Cancer Topics – ICC Program Malaysia

Providing high-quality cancer care to patients is the goal for any oncologist, yet there are many places across the globe that face multiple hurdles in achieving that goal. In this ASCO Education podcast we explore how one group is making a positive impact in the state of Surawak in Malaysia via the efforts of ASCO’s International Cancer Corp Program (ICC).  Dr. Roselle de Guzman, past chair of the Asia Pacific Regional Council of ASCO, Dr Voon Pei Jaye medical oncologist and onsite director of the ICC Program at Sarawak and Dr. Evangelia D. Razis medical oncologist focused on neuro-oncology from Athens, Greece and ASCO volunteer of the ICC Malaysia Program describe the benefits of implementing the efforts of Project ECHO (Extension of Community Healthcare Outcomes) (3:38), the challenges in providing quality cancer care in Sarawak (8:31) and details on how to volunteer for the ICC program (19:45). 

Speaker Disclosures Dr. Roselle de Guzman:  Honoraria - Roche Oncology (Philippines); AstraZeneca; Merck Serono, MSD Oncology Recipient, Boehringer Ingelheim, Zuellig Pharma Consulting or Advisory Role - Roche Recipient, Novartis, Boehringer Ingelheim, AstraZeneca, Zuellig Pharma (ZP) Therapeutics, Eisai Recipient, MSD Oncology Research Funding - Centus Biotherapeutics Travel, Accommodations, Expenses - Hospira (Philippines), Roche (Philippines), Merck Sharp & Dohme, Eisai, Boehringer Ingelheim, AstraZeneca, Pfizer Dr. Evangelia D. Razis: Honoraria Company - Servier pharmaceuticals. ESMO Research Funding – Tesaro, IQvia, AstraZeneca, Exelixis, PPD Global, MSD Travel, Accommodations, Expenses - Genesis Pharmaceuticals, Roche, Pfizer, Karyo Dr. Pei Jye Voon: Research Funding - Novartis Recipient, Boehringer Ingelheim, Viracta Therapeutics Inc,  ROCHE, Merck KGaA, Merck Sharp & Dohme, BeiGene, AstraZeneca, Janssen-Cilag, Johnson & Johnson Resources  If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org.

TRANSCRIPT

Disclosures for this podcast are listed in the podcast page. 

Dr. Roselle De Guzman: Providing high-quality cancer care to patients is the goal for any oncologist, yet there are many places across the globe that face multiple hurdles in achieving that goal. One such location has limited trained personnel, financial constraints, geographical challenges, and limited access to healthcare service in rural areas. The location, the state of Sarawak, located in the eastern part of Malaysia. The population is almost evenly split between urban and rural areas, which are the most dispersed in Malaysia. 

The major challenge in Sarawak is the inadequate connectivity in the rural area and limited access to healthcare service. To address these issues, in 2020, a collaboration was formed between Sarawak General Hospital, University of Malaysia Sarawak and ASCO through ASCO's International Cancer Corp Program, or ICC for short. The ICC program is focused on three basic goals: incorporating a multidisciplinary approach into cancer care, integration of palliative care into oncology care, and quality improvement through ASCO's Quality Oncology Practice Initiative, or COPI program. This podcast will spotlight all the planning, activities, and results thus far of the ASCO ICC program in Malaysia.

Hello, I'm Dr. Roselle de Guzman, past chair of the Asia Pacific Regional Council of ASCO. I am pleased to spotlight one of ASCO's collaborations with a lower-resource country to improve the quality of cancer care through a multifaceted approach. This year, we are focusing on Malaysia, where, through the ICC program, ASCO has been providing training in multidisciplinary care, palliative care, and quality measurement. Joining us later in the podcast will be medical oncologist Dr. Voon Pei Jye, who serves as the Onsite Coordinator for the ICC program at Sarawak.  

First, we will speak to an ASCO volunteer of the ICC Malaysia Program, a medical oncologist focused on neuro-oncology, Dr. Evangelia Razis from Athens, Greece. 

Welcome, Dr. Razis. 

Dr. Evangelia Razis: Thank you. Thank you for the opportunity.

Dr. Roselle De Guzman: First of all, Dr. Razis, what made you want to volunteer for the ICC Malaysia program, and what has been the most rewarding aspect of this service for you?

Dr. Evangelia Razis: So, I've been actually collaborating with ICC for many years through ASCO and other programs as well, such as Honduras, and I find volunteering an extremely rewarding experience because you share and interact with colleagues from all over the world, you offer to those less fortunate, and you actually learn a lot through this process as well. So, volunteering is a very rewarding process for me, and I've been involved in it for many years. Plus, the opportunity to do something in neuro-oncology, which is very close to my heart, is very important, because this is a new field. I feel it needs to be exposed in all countries because it has many intricacies. 

Dr. Roselle De Guzman: Well, that's really rewarding and must be really fulfilling work for you, Dr. Razis.  

Dr. Razis, you also serve as a lead facilitator of the Project ECHO Neuro-Oncology Mock Tumor Board series, which delivers monthly online training to physicians from Malaysia. Can you tell us more about this project? What are mock tumor boards?

Dr. Evangelia Razis: So, Project ECHO, the word stands for Extension of Community Healthcare Outcomes, and it's a project that has attempted to be near community healthcare delivered in low and middle-income countries through virtual media to support the healthcare in these areas. And in this particular effort, we are holding a neuro-oncology tumor board once a month since September with the Malaysia team. It's mock because we don't actually deliver specific patient advice for the purpose of patient care. We actually do it for educational purposes. So, we present cases and then discuss a topic.  

The program has been set up for several months now by the Malaysia team based on their needs, which neuro-oncology topics they want to highlight. And we have a once a month, one-and-a-half-hour session, whereby cases are presented, and then an invited speaker from several places around the world, as I'll tell you in a minute, highlights this topic and then discusses the cases and discusses the questions that the group from Malaysia has. 

And not only have we been able to be joined very regularly by the Sarawak team, but other parts of Malaysia have joined in, other centers in Malaysia have joined in different occasions. Now, the speakers have been experts from Europe and the United States based on their expertise in particular neuro-oncology topics. 

Dr. Roselle De Guzman: So, Project ECHO is one of those innovative ways of delivering healthcare to extraordinarily challenging environments, those which are extremely remote or under-resourced areas. So to your knowledge, Dr. Razis, what improvements have been made since the implementation of Project ECHO?

Dr. Evangelia Razis: Over the last nine months, I have noticed more insightful questions that show that some understanding of the standard neuro-oncology way of thinking, if you will, has come through to the colleagues that are joining us, though I must say that they were very knowledgeable from the beginning. I also hope that certain intricacies of neuro-oncology, such as, for example, the way to read scans and evaluate the fact that there may be pseudo progression or pseudoresponse, the way to integrate molecular parameters into the decision-making process, has now become part of the way they think about patients. And ultimately, the most important aspect has been the multidisciplinary approach to neuro-oncology and the constant use of all specialties to make a decision. Surgery, radiotherapy, radiology, pathology, all of these specialists need to come together to produce an appropriate decision for the patient.

Dr. Roselle De Guzman: So one thing that's interesting as well is in 2013, Dr. Razis, your institution, HYGEIA Hospital in Athens, Greece, was one of the first outside the United States to join the Quality Oncology Practice Initiative or COPI program of ASCO. And your program was also the one to be accredited. So, Sarawak General Hospital in Malaysia is collaborating with ASCO as well for the COPI program that focuses on quality improvement. So, based on your experience, what benefits does the COPI program bring to an institution?

Dr. Evangelia Razis: So, COPI, in fact, is an extremely useful way to streamline one's work and increase patient safety and patient satisfaction. I would also say that it helps reduce waste of resources, which is particularly important in resource-limited settings. And we do have a COPI version that is for limited resource settings. It's amazing, but just doing one's work lege artis does result not only in better outcomes but less waste. And that I think is extremely important for Sarawak. So, I think they will find it very useful to be streamlining their work through COPI.

Dr. Roselle De Guzman: Thank you, Dr. Razis, for sharing your experience, your expertise, and your insights. Now, at this point, I would also like to introduce medical oncologist Dr. Pei Jye Voon, who serves as the Onsite Coordinator for the ICC program at Sarawak. 

Dr. Voon, Welcome.

Dr. Pei Jye Voon: Thank you so much.  

Dr. Roselle De Guzman: Dr. Voon, can you describe what cancer care was like in this area of Malaysia for the past few years and what are the main challenges in providing quality cancer care?

Dr. Pei Jye Voon: Yes, of course. So first of all, I would like to give a brief introduction of Sarawak, which is situated at the Borneo island of Malaysia and is the largest state in Malaysia with a very large land area populated by only 2.9 million people, meaning it is very sparsely populated. And for information, newly diagnosed cancer cases in our state is about 2300 cases a year, and the common cancer include breast cancer, followed by colorectal and lung cancer, as well as a cancer that is peculiar to our setting here: nasopharyngeal cancer.  

Half of our 2.9 million population, as mentioned before, are residing outside the urban area, which causes the issue of accessibility of health care, particularly good cancer care, for this rural population. It has always been a great challenge as we have only one public comprehensive cancer center, and thus inequity of access to cancer care is one of the major hurdles in providing good quality cancer care in our state here. In addition, inadequate formally trained, for example, oncologists and palliative care physicians, as well as other healthcare personnel, like oncology nurses, perioperative nurses, which has also negatively impacted the quality of care that we are providing here.  

Furthermore, limited availability of good, top-notch cancer infrastructures, especially at the district hospitals outside our capital city of Kuching, also poses a great challenge to us in developing good quality cancer care across the whole state. Moreover, similar to many parts of the world, the ever-increasing cost of cancer treatment, especially on the expensive new anti-cancer drugs, is another pressing issue for us as well. 

In summary, I can say that inequity of access due to the geographical barrier, lack of human resources, inadequate infrastructure, and also the ever-increasing cost of cancer, are the major challenges that we are facing here in Sarawak. 

Dr. Roselle De Guzman: Thank you, Dr. Voon. I'm sure the situation in Sarawak resonates with other countries, low- and middle-income countries. Of course, there are truly challenges, but of course, with the challenges come opportunities. So what benefits or changes have taken place through this collaborative ICC program?

Dr. Pei Jye Voon: I have to say that participating in the ASCO ICC program is one of the greatest things that has happened to our radiotherapy oncology and palliative care department at Sarawak General Hospital. We have gained tremendously, definitely from that. And for instance, we have been actively participating in a highly personalized palliative care education program which is one of the highlights of this collaboration. Various projects have been successfully conducted, including the ASCO Palliative Care e-Course course, which subsequently led to the Train the Trainer’s program. This program benefited not only the Sarawak team, but also healthcare providers across Malaysia as well. And this aspect of human development in palliative care was further consolidated with the in-person training by Dr. Frank Ferris as well as Dr Shannon Moore in November last year when they came to visit us physically. We are very grateful for that. 

And in addition to enhancing palliative care, another very interesting project that is actively ongoing is the project ECHO Neuro-oncology Tumor Board Series, which delivers online monthly training to physicians across Malaysia on neuro-oncology care. This was discussed by Dr. Razis earlier on in the podcast, so I'm not going to elaborate at length here. But essentially, the idea of this project was conceived initially in view of the gap that we noted in our neuro-oncology management in our hospital, as compared to those of common cancers that we are actually treating. So through the diverse lectures and many case discussions of the recent in-person visit by the ASCO team that we saw, the management of our neuro-oncology cases has definitely been enhanced and we are looking forward to Dr. Razis coming to visit us physically as well.  

At the same time, we are also looking forward to the incoming multidisciplinary board project under the ASCO ICC program on breast cancer management in August this year. I believe that Dr. Guzman is going to come to visit us, and we are looking very much forward for this as well. And at the same time, this exciting project is under active planning now. Furthermore, we are also eagerly awaiting the improvement of quality cancer care programs using evidence-based quality measures via the COPI project in the near future.

Dr. Roselle De Guzman: Dr. Voon, it seems there is a lot of things happening with Sarawak General Hospital, and we know that there are so many patients globally that do not get the comforts and benefits of palliative care program. You have mentioned palliative care program. Has the ICC Sarawak program made a difference in patient quality of life thus far? 

Dr. Pei Jye Voon: Again, the answer is yes. Definitely yes. So the ASCO Sarawak Palliative Care program has definitely made a great difference in the patient's quality of life. This collaborative work between SarGenHospital, our university, UNIMAS, and ASCO has been in its third year. And many important palliative care milestones in Sarawak have been accomplished. This specially designed program—I would say that this is a specially design program that fits us, that fits our needs—has been mentioned before and includes the ASCO e-course, Train the Trainer program, the mentorship program through the International Development and Education Awards through the Conquer Cancer Foundation, and last but not least is the translation of the ASCO Palliative Care Interdisciplinary Curriculum Resources to our national language to reduce the language barrier in training and education for our people here.  

All these innovative programs have provided a fundamental framework of palliative care  education that is invaluable in equipping our oncologists as well as oncology trainees with the necessary knowledge and skill set to better identify and also meet the palliative care needs amongst our patients. It also ensures a more competent and timely palliative care provision at a general level by the oncology team of our hospital. I think that is extremely important. And it enables the team to incorporate the best palliative care management early in the course of the disease. We call this early introduction through palliative care in our hospital. And in some ways, actually, the ASCO collaboration has enhanced the teamwork and helped the oncology team to recognize our own limitations while providing general palliative care, thereby encouraging the timely palliative care referral whenever appropriate to ensure that patients with more complex physical, psychosocial, and spiritual needs have the necessary input and support from our palliative care team throughout the course of their illnesses. 

Dr. Roselle De Guzman: So we have been discussing important points on the ICC program focusing on multidisciplinary cancer care management, palliative care program, and the COPI program. What do you think are other solutions? Are there others that exist to overcome hurdles to provide quality cancer care to people in Malaysia? Dr. Voon?

Dr. Pei Jye Voon: Yes. Definitely yes as we have discussed in our conversation. So besides the ASCO ICC program, various existing and some projects which are in planning now to overcome hurdles to provide quality care to the people in Sarawak have been implemented or are currently in a very active planning phase. So in terms of inequity of access to good cancer care due to the geographical barrier, we have actually undertaken decentralization efforts of cancer care here in Sarawak. One of the actual efforts around initiatives is to host our senior long-term oncology liaison medical officers with adequate oncology experience to other district hospitals in Sarawak so that better cancer care could be delivered to patients closer to their homes. This was also consolidated with our regular visiting oncologists to these district hospitals as part of decentralization efforts as well. There is also a nursing training program for systemic treatment administration being conducted since last year in all major district hospitals, with the aim of credentialing all our nurses in the state managing cancer care patients with this essential nursing skill of administering systemic therapy in their own hospital.  

In addition to that, weekly oncology and palliative care continuous medical education program across the state has been conducted since the fourth quarter of last year, to disseminate oncology knowledge rapidly to healthcare providers, especially those outside our capital city, who have inadequate exposure in oncology care. And upgrading of our cancer care infrastructure has also been actively planned and we are actually looking forward to a new comprehensive cancer center in our city in the next few years.  

Besides that, our center is also robustly developing our clinical trial capacity in the hope that we can provide additional treatment options to our patients who have limited optional treatment due to cost constraints. In summary, I can say that various initiatives have been implemented to enhance the cancer care in Sarawak, and one thing for sure is the ASCO ICC program has been facilitating all this positive development.

Dr. Roselle De Guzman: So many things are happening, so many things are being done. And with all your efforts, knowledge, and expertise, of course, nothing is impossible. And it's always helpful if you have a very dedicated and committed team, right?

Dr. Pei Jye Voon: Yeah, definitely. We have a very dedicated team, that's for sure.

Dr. Roselle De Guzman: So Dr. Voon, thank you for being with us today and for your onsite coordination of the program. And Dr. Evangelia Razis, thank you for volunteering your time and insights to the ICC program and to our podcast. 

Malaysia is not the only location that the ICC program has been implemented in. There are currently nine sites in Asia, Africa, and South America currently accepting volunteers. Now I would like to give a brief information for volunteers wanting to participate. ASCO pairs eligible oncology professionals with a medical center whose needs match the expertise of the volunteer. Volunteers must be appropriately trained and credentialed medical professionals who specialize in oncology. This includes physicians specializing in medical, radiation, and surgical oncology, laboratory professionals, and nurses. Final-year oncology fellows may also participate if paired with an experienced volunteer.

Volunteers spend one to four weeks on site. During that time, they teach and train staff, residents, and students, and gain insight into cancer management needs and challenges at that institution. As an added benefit, the program enables volunteers to form long-term supportive relationships with clinicians in participating countries. If you are interested in volunteering for the ASCO ICC program, please go to volunteer.asco.org - that's volunteer.asco.org - to apply. I'm Dr. Roselle De Guzman, past Chair of Asia Pacific Regional Council of ASCO.  

Thank you for listening to this ASCO Education Podcast. The ASCO Education Podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncology well-being and professional development. If you have an idea for a topic or guest you would like to see on the show, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit education.asco.org. 

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