Letters | How Malaysia’s Sarawak state highlights gaps in cancer care in Southeast Asia

Worldwide there are various gaps in cancer care. Income, education, location, gender and age negatively affect care. We also face such gaps across Southeast Asia.

In Sarawak, for instance, cancer health care infrastructure is lacking. We have only one tertiary government hospital in the whole state of 2.8 million people, covering an area of 124,450 sq km, which is the sole provider of complete cancer care including oncologists and radiation therapy. And there are only five oncologists at Sarawak General Hospital as of the end of last year.

The recent announcement that the Sarawak government will fund a planned cancer centre is a good step. However, it is not the only gap to close, as many patients live outside Kuching and they will incur extra costs for transport and accommodation (not only for themselves but for any carer who follows them) when they need medical care, not to mention the opportunity costs as the longer travelling time means a longer time away from work.

Such a problem is certainly not unique to Sarawak and Malaysia as a whole. Neither is it inevitable. Indonesia and Thailand, for instance, have implemented more decentralised or regionalised health systems, which allow different regions to develop different models of health coverage according to local disease burdens and other requirements.

However, a major barrier to accessing care is financial insecurity. In 2018, Asia accounted for nearly half of new cancer cases globally and more than half of related deaths. These numbers are only expected to grow, placing further burden on individuals and health systems. The affordability and accessibility of preventive screening, medicines and treatment are paramount if we are to avoid a growing gap between those who can pay – and live – and those who cannot.