The care female cancer patients need goes well beyond the management of the disease, extending to areas like household and family responsibilities that usually fall on their shoulders. — Filepic
While it is acknowledged that access to life-saving diagnostics, treatments and medical technologies is responsible for much of the progress in cancer control that we have observed globally, these advances often fail to fully account for the unique barriers that women face as they navigate cancer prevention, care and survivorship.
This piece is inspired by my lived experience as a physician and public health medicine specialist in Malaysia, and my role as a commissioner of the Lancet Commission on Women, Power and Cancer.
Specifically, it focuses on the challenges faced by Malaysian women as they navigate their cancer journey.
The stark reality is that an all-of-society approach is needed to address the systemic barriers that our women encounter when dealing with cancer.
But where do healthcare professionals fit into this bigger picture?
Is this beyond their scope of influence?
Perhaps it is time that healthcare professionals shift their mindsets and take charge by leading the change.
Unique challenges
Malaysian women face unique challenges throughout their cancer journey, which are shaped by societal expectations, cultural norms and male-dominated systems (patriarchy).
These pressures unfortunately tend to strip our women of the power and autonomy needed to make decisions about their health.
Across our country’s multiethnic population, women have traditionally been expected to prioritise their families over their well-being, creating substantial barriers to focusing on their personal health needs.
These include maintaining healthy lifestyles, getting vaccinated, attending cancer screenings, or seeking treatment and care when needed.
It is also not uncommon for Malaysian women to be required to seek permission from their spouses or family members before accessing care, which often leads to delays in receiving medical attention.
In a diverse and culturally-rich country like Malaysia, myths about cancer, including beliefs in curses and divine punishment or beliefs that cancer is a death sentence, can also delay care-seeking.
For some women, a cancer diagnosis may not only be deemed a health issue, but also a source of shame.
They may fear that disclosing their illness will lead to stigma for their families, with their daughters labelled as more likely to get cancer, potentially affecting future marriage prospects.
Others may refuse life-saving cancer treatments like mastectomies (surgical removal of the breast) or chemotherapy, fearing disfigurement, hair loss, or even abandonment by their husbands.
Financial barriers tend to compound these issues, particularly for women from lower income backgrounds, housewives, and women working in informal jobs such as domestic helpers, babysitters or small business owners, who often lack access to formal employment benefits like private health insurance or Socso.
These constraints can make it difficult to afford screening, cancer treatment and the related costs.
Also of concern is that much of the current focus on cancer promotion activities in Malaysia tend to revolve around breast and cervical cancers, i.e. female cancers.
This might pose a problem considering the upward trend in incidence of colorectal and lung cancers among Malaysian women.
As these cancers have traditionally received less coverage, it is conceivable that many women still remain uninformed about their risks and symptoms, potentially leading to delays in detection and management.
Actionable solutions
Healthcare professionals in Malaysia have a critical role to play in addressing these challenges.
First and foremost, within healthcare settings, whether it be in outpatient clinics or hospitals, it is paramount that patients feel supported and not blamed.
This is as this foundation of trust and empathy is key to improving health outcomes.
Here, it is noteworthy that culturally-appropriate and respectful communication are essential to empower women to make informed health-related decisions.
Creating an environment where women feel safe, heard and understood is expected to lead to a myriad of positive outcomes.
This includes improving vaccine acceptance, encouraging participation in cancer screening, enabling patients to cope well with cancer diagnosis, and also promoting treatment adherence and follow-up care.
Likewise, having female healthcare professionals available for screenings and gender- sensitive procedures like mammograms and pelvic exams may encourage participation in care, especially for women from conservative backgrounds or rural areas.
This highlights the importance of gender-sensitive care, which, while crucial for women, will also be beneficial for men.
Such a strategy nonetheless requires workforce planning, including recruiting, training and distributing staff to areas where cultural sensitivities may limit access.
Considering the unique challenges that women face, having patient navigation services will be important in ensuring timely and accessible care.
These services are where a dedicated healthcare worker or trained volunteer guides women through the healthcare system and connects them with needed health, financial and community resources.
Such services are crucial in helping a woman achieve a timely diagnosis from the moment she presents with suspicious symptoms.
Importantly, patient navigation services remain critical even after a cancer diagnosis, as they ensure that women receive the necessary care and support to access and complete treatment, deal with adverse effects, and also, navigate the survivorship phase.
Financial support services are equally vital in reducing the economic burden of cancer, enabling vulnerable patients to access timely care and adhere to management plans.
Patient navigators may also be able to connect women to community resources such as peer support groups, household help and return-to-work programmes.
While some public hospitals in Malaysia are offering patient navigation services, and cancer non-governmental organisations such as the National Cancer Society of Malaysia are providing structured training for patient navigators, all these efforts are currently focused primarily on breast cancer.
Scaling up these services will be one of the best buys in closing the gender gap in cancer.
Not only should such services be expanded to more hospitals, they should also cover other common cancers such as colorectal and cervical cancer.
More than disease needs
Central to this discussion is the notion that addressing the full spectrum of needs of Malaysian women with cancer requires a focus on wider aspect of well- being.
This would include not just cancer-related concerns, but also non-cancer related medical needs such as sexual health and other concurrent health issues, financial challenges, emotional well-being, and practical issues like childcare and household duties.
Here, an all-of-society approach is needed, given that addressing these challenges demands multidisciplinary and multisectoral interventions.
Therefore, beyond individual patient care, healthcare professionals should step out of their comfort zone by taking leadership roles in mobilising the wider community to take collective action.
Leveraging on the high respect and trust from society, it is strongly believed that the healthcare fraternity is well-positioned to play a pivotal role in driving change.
Beyond their traditional roles as resource persons, there is now a need for healthcare professionals to collaborate with key cancer stakeholders – namely, cancer civil societies and patient representatives – to advocate for policies that promote gender equity in cancer care, ensuring that no woman is left behind, irrespective of her geographical location, economic status, ethnicity or any other factors.
Last, but not least, collecting and presenting data separated by gender (disaggregated data) is essential to understanding how cancer uniquely impacts women in the local settings.
Such data will inform healthcare planning and ensure that health resources are strategically allocated, helping to better tailor prevention, screening, treatment and supportive care strategies to meet women’s specific needs.
By fostering a culture of trust, respect and support, healthcare professionals can help Malaysian women not only navigate their cancer journey, but also live well with cancer, free from fear, shame or feelings of helplessness.
Dr Nirmala Bhoo-Pathy is an epidemiologist and public health physician specialising in cancer control and cancer policy, and professor of epidemiology at Universiti Malaya. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
