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.

An Expert Discusses What Happened to the Generational Endgame Bill of Malaysia

WORDS MUHAMMAD ZAID ZAINUDDIN

FEATURED EXPERT
MUHAMMAD ZAID ZAINUDDIN
Lecturer (Anatomy)
Centre of Preclinical Science Studies
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
IN RECENT NEWS

In November 2023, the Dewan Rakyat passed the Control of Smoking Products and Public Health Bill.

The Bill aims to regulate the sale and purchase of tobacco products, smoking materials, tobacco substitute products, and smoking devices, which includes smoking products such as electronic cigarettes or vape.

Though the passing of the bill is a positive step for the country’s public healthcare system and future generations, it has left members of the parliament and public health experts outraged.

WHY THE OUTRAGE?

The passed Control of Smoking Products and Public Health Bill is a watered-down version of the ambitious proposal initiated by our former Minister of Health, Khairy Jamaluddin.

The previous bill, dubbed the “Generational Endgame Bill”, proposed to prohibit persons born on or after 1 January 2007 from purchasing and smoking tobacco products, substitute tobacco products and smoking substances which includes e-cigarettes and vapes.

The bill passed in November 2023 removed this bold clause that would give rise to a smoke-free Malaysian generation in the future.

WHAT WOULD HAPPEN IF THE GENERATIONAL ENDGAME BILL WAS PASSED IN ITS ORIGINAL PROPOSED FORM?

In terms of impact on healthcare, the proposed Generational Endgame policy would ban smoking and vaping for those born in 2007 and onwards for the rest of their lives.

Ideally, this will create a smoke-free generation in the coming decades and save north of RM6 billion ringgit per year in terms of healthcare expenditure in the years to come.

This is stipulated by 2020 data, whereby the country had spent RM6.2 billion to treat three major diseases caused by smoking; lung cancer, heart disease, and chronic obstructive pulmonary disease. This cost was estimated to increase to RM8.8 billion by 2030 and will increase further if smoking had not been curbed.

THEN, WHY WAS THE GENERATIONAL ENDGAME CLAUSE DROPPED?

The Generational Endgame clause was dropped after considering the views from the Attorney-General’s Chambers, who claimed potential constitutional arguments.

The clause is unconstitutional.

In brief, the passing of the bill would create unequal treatment under the law between persons born before 1 January 2007, and individuals born after.

This is contradictory to Article 8 (1) of the Federal Constitution, which states that every person shall be equal under the law and have equal protection of the law.

The proposed bill would be unconstitutional as it would create two sets of laws for two different groups of citizens based on age.

Socio-economic impact on Malaysians.

An assessment of Malaysia’s Generational Endgame Policy by Oxford Economics, published in September 2023, states that the policy would be unlikely to deliver a reduction in healthcare costs. This is because future smokers would switch to illicit products.

This is on the basis that Malaysia has one of the largest illicit tobacco problems globally, with an estimated 57% of all cigarette sales in 2022 occurring through illicit channels.

An argument against the bill claims that a total ban of tobacco products would just expand the illicit tobacco market.

Impact on the economy.

The report also estimates that the legal tobacco industry in Malaysia currently supports a RM983 million contribution to the country’s GDP, RM3.3 billion in tax receipts, and 7,940 jobs.

A total ban of tobacco products would decrease these economic benefits on top of having to sustain an expensive expenditure on policy implementation, public communication, and enforcement programmes in addition to efforts needed to control the expanding of illicit markets.

IS THIS THE END OF THE GENERATIONAL ENDGAME POLICY?

Absolutely not!

The passing of the current bill is a small step forward toward achieving the Generational Endgame policy.

Though not banning the selling of tobacco products in its entirety, the Control of Smoking Products and Public Health Bill protects the younger generation from modern smoking devices, a rampant disease amongst our teenage youths.

The bill prohibits the sale and purchase of tobacco products, smoking materials, or substitute tobacco products as well as the provision of any services for smoking to under 18-year-olds, ultimately curbing the increase of smoking and vaping habit amongst children and teenagers.

IN CONCLUSION

Though our healthcare workers and policy makers are working hard to curb the rise of smoking and vaping, it is of the highest importance to maintain public awareness of the dangers of smoking and vaping. Such public awareness should be promoted and reiterated from generation to generation.

References:

  1. Bernama. (2023, December 7). Experts: Anti-smoking bill first step towards a smoke-free generation. NST Online. https://www.nst.com.my/news/government-public-policy/2023/12/987431/experts-anti-smoking-bill-first-step-towards-smoke-free
  2. Choy, N.Y. (2023, November 23). Health minister pledges to table Generational Endgame bill on tobacco before the end of Parliament sitting. The Edge Malaysia. https://theedgemalaysia.com/node/690959
  3. Harun, H. N. (2023, November 28). GEG dropped due to constitutional arguments – Dr Zaliha. NST Online. https://www.nst.com.my/news/government-public-policy/2023/11/984010/geg-dropped-due-constitutional-arguments-dr-zaliha
  4. Cabello, K. (2023, October 6). An assessment of Malaysia’s ‘Generational Endgame Policy’. Oxford Economics. https://www.oxfordeconomics.com/resource/gegmalaysia/