
  • Dr Hayati clarifies that hospice care is a part of palliative care but is only for patients when treatment is no longer aimed to cure. It focuses on managing symptoms during the remaining phase of life.
  • Palliative care focuses on improving the quality of life for patients and their loved ones throughout the entire journey.
  • Unlike traditional medical care, palliative care mainly focuses on treating the disease holistically and being patient-centred, ensuring comfort in every aspect of the patient’s and family’s experiences.
  • “In a world where only 14% of people globally receive the palliative care they need, this underscores the importance of expanding the support, especially as Malaysia’s ageing population continues to grow,” says Dr Hayati.

Dr Hayati recalls how, one month after her patient passed away, a family member returned to her for emotional support. “He had fallen into depression,” she shares, “and his inability to manage the emotional strain was affecting his work and overall well-being.”

The story highlights a crucial, often overlooked aspect of palliative care—it extends beyond the patient’s passing.

PALLIATIVE CARE EXPLAINED IN MORE DETAIL
  • The word “pallative” is derived from the Latin word ‘pallium’, which means ‘cloak’.
  • Palliative care focuses on ‘cloaking’ or relieving the suffering of those with life-threatening illnesses and improving their quality of life.
  • Palliative care can be introduced at any stage of a serious illness, working alongside ongoing treatment to improve the patient’s quality of life by managing symptoms and providing comprehensive support.
  • Beginning from the patient’s diagnosis and continuing through the patient’s treatment, the palliative care physician will work alongside other specialists such as oncologists and cardiologists to offer both physical and emotional support to the patient and their families.
THE PALLIATIVE CARE SYSTEM IN MALAYSIA

According to Dr Hayati, the palliative care in Malaysia can be categorized into:

  • Hospital-based hospices
  • Community-based hospices, primarily run by non-governmental organizations (NGOs)

While both categories are tended by healthcare professionals, community-based hospices are especially beneficial for patients who prefer not to remain in a hospital.

WHO SHOULD CONSIDER GETTING PALLIATIVE CARE?

Among those that would benefit from palliative are people that are suffering from chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, AIDS, and diabetes.

Dr Hayati explains: “With these diseases, patients may struggle with symptoms like shortness of breath or pain. Palliative care can help alleviate the symptoms and manage the comorbidities associated with the disease.”

“In cases of cancer, it assists patients in managing the side effects of chemotherapy or radiation such as nausea or vomiting, allowing them to live as fully as possible,” she adds.

By integrating palliative care into the overall healthcare plan, patients can continue to receive treatment for their illness while also benefiting from the additional support provided through palliative care.

MORE THAN JUST TREATMENT

Dr Hayati further reveals that palliative care can offer emotional and spiritual support for patients’ families and caregivers in navigating the challenges of their loved one’s illness.

“Beyond emotional care, they can also rely on palliative care providers for practical assistance such as patient care education, caregiver support and education, access to necessary equipment, and spiritual guidance,” she explains.

“This ensures that they are not alone throughout the entire process, even after the patient passes away. By offering consistent, compassionate and clear communication, palliative providers build trust and provide stable support systems for families and caregivers.”

PALLIATIVE CARE IS NOT AN ACT OF GIVING UP; IT IS A COMPASSIONATE APPROACH

Dr Hayati assures us that palliative care should not be seen as a sign of giving up.

“Rather, it should be viewed as a compassionate approach that empowers patients and their families to live as actively as possible throughout the healthcare journey,” she states.

 

Healing Across Genders: The Bald Oncologist Tackles Cultural Norms in Malaysian Cancer Treatment

WORDS LIM TECK CHOON

FEATURED EXPERT
DR MALWINDER SINGH SANDHU
“The Bald Oncologist”
Consultant Clinical Oncologist
Pantai Hospital Kuala Lumpur
Website and Social Media

In the realm of oncology, gender plays a crucial role in shaping caregiving dynamics and communication between patients and healthcare providers. To give us a better understanding of this, Dr Malwinder Singh Sandhu, also known as “The Bald Oncologist”, joins to share some valuable insights into how gender influences caregiving responsibilities and impacts the support needs of patients navigating cancer treatment.

GENDER NORMS AND CANCER COMMUNICATION

Dr Malwinder reveals that, in Malaysia, cultural expectations and gender norms play a crucial role in shaping the way cancer patients communicate with healthcare providers, adhere to treatment plans, and cope with the challenges of the disease. These gender-specific factors have significant implications for both the diagnosis and management of cancer.

MEN WOMEN
  • Expected to be stoic.
  • May downplay symptoms or avoid discussing discomfort, leading to delayed diagnoses and inadequate symptom management.
  • Might feel more comfortable discussing symptoms but may be hesitant to talk about reproductive health, especially with male doctors.
  • Caregiving responsibilities often cause women to prioritize their family over their own health, which can lead to underreporting symptoms.
GENDER-SPECIFIC BARRIERS TO CANCER CARE 

According to Dr Malwinder, gender norms can also present barriers to accessing cancer care,

MEN WOMEN
  • Cultural pressures to remain strong may delay seeking treatment until symptoms are severe.
  • Men may also find it hard to adhere to treatment regimens if they feel it interferes with their work or provider roles.
  • Stigma surrounding certain cancers, like breast and cervical cancer, can cause delays in seeking care.
  • Balancing caregiving duties with their own health needs can also lead to treatment adherence challenges
PSYCHOLOGICAL IMPACT OF CANCER DIAGNOSIS & TREATMENT

“Men and women experience cancer’s psychological toll differently,” Dr Malwinder tells us.

MEN WOMEN
  • Often suppress emotions, internalizing anxiety and fear.
  • This can worsen their mental health, but men are also less likely to seek psychological support due to societal expectations of emotional strength.
  • While women may be more emotionally open, they often worry about becoming a burden on their families.
  • Guilt and anxiety about their family’s future are common psychological challenges.

One way to address these psychological challenges for both men and women is by joining a support group.

  • These groups provide a safe space for patients to share their concerns, gain emotional support, and learn how to cope with their illness from others facing similar experiences.
  • Support groups can help break down gender barriers, encouraging both men and women to open up about their struggles, and ultimately improve their overall mental health.
BODY IMAGE CONCERNS IN CANCER PATIENTS

“Changes in physical appearance from cancer treatments, such as surgery or chemotherapy, can cause body image issues,” says Dr Malwinder. “These concerns are also shaped by gender.”

WOMEN MEN
Physical changes, like hair loss or mastectomies, can severely impact a woman’s sense of identity, exacerbating stress and leading to potential identity crises. While not discussed as openly, men also struggle with body image issues, especially when treatments cause weakness or weight loss, challenging their sense of masculinity
HOW GENDER INFLUENCES OTHER ASPECTS OF CANCER CARE

Dr Malwinder further shares the following information.

MEN WOMEN
  • Treatment adherence and follow-up care. May be less consistent with follow-up appointments, especially if they feel “recovered” enough to resume their responsibilities.
  • Palliative care. Cultural norms of resilience may prevent men from discussing pain, leading to inadequate pain management.
  • Support. Tend to have smaller, less emotionally-focused support networks. Cultural expectations of strength can leave them feeling isolated, with limited community support.
  • Treatment adherence and follow-up care. While balancing family obligations can be a challenge, women are generally more consistent with follow-up care when encouraged by healthcare providers.
  • Palliative care. Women in traditional caregiving roles may prioritize their family’s needs, making them reluctant to seek end-of-life care.
  • Support. Often have wider social networks, supported by family and female friends, and are more likely to seek emotional support from community or religious groups.
DR MALWINDER’S RECOMMENDATIONS TO HEALTHCARE PROVIDERS FOR A MORE GENDER-INCLUSIVE APPROACH TO CANCER CARE
Diagnosis
MEN WOMEN
Oncologists should create a safe environment for men to express vulnerability without judgment. Healthcare providers should encourage women to prioritize their own health over caregiving responsibilities.
Treatment
MEN WOMEN
Treatment plans should accommodate men’s work commitments to improve adherence. Offer support for balancing family care and treatment helps women adhere to their treatment plans.
Follow-up Care
MEN WOMEN
  • Regular check-ins with encouragement to stay consistent in their care are vital.
  • Promote support groups to help deal with emotional and psychological challenges.
  • Support systems that alleviate caregiving burdens can improve treatment adherence.
  • Promote support groups to help deal with emotional and psychological challenges.
Caregiving Support
  1. Acknowledge the different strengths of male and female caregivers.
    • Support programs should cater to the strengths and challenges of both genders.
    • Female caregivers might need respite care and emotional support, while male caregivers could benefit from guidance in providing more emotional care.
  2. Encourage open communication.
    • Open conversations about caregiving and support can break down gender norms.
    • Male caregivers should be encouraged to engage emotionally, while female caregivers should feel empowered to ask for help and set boundaries.
  3. Expand support networks for male patients.
    • Community programs should be developed to help male cancer survivors and caregivers connect.
    • Tailored support groups for men can provide a space to discuss struggles and break cultural barriers.
  4. Establish family support structures.
    • Families should be educated on sharing caregiving responsibilities equally, encouraging sons and male relatives to take on more emotional caregiving roles.
  5. Leverage community and religious groups.
    • Community and religious organizations play a crucial role in providing social support, especially for female patients.
    • Encourage these groups to also support male patients and caregivers as an essential step to extend care networks.

Ovarian Tissue Cryopreservation Offers Hope for Women with Cancer to Preserve Their Fertility

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR MOHD FAIZAL AHMAD
Consultant Obstetrician & Gynaecologist and Fertility Specialist
Sunfert International Fertility Centre

Ovarian tissue cryopreservation or OTC is a technique that allows female cancer patients the opportunity to preserve their fertility.

5 FACTS ABOUT OVARIAN TISSUE CRYOPRESERVATION
  1. It was introduced in Denmark and Europe over 25 years ago.
  2. This technique involves the harvesting the woman’s entire ovary and dissecting the cortical layer containing eggs through a process called laparoscopic procedure.
  3. The ovary is then frozen in a specialized titanium device and stored in a cryopreservation tank at -190º Celsius. It can be safely kept in good condition for up to 20 years.
  4. No medications needed.
  5. This is a quick procedure, taking only about 15 to 20 minutes.
WHAT HAPPENS AFTER THE OVARY IS FROZEN?

Once the woman is cleared of cancer and is ready to start a family, the ovary will be thawed and eventually transplanted back into her body.

WHO SHOULD CONSIDER OVARIAN TISSUE CRYOPRESERVATION?

According to Associate Professor Dr Mohd Faizal Ahmad, OTC is well-suited for:

  • Pre-pubescent girls who may be diagnosed with cancer, as they typically lack mature eggs suitable for freezing.
  • Women in their reproductive years that are diagnosed with cancer and need to start chemotherapy or radiotherapy treatments right away.
HOW IS THIS PROCEDURE DIFFERENT FROM CONVENTIONAL EMBRYO AND EGG FREEZING?
  • It is less invasive.
  • It is a faster procedure.

An Oncologist Spotlights the Newest & The Latest in Stereotactic Radiosurgery Technology

WORDS DR AMINUDIN RAHMAN MOHD MYDIN

FEATURED EXPERT
DR AMINUDIN RAHMAN MOHD MYDIN
Consultant Clinical Oncologist
KPJ Damansara Specialist Hospital

It’s an undeniable fact that cancer is one of the leading causes of death both in Malaysia and worldwide.

HOWEVER, CANCER NEED NOT NECESSARILY BE A DEATH SENTENCE THESE DAYS

There are numerous developments in the technology behind cancer screening that allows more precise cancer treatment and hence a greater potential for better treatment outcome.

Many exciting developments have taken place in the field of radiation therapy, also called radiotherapy.

Radiation therapy involves the use of high-powered X-rays and other types of radiation to disrupt the growth of a tumour.

As a result, the tumour will eventually start to shrink.

Depending on the type and severity of cancer, it can be used as a single form of cancer treatment.

It can also be used alongside chemotherapy and other forms of cancer treatments. For example, after a surgery to remove a tumour, the patient may receive radiation therapy to eliminate any leftover cancer cells in their body.

One significant development in radiation therapy is stereotactic radiosurgery, which is available in Malaysia.

WHAT IS STEREOTACTIC RADIOSURGERY (SRS)?

Click on the image for a larger, clearer version.

  • This is a very precise form of radiation therapy.
  • It can be used on both cancerous and non-cancerous or benign tumours.
The advantage of SRS over older radiotherapy systems
  • Delivers high doses of radiation in tiny, precise beams that target the tumour(s) while minimizing damage to surrounding tissues.
  • Its high precision allows for treatment of very small tumours as well as tumours located close to important organs.
  • High doses of radiation allow for more effective treatment of tumours.
  • Less damage to surrounding healthy tissues means fewer potential side effects compared to older systems.

Stereotactic radiosurgery is commonly used to treat the following:

  • Abnormalities in the brain and spine, including cancer.
  • Benign or non-cancerous tumours.
  • Epilepsy.
  • Trigeminal neuralgia, a rare and very painful chronic disease that affects the trigerminal nerve in the brain.
  • Abnormal connections between arteries and veins, or arteriovenous malformations.
THE DIFFERENT TYPES OF STEREOTACTIC RADIOSURGERY
Gamma knife
  • Commonly used to treat tumours and lesions in the brain.
  • No actual knives are involved here—the ‘knife’ here is a highly focused beam of radiation!
  • The beam is typically delivered under the control of a computer-guided treatment.
  • The use of artificial intelligence or AI shows promise in optimizing delivery route of the radiation beam to the targeted areas of treatment.
Stereotactic body radiation therapy (SBRT)
  • Commonly used on cancers that are still confined to a small area of the body and have not yet spread into nearby tissues.
  • SBRT is used for tumours and cancers outside the brain, commonly those in the head and neck, lung, liver, pancreas, kidney, prostate, and spine regions.
  • This treatment method delivers high doses of radiation to the targeted area over a matter of days. (Conventional radiation therapy may take place over a matter of weeks.)
  • While highly concentrated radiation is applied, don’t worry—the treatment isn’t painful.

Proton therapy

  • Commonly used to treat both cancerous and non-cancerous tumours that are located near important organs such as brain and spinal cord. It is also frequently used to treat cancer in children.
  • This is a pretty complicated treatment, as the oncologist and their colleagues would need to first determine the specific location, size, and dimension of the tumour. This is often done via imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI).
  • Once these details are obtained, the radiation oncologist will direct high-energy proton beams onto the tumour.

Linear accelerator (LINAC)

  • Commonly used to treat cancers and tumours of the brain, spine, prostate, lung, breast, oesophagus, stomach, rectum, uterus, bladder, liver, kidney and more.
  • This is a high-definition dynamic radiosurgery (HDRS) treatment that allows for accurate delivery to small areas of the body.
  • It can target areas accurately, thereby minimizing exposure to healthy cells and hence side effects.
  • It is also capable of delivering high-dosage radiation beams. This usually means that the patient’s radiotherapy sessions will take less time, and they will also require fewer sessions compared older radiotherapy systems.

A Significant Milestone in Improving the Access of Malaysians to Comprehensive Genomic Profiling

Recently, Roche Pharmaceuticals and Roche Diagnostics cemented a partnership with Premier Integrated Labs with the signing of a memorandum of understanding (MOU). This MOU is effective from November 2023.

The objectives of this partnership include improving patient access to comprehensive genomic profiling or CGP as well as promoting greater awareness and understanding of CGP among Malaysians.

MS HENG CHAI YIN
General Manager
Roche Diagnostics (M) Sdn Bhd

“While awareness and understanding are crucial, our ultimate goal is to ensure that CGP is accessible to all patients in Malaysia. It is about providing every patient with the best possible chance for an accurate diagnosis and tailored treatment plan,” says Ms Heng Chai Yin, the General Manager of Roche Diagnostics Sdn Bhd.

WHAT IS COMPREHENSIVE GENOMIC PROFILING (CGP)?

With a single test, comprehensive genomic profiling (CGP) can analyse a broad panel of genes that is known to drive cancer growth. This type of testing produces comprehensive patient reports with broad and deep assessments of the possible underlying cancer drivers.1

HOW CGP PLAYS A KEY ROLE IN PRECISION MEDICINE

Precision medicine involves the use of personalized treatments for an individual with regards to a disease.2

Different people can respond differently to the same medication for the same disease, and there are many possible factors that are responsible for these differences.

Hence, a big part of precision medicine involves the identification of these differences through investigative methods such as in the image below.

Click on the image for a larger, clearer version. CGP falls under omics. Hence, it is one of the important procedures that provide healthcare professionals with the necessary data to design the best personalized treatments for their patients.
HOW CGP CAN IMPROVE THE PRECISION OF CANCER TREATMENT IN MALAYSIA
MS DEEPTI SARAF
General Manager
Roche (Malaysia) Sdn Bhd

According to Ms Deepti Saraf, CGP holds the key to unlocking the full potential of personalized medicine. It allows us to explore the genetic makeup of individuals, thereby enabling more precise and tailored treatment approaches.

Let’s look at lung cancer as an example.

How CGP could improve treatment for lung cancer and benefit both the patient and the oncologist. Click the image for a larger, clearer version.
CGP IS DIFFERENT FROM CONVENTIONAL GENOMIC TESTS

Ms Deepti Saraf points out that, unlike those genomic tests in the market that let you know about your genes and ancestry, CGP is more of a diagnostic tool that empowers doctors, especially oncologists, to create the most optimal personalized treatments for their patients based on available data.

EN HAREEFF MUHAMMED
Chief Executive Officer
Premier Integrated Labs

En Hareeff Muhammed brings up that, with the wealth of genomic data obtained through the use of CGP, databases can be created to analyse which treatments would work best for different groups of patients.

This goes back to Ms Deepti Saraf’s statement that CGP allows healthcare professionals to design the best personalized treatments for their patients. They can do this by using the information found in the database to help shape their decisions.

“It’s not just useful for the patients and saves time,” En Hareeff elaborates. “It also supports doctors in making better decisions.”

This is an educational article brought to you by

References:

  1. Foundation Medicine. (n.d.). Why comprehensive genomic profiling? https://www.foundationmedicine.com/resource/why-comprehensive-genomic-profiling
  2. König, I. R., Fuchs, O., Hansen, G., von Mutius, E., & Kopp, M. V. (2017). What is precision
    medicine?. The European respiratory journal, 50(4), 1700391. https://doi.org/10.1183/13993003.00391-2017
  3. Omics-based clinical discovery: Science, technology, and applications. (2012, March 23). In C.M. Micheel, S.J. Nass, & G.S. Omenn (Eds), Evolution of translational omics: lessons learned and the path forward (p. 33). National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK202165/
  4. Tan, J., Hu, C., Deng, P., Wan, R., Cao, L., Li, M., Yang, H., Gu, Q., An, J., & Jiang, J. (2021). The predictive values of advanced non-small cell lung cancer patients harboring uncommon EGFR mutations-the mutation patterns, use of different generations of EGFR-TKIs, and concurrent genetic alterations. Frontiers in oncology, 11, 646577. https://doi.org/10.3389/fonc.2021.646577
  5. American Lung Association. (2022, November 17). EGFR and lung cancer. https://www.lung.org/lung-health-diseases/lung-disease-lookup/lungcancer/symptoms-diagnosis/biomarker-testing/egfr

IFPMA Launches New Video to Share How Innovative Ideas Are Changing Cancer Care for the Better

WORDS LIM TECK CHOON

#AlwaysInnovating is an initiative by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), which aims to share with the world the expertise, collaboration, and perseverance involved in transforming ideas and innovations into real-world medicines and vaccines.

We’re pleased to share with you the latest film and expert insight from #AlwaysInnovating, in which an animated guide called Sparky will explain how decades of dedicated cancer research and innovation have paved the way for a reimagined approach to cancer care bringing fresh hope to people with cancer as well as their carers.

HERE’S THE VIDEO

FOR MORE INFORMATION

Click here to access the IFPMA webpage to learn the sobering statistics of the cost of cancer of our lives and how, driven by this cost, the pharmaceutical industry is driving innovation across all areas of medicine to delivering new medicines to those in need. Link opens in a new tab.