Non-communicable diseases (NCDs) are estimated to claim the lives of around 41 million people per year, accounting for 71% of all deaths worldwide.1 The main NCDs, namely cardiovascular diseases, cancers, chronic respiratory disease and diabetes, are among the top 10 leading causes of death.

In Malaysia, there is an estimated 8 million adults living with hypercholesterolemia, 6.4 million with hypertension, 4.1 million with obesity and 3.9 million with diabetes.

1 in 7 Malaysians are now estimated to develop cancer before reaching 75 years of age.

Amidst the COVID-19 crisis, approximately 49,000 people in Malaysia were estimated to be newly diagnosed with cancer in 2020, and this is expected to rise to more than 66,000 new cases annually by 2030.

Over several decades, Malaysia has made progress in universal coverage of cancer care through its health system, particularly through the public healthcare service. However, effective cancer control remains elusive, and the disease still devastates thousands of lives, families, and communities.

Interventions to prevent and treat cancer must address a challenging context which includes late presentation of disease, an ageing population, rapid urbanisation, inactive and sedentary lifestyles, and unhealthy diets.

The late presentation for the disease which has resulted in high prevalence of advanced-stage cancer, has been a barrier since the 1990s, when the Penang Cancer Registry first discovered that 53% of cases were diagnosed in Stage III and IV.5 This has often led to delays in diagnosis and treatment, resulting in poorer outcomes and low survival rates, for people with certain types of cancer.

In 2020, the redeployment of healthcare workers to frontline efforts and widespread movement restrictions to prevent the spread of SARS-CoV-2 have had knock-on effects to the cancer care landscape, particularly diagnosis and follow-up treatment.

Financial toxicity, particularly for those living with cancer from lower and middle-income households, is expected to deepen and spread due to economic disruptions and rising health costs.

Out-of-pocket payments are increasing as patients discover that they have inadequate insurance coverage or forced to depend on private healthcare due to insufficient access to necessary treatment in the public healthcare system.

Three actions are needed to reduce cancer’s devastating impact on Malaysians

• get more people to be screened and detected at an earlier stage of their cancer
• provide timely and effective treatment when it is needed to avoid the burden of undertreated cancer
• optimise financing and governance of cancer care to steer towards better survival and reduced burden

The consequence of late diagnosis often resulting in fewer treatment options available in the latter.

Malaysia has been recognised as having the National Strategic Plan for Cancer Control Programme (2016-2020) which emphasised prevention and is committed to providing treatment access for all.

The successor to this strategic plan covering the period of 2021-2025 is expected to approach cancer care more comprehensively, extending beyond treatment. It will be end-to-end, covering preventative measures to palliative care.

Such a plan requires strong political and institutional support, utilises public-private partnerships, and is sufficiently funded to ensure its successful and effective implementation. However, the lack of sufficient funding, monitoring, reimbursements, and effective governance presents significant challenges to the strategic plan.

Operationalising such plans and producing successful health outcomes require committed resources which are ideally sustained over a multi-year period, utilising both public and private resources.

Increased investments and commitments in health, specifically in cancer, will have a direct impact on overall population health outcomes, particularly reducing the human and financial costs resulting from late-stage presentation of cancer, and premature deaths.

This paper emphasises on three key areas for action to reduce the impact of cancer on Malaysians.

More people need to be screened and diagnosed at an earlier stage of their cancer when treatment is most effective, and the chance of survival is at its highest.

Timely, effective and innovative treatment should be made available when it is needed to avoid the burden of undertreated cancer. Not all cancers can be detected early, and the health system must not leave behind those diagnosed with advanced cancer.

The financing and governance of cancer care needs to be optimised to steer towards better survival, reduced burden from cancer, and overall better health outcomes.

This document has been prepared to raise awareness about the burden of cancer in the country and the challenges faced by people living with this disease.

It outlines feasible and pragmatic policy recommendations that have the potential to produce better outcomes for people living with cancer in Malaysia.

Cancer Policy Recommendations

• Reform health financing for cancer care
• Move towards value-based medicine
• Coordinate stakeholders under a central governance body
• Mainstream patient navigation and psychosocial support
• Strengthen monitoring and application of cancer control data

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