Surgeon and National Head
Clinical Services for General Surgery, Ministry of Health, Malaysia
Dato’ Seri Dr Mohamed Yusof Bin Hj Abdul Wahab graduated from University Sains Malaysia in 1987. He completed his training as a House Officer in Seremban General Hospital in 1988, then transferred to Muar District Hospital and served there as a very young and enthusiastic medical officer. In January 1990, he was posted to Tanjong Karang Hospital. Early 1991, he was transferred to Hospital Tengku Ampuan Rahimah Klang, where he is still serving, for the past 26 years. In the year 1995, he completed his FRCS (Edin), became a General Surgeon, then the Head of Department of Surgery HTAR Klang and Selangor State Head of General Surgical Services in the year 2002. He is actively involved in many state and national level committees and training activities.
His main area of interest is laparoscopy in general surgery, including video assisted thoracic surgery for empyema thoracic. He is currently actively championing a Patient Navigation Programme for Breast Cancer. He’s an instructor for Advanced Trauma Life Support (ATLS), honorary lecturer of University Malaya & University Kebangsaan Malaysia. He is a member of the Conjoined Board of Examiners, MRCS Board Examiner & NSR Committee member.
Dato’ Seri Yusof is currently the Head of General Surgical Services Malaysia.
Patient Navigation Program: A New Horizon for Breast Cancer Care
Late stage presentation and poor adherence to treatment protocol remains a major contributor to poor survival for patient with breast cancer in Malaysia. Most women experience psychological distress throughout the course of their journey in battling this disease. It can be related to physical problems like illness or disability, psychological problems, family issues and social concerns such as those related to employment, insurance and supportive care access. Addressing the physical demands of the disease is just one component of the comprehensive treatment regimen for breast cancer; treatment must account for patient’s psychological needs as most of the patient will link cancer with death which results in anxiety and depression.
In Ministry of Health Hospital, breast cancer patients are managed either by the general surgeon or the breast surgeon. In Hospitals where the cases are manage by the general surgeon, the challenge is to offer personalized and dedicated care. Realising this need, in 2004 breast cancer patients presenting to HTAR was manage by a dedicated team (Medical Officer and nurse). Process of care was monitored closely with timeline for both investigation and treatment define. However, the defaulter rate was still high (11.5% in 2014). We realized we needed other initiatives to improve the compliance to treatment.
In 2015, HTAR Surgical Department established a partnership with Cancer Research Malaysia (CRM) and integrated patient navigation program (PN) in the management of breast cancer patient. We named our centre providing patient navigation as Pink Ribbon Centre (PRC). Our aim is to improve the overall compliance of patient to treatment plan. To achieve these, navigators who are qualified nurses in general nursing, oncology and breast care and surgery became part of our management team. Navigators provided patient and family with education tools, supportive care and visit, and practical help in overcoming individual patient barriers. A community navigator from CRM was also placed to address patients’ social welfare needs that hinder completion of cancer care. In addition, the PRC had increased clinic days, dedicated phone lines and implemented an appointment reminder call.We audited our outcome as regards to timeliness of our work process. Compared to the cohort of patients in the year prior to PN, women with PN received timely mammography (96.4% vs. 74.4%, p<0.001), biopsy (92,5% vs. 76.1%, p=0.003), and communication of news (80.0% vs. 58.5%, p <0.001). PN reduced treatment defaulter rates (4.4% vs. 11.5%, p=0.048). Among navigated patients, late stage at presentation was independently associated with having emotional and language barriers (p=0.01). Finally, the main reason reported for delay, default, or refusal of treatment was the preference for alternative therapy. PN is feasible in addressing barriers to cancer care when integrated with a breast clinic in HTAR. Its implementation resulted in improved diagnostic timeliness and reduced treatment default. Wider adoption of PN could be a key element of cancer control in Malaysia.