By Faye Lynette Lim, FRCR, MBBS, MRCP 

I had often heard about ASCO members volunteering their time at faculty courses throughout the world but did not really think that it was something I could do because I had no knowledge of the process or the volunteering criteria.

So, imagine my surprise when I was invited to join as ASCO faculty at the 8^th Malaysian Breast and Endocrine Surgery Conference held in Sarawak. The emphasis was to be on multidisciplinary team management, and we were tasked with running the pre-conference Multidisciplinary Cancer Management Course (MCMC). Planning started in July and Zoom allowed course faculty to connect with one another and to fine-tune the program.

As September drew closer and I prepared to travel to Malaysia from Singapore, where I live and practice, I was excited yet apprehensive—not knowing what to expect, but nonetheless looking forward to this new experience.

Sarawak is the largest of Malaysia’s 13 states and is located on Borneo, the third largest island in the world. The land area is approximately 124,450 sq km (approximately 48,050 sq mi) and has a population of 2.61 million made up of 31 ethnic groups, mainly Iban, Chinese, Malay, Bidayuh, and Melanau. The capital of Sarawak is Kuching, also known as the “Cat City.”

When I reached Kuching for the course, I was bowled over by how welcoming everyone was. The local faculty, comprising of Dr. Voon Pei Jye, Dr. Adibah Ali, Dr. Lim Yueh Ni, and Dr. Adeline Lau, treated us to their fine local cuisine and introduced us to their local culture and customs.

I also had the pleasure of meeting the other members of the ASCO faculty, Dr. Anees Chagpar and Dr. Rozelle De Guzman, and ASCO staff Vanessa Sarchet and Jessica Williams.

The MCMC was well received and the participants, who came from all over Sarawak and Peninsular Malaysia, were engaged and enthused. Dr. Chagpar and Dr. De Guzman ran an excellent mock tumor board with the conference delegates role-playing. The workshop also touched on the use of digital platforms to run more effective tumor boards.

The Oncology Landscape in Sarawak

We had the opportunity to visit the biggest general hospital in Sarawak (Sarawak General Hospital) and were invited to sit in and contribute at the local tumor board. This was an invaluable experience to both our faculty and to the members of the local tumor board. We discussed many complex breast cancer cases which required input from the various disciplines.

In my opinion, the collaborative tumor board was the highlight of the visit. It forced me out of my usual comfort zone and made me think laterally when considering patient care options, as many investigations and processes that we take for granted are just not possible for patients who are located hundreds of kilometers away from Sarawak General Hospital. Access to oncology services is difficult due to the size of the region and population and the distribution of medical centers. Patients might wait 3 months from presentation to consultation with an oncologist (including diagnostic procedures and surgery).

To improve access to oncology care, Sarawak General Hospital has sent out liaison medical officers to the districts to facilitate referral to the main center. These are usually medical officers who have shown an interest in pursuing oncology as a specialty. Currently there are appointments in the hospitals of Sibu, Miri, and Bintulu—three out of 23 total hospitals in the state of Sarawak. The oncology team hopes to send out more.

There are only five MRI scanners in the whole of Sarawak: three in Kuching and one each in Sibu and Miri. PET CT scanners in the government sector are only available in Putrajaya, the administrative and judicial capital of Malaysia; for patients in Sarawak, this means a flight to the west of Malaysia. Bone scans are difficult to obtain—there is only one in Sarawak.

Treatment is also a challenge to administer. The chemotherapy suite at Sarawak General Hospital runs daily from 7:30 AM to 5:30 PM and is fully booked. Patients are closely packed together while hooked up to their chemotherapy drugs. Patients requiring radiotherapy are treated mainly on two linear accelerators, which treat from 7 AM to 10 PM, 5 days a week. On the day I visited, the department was buzzing with activity, patients as far as the eye could see.

Despite the many challenges, the staff of Sarawak General Hospital are to be commended.

Under the auspices of the Ministry of Health of Malaysia and Clinical Research Malaysia, a trials unit has been set up and many phase I to III trials are ongoing.

ASCO Collaborations in the Region

Sarawak General Hospital has also benefited from the numerous programs that ASCO runs. After a competitive application process, Sarawak General Hospital was selected by the ASCO Asia Pacific Regional Council to be an ASCO International Cancer Corps site. As a first step, in 2020, during the height of COVID, the Palliative Care e-Course was launched together with ASCO. The first course was attended virtually by 30 participants comprising nurses, oncology trainees, palliative physicians, and pharmacists. Since its inauguration, the course has grown from strength to strength. In 2021, ASCO and Sarawak General Hospital introduced Train the Trainer modules; the 2023 course has been oversubscribed.

The ASCO Palliative Care e-Course was held weekly over 3 months and included training focused on communication skills. This training has had an immediate effect on practice: it has reduced miscommunication and helped physicians to be more competent in breaking bad news.

Another area that is benefiting from ASCO’s input is the formation of monthly virtual multidisciplinary teams, where local cases are presented and experts are invited to give opinions on management and practice updates. These have proven invaluable and have strengthened collaboration among the local team members as well as with external experts.

Finally, local trainees have benefited from the International Development and Education Award (IDEA), allowing them access to mentors in the U.S. and attendance at the ASCO Annual Meeting. This investment pays dividends when the trainees return, where they contribute to many ongoing initiatives to improve patient care.

There is so much more that can be done, and I am proud to have been able to contribute in a small way to help improve health care for the patients of this world. So, if you are still in two minds as to whether to volunteer, I urge you to say, “Yes!” You will not regret it.

Dr. Lim is a senior radiation oncologist at the National Cancer Centre Singapore with a special interest in breast and upper and lower gastrointestinal cancers. Her special interests include optimizing radiotherapy and sequencing its use with other treatment modalities in the treatment of cancers. In her free time, she can be found exploring cities via their running routes.