CHAPTER 8 ONCOLOgY SERVICES IN MALAYSIAN HOSPITALS · 101 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS CHAPTER 8 | ONCOLOgY SERVICES IN MALAYSIAN HOSPITALS

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NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

CHAPTER 8 | ONCOLOgY SERVICES IN MALAYSIAN HOSPITALSGerard LCC1, Tahrani PK2*, Kamilah D2*, I. Fuad3, Ros SAB1, Hafizah ZA4, Lim YS5, Aslan NMA3, NLC Cheah4, Lau KL1, Sarah Lee A1, Anisah N1, Suryati M1.

1. Hospital Kuala Lumpur 2. Clinical Research Centre, Ministry of Health 3. Universiti Kebangsaan Malaysia Medical Centre 4. Hospital Pulau Pinang 5. Hospital Ampang * Corresponding author.

Summary: There were 55 hospitals offering oncology services and 67 oncologists serving the country. Only 20 of the hospitals have radiotherapy facilities. There has been a steady increase in the number of oncologists, support staff and oncology centres but the numbers are still low. There is disparity in terms of access to services as many states in the west coast of Peninsular Malaysia are relatively well equipped while other states have minimal service. New centres, more sophisticated equipment in tandem with increase in staff, are needed to improve access to radiotherapy and upgrade the service for complex radiotherapy treatment.

Overview

Oncology services refer to the services provided by resident or visiting oncologists in public or private hospitals. This report includes data on specialised radiotherapy treatments such as brachytherapy and high-end radiotherapy techniques such as intensity modulated radiotherapy (IMRT), image guided radiotherapy (IGRT), stereotactic radiosurgery (SRS) and intraoperative radiotherapy (IORT). Data on support staff; namely oncology trained nurses, radiation therapists and physicists; facilities providing radiotherapy and chemotherapy services; and medical devices such as physics equipment and treatment planning systems, have also been reported. In addition, we have also further refined and analysed data on hospitals that provide oncology services, with or without oncologists, and the number of oncology trainees in the country.

facilities

There were 55 hospitals providing oncology services in 2010, 28 were in the public sector, including 3 university hospitals, and 27 were in the private sector. All provided responses to this survey. Of the 55 hospitals, only 50 had resident or visiting oncologists. The remaining 5 hospitals did not have clinical or radiation oncologists. These centres were supervised by physicians, surgeons or gynaecologists with special interest in oncology. In addition, Hospital Ampang that provides hemato-oncology services was included due to provision of basic oncology services. The distribution for oncology services was skewed towards the urban areas, especially in the Klang Valley and the west coast of Peninsular Malaysia. The three regions with the highest oncology centres were Pulau Pinang with 9 centres, Selangor with 9 and Wilayah Persekutuan Kuala Lumpur (WPKL) with 8 (Table 8.1). Overall, the density of oncology centres in the country ranged from 0.06 to 0.01 per 10,000 population. On the other hand, over a one year period there was only one new centre established in Sabah, namely Hospital Likas and one in the east coast of Peninsular Malaysia.

The number of clean rooms for chemotherapy reconstitution was 49 in 2010 and this is in tandem with the increase in the number of public hospitals providing basic oncology services (Table 8.2). There were some centres providing Cytotoxic Drug Reconstitution (CDR) facilities but were without visiting oncologists (Table 8.3).

Workforce

There has been an increase in the number of oncologists in the country, from 57 in 2009 to 67 in 2010. The number of oncologists in the public sector increased from 29 in 2009 to 33 in 2010, while in the private sector the increase was from 28 to 34 in over a one year period. The ratio of oncologists varied between states. The oncologist to population ratio was 2 per million population which is low when compared to 8.8 oncologists per million in developed countries1. This demonstrates that there is a huge shortage of oncologist in Malaysia. The local Masters of Clinical Oncology programme which started in 2002 has contributed to 17 oncologists in the country. The program had 21 trainees in varying stages in 2010 and the training centres are mostly located in WPKL (Table 8.4).

Data on oncology trained nurses was gathered for the first time in 2010. In general, nearly all hospitals, except for Terengganu, had oncology trained nurses. Klang Valley had the most number of trained oncology nurses (146) which corresponded with locations that provide oncology centres. This was followed by Johor and Pulau Pinang with 53 and 26 trained nurses respectively (Table 8.5).

There were 257 radiation therapists in 2010. Approximately 73% radiation therapists were serving in the public sector. A particular strength of public sector oncology service is the availability of a high number of trained radiation therapists to provide care to the oncology patients (Table 8.5).

Chemotherapy drug reconstitution (CDR) is usually done in the clean rooms by CDR pharmacists. There were 47 CDR pharmacists and 38 assistant CDR pharmacists in the public sector. While there were more CDR pharmacists in the public compared to the private sector, the situation for assistant pharmacists was the reverse, with 140 in the private sector compared to only 38 in the public sector. The greatest number of CDR personnel were found to be concentrated in Selangor & WP Putrajaya & WPKL (68 personnel) and Pulau Pinang (58 personnel) (Table 8.6).

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Medical Devices

There was an increase by 11% in the number of megavoltage machines, from 35 to 39 within a one year period2. Both public and private sectors installed two new megavoltage machines each in 2010. The Klang Valley had the highest number of machines (18) installed or 46% of the total number of machines. However, it ranks third in the density of megavoltage machine (2.50 per million population) behind Pulau Pinang (3.84 per million) and Melaka (3.65 per million). All the new machines installed in 2010 were in the West Coast of Peninsular Malaysia (Table 8.7).

Forty six percent of the megavoltage machines were located in the Klang Valley with a density of 2.50 machines per million population. Hospitals in WPKL had the highest number and density of megavoltage machines per million population (7.17), followed by Pulau Pinang and Melaka which were 3.84 and 3.65 respectively. On the other hand, East Coast of Peninsular Malaysia and East Malaysia had no new machines installed in 2010.

Brachytherapy treatment in Malaysia is mostly used with radiotherapy in the treatment of cervical cancer. There were 15 brachytherapy machines in public hospitals of which 8 were situated in the Klang Valley. Most of the regional oncology centres with megavoltage machines also offered brachytherapy services except for Perak (Table 8.7). The distribution of physics equipments and treatment planning system devices followed the distribution of the radiotherapy centres in the country. More private hospitals had physics equipments and treatment planning system devices compared to the public hospitals, 16 and 7 respectively (Table 8.8). These hospitals were mainly located in Klang Valley, Pulau Pinang, Melaka, Negeri Sembilan and Johor. More than half of the radiotherapy centres were capable of carrying out IMRT and IGRT (Table 8.9).

More recent publications on projections for the workforce and equipment for the treatment of patients with cancer3 suggest that there is much more room for improvement in the current situation in Malaysia.

Limitation

1. This survey does not capture oncology activities and, thus, we are unable to report the workload of oncologists in the country.

References

1. Department of Health and Children. Model of service delivery. The Development of Radiation Oncology Services in Ireland. Dublin: The Stationary Office; 2000. p. 90.

2. Clinical Research Centre. National Healthcare Establishments & Workforce Statistics (Hospital) 2008-2009. Kuala Lumpur 2011. p. 75.

3. Planning for the Best. Tripartite National Strategic Plan for Radiation Oncology 2012-2022. The Royal Australian and New Zealand College of Radiologists, Australian Institute of Radiography, Australasian Institute of Physical Scientists and Engineers in Medicine. 2012

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Table 8.1 Number & Density of Hospitals Providing Oncology Services With & Without Oncologists in Malaysia by State & Sector, 2010

STATE SECTOR

HOSPITALS PROVIDINg ONCOLOgY SERVICES

HOSPITALS PROVIDINg ONCOLOgY SERVICES WITH

ONCOLOgISTS

HOSPITALS PROVIDINg bASIC ONCOLOgY SERVICES

WITHOuT ONCOLOgISTS

NO.PER 10,000

POPuLATIONNO.

PER 10,000 POPuLATION

NO.PER 10,000

POPuLATIONMalaysia Public 28 - 24 - 4 -Malaysia Private 27 - 26 - 1 -Malaysia Total 55 0.02 50 0.02 5 0.00Perlis Public 0 - 0 - 0 -Perlis Private 0 na 0 na 0 naPerlis Total 0 0.00 0 0.00 0 0.00Kedah Public 2 - 1 - 1 -Kedah Private 0 - 0 - 0 -Kedah Total 2 0.01 1 0.01 1 0.01Kedah & Perlis Public 2 - 1 - 1 -Kedah & Perlis Private 0 - 0 - 0 -Kedah & Perlis Total 2 0.01 1 0.00 1 0.00Pulau Pinang Public 2 - 2 - 0 -Pulau Pinang Private 7 - 7 - 0 -Pulau Pinang Total 9 0.06 9 0.06 0 0.00Perak Public 4 - 2 - 2 -Perak Private 3 - 2 - 1 -Perak Total 7 0.03 4 0.02 3 0.01Selangor & WP Putrajaya Public 3 - 3 - 0 -Selangor & WP Putrajaya Private 6 - 6 - 0 -Selangor & WP Putrajaya Total 9 0.02 9 0.02 0 0.00WP Kuala Lumpur Public 3 - 3 - 0 -WP Kuala Lumpur Private 5 - 5 - 0 -WP Kuala Lumpur Total 8 0.05 8 0.05 0 0.00Selangor & WP Putrajaya & WPKL Public 6 - 6 - 0 -Selangor & WP Putrajaya & WPKL Private 11 - 11 - 0 -Selangor & WP Putrajaya & WPKL Total 17 0.02 17 0.02 0 0.00Negeri Sembilan Public 1 - 1 - 0 -Negeri Sembilan Private 1 - 1 - 0 -Negeri Sembilan Total 2 0.02 2 0.02 0 0.00Melaka Public 1 - 1 - 0 -Melaka Private 2 - 2 - 0 -Melaka Total 3 0.04 3 0.04 0 0.00Johor Public 4 - 4 - 0 -Johor Private 1 - 1 - 0 -Johor Total 5 0.01 5 0.01 0 0.00Pahang Public 1 - 1 - 0 -Pahang Private 0 - 0 - 0 -Pahang Total 1 0.01 1 0.01 0 0.00Terengganu Public 1 - 1 - 0 -Terengganu Private 0 - 0 - 0 -Terengganu Total 1 0.01 1 0.01 0 0.00Kelantan Public 2 - 2 - 0 -Kelantan Private 0 - 0 - 0 -Kelantan Total 2 0.01 2 0.01 0 0.00Sabah & WP Labuan Public 1 - 1 - 0 -Sabah & WP Labuan Private 1 - 1 - 0 -Sabah & WP Labuan Total 2 0.01 2 0.01 0 0.00Sarawak Public 3 - 2 - 1 -Sarawak Private 1 - 1 - 0 -Sarawak Total 4 0.02 3 0.01 1 0.00

Abbreviation: na – not applicable

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Table 8.2 Number and Density of Hospitals With Clean Room for Reconstitution of Cytotoxic Drugs and Total Clean Room for Reconstitution of Cytotoxic Drugs in Malaysia by State and Sector, 2010

STATE SECTOR

2010HOSPITAL PROVIDINg

CLEANROOM fOR CYTOTOxIC DRugS

HOSPITAL PROVIDINg CLEANROOM fOR CYTOTOxIC DRugS WITH ONCOLOgISTS

TOTAL CLEANROOM fOR CYTOTOxIC DRugS

NO.PER 10,000

POPuLATIONNO.


NO.PER 10,000

POPuLATIONMalaysia Public 24 - 20 - 27 -Malaysia Private 22 - 21 - 22 -Malaysia Total 46 0.02 41 0.01 49 0.02Perlis Public 0 - 0 - 0 -Perlis Private na na na na na naPerlis Total 0 0.00 0 0.00 0 0.00Kedah Public 2 - 1 - 2 -Kedah Private 0 - 0 - 0 -Kedah Total 2 0.01 1 0.01 2 0.01Kedah & Perlis Public 2 - 1 - 2 -Kedah & Perlis Private 0 - 0 - 0 -Kedah & Perlis Total 2 0.01 1 0.00 2 0.01Pulau Pinang Public 0 - 0 - 0 -Pulau Pinang Private 6 - 6 - 6 -Pulau Pinang Total 6 0.04 6 0.04 6 0.04Perak Public 3 - 1 - 3 -Perak Private 3 - 2 - 3 -Perak Total 6 0.03 3 0.01 6 0.03Selangor & WP Putrajaya Public 3 - 3 - 4 -Selangor & WP Putrajaya Private 5 - 5 - 5 -Selangor & WP Putrajaya Total 8 0.01 8 0.01 9 0.02WP Kuala Lumpur Public 3 - 3 - 4 -WP Kuala Lumpur Private 3 - 3 - 3 -WP Kuala Lumpur Total 6 0.04 6 0.04 7 0.04Selangor & WP Putrajaya & WPKL Public 6 - 6 - 8 -Selangor & WP Putrajaya & WPKL Private 8 - 8 - 8 -Selangor & WP Putrajaya & WPKL Total 14 0.02 14 0.02 16 0.02Negeri Sembilan Public 1 - 1 - 1 -Negeri Sembilan Private 1 - 1 - 1 -Negeri Sembilan Total 2 0.02 2 0.02 2 0.02Melaka Public 1 - 1 - 1 -Melaka Private 2 - 2 - 2 -Melaka Total 3 0.04 3 0.04 3 0.04Johor Public 4 - 4 - 4 -Johor Private 1 - 1 - 1 -Johor Total 5 0.01 5 0.01 5 0.01Pahang Public 1 - 1 - 1 -Pahang Private 0 - 0 - 0 -Pahang Total 1 0.01 1 0.01 1 0.01Terengganu Public 1 - 1 - 1 -Terengganu Private 0 - 0 - 0 -Terengganu Total 1 0.01 1 0.01 1 0.01Kelantan Public 1 - 1 - 1 -Kelantan Private 0 - 0 - 0 -Kelantan Total 1 0.01 1 0.01 1 0.01Sabah & WP Labuan Public 1 - 1 - 1 -Sabah & WP Labuan Private 0 - 0 - 0 -Sabah & WP Labuan Total 1 0.00 1 0.00 1 0.00Sarawak Public 3 - 2 - 4 -Sarawak Private 1 - 1 - 1 -Sarawak Total 4 0.02 3 0.01 5 0.02


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Table 8.3 Number and Density of Hospitals Providing Cytotoxic Drug Reconstitution (CDR) Isolator and Cytotoxic Safety Cabinets in Malaysia by State and Sector, 2010

STATE SECTOR

HOSPITALS WITH CYTOTOxIC DRug RECONSTITuTION

(CDR) ISOLATOR

HOSPITALS WITH CYTOTOxIC SAfETY

CAbINETS

CYTOTOxIC SAfETY CAbINETS

NO.PER 10,000

POPuLATIONNO.


NO.PER 10,000



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Table 8.4 Number and Density of Oncologists and Oncology Trainees in Malaysia by State and Sector, 2009 and 2010

STATE SECTORONCOLOgISTS 2009 ONCOLOgISTS 2010 ONCOLOgY TRAINEES

NO.PER 10,000

POPuLATIONNO.


NO.PER 10,000

POPuLATIONMalaysia Public 29 - 33 - 21 -Malaysia Private 28 - 34 - 0 -Malaysia Total 57 0.02 67 0.02 21 0.01Perlis Public 0 - 0 - 0 -Perlis Private na na na na na naPerlis Total 0 0 0 0.00 0 0.00Kedah Public 0 - 0 - 0 -Kedah Private 0 - 0 - 0 -Kedah Total 0 0 0 0.00 0 0.00Kedah & Perlis Public 0 - 0 - 0 -Kedah & Perlis Private 0 - 0 - 0 -Kedah & Perlis Total 0 0 0 0.00 0 0.00Pulau Pinang Public 2 - 2 - 0 -Pulau Pinang Private 7 - 10 - 0 -Pulau Pinang Total 9 0.06 12 0.08 0 0.00Perak Public 0 - 0 - 0 -Perak Private 2 - 2 - 0 -Perak Total 2 0.01 2 0.01 0 0.00Selangor & WP Putrajaya Public 0 - 0 - 0 -Selangor & WP Putrajaya Private 6 - 9 - 0 -Selangor & WP Putrajaya Total 6 0.01 9 0.02 0 0.00WP Kuala Lumpur Public 17 - 21 - 21 -WP Kuala Lumpur Private 6 - 5 - 0 -WP Kuala Lumpur Total 23 0.14 26 0.16 21 0.13Selangor & WP Putrajaya & WPKL Public 17 - 21 - 21 -Selangor & WP Putrajaya & WPKL Private 12 - 14 - 0 -Selangor & WP Putrajaya & WPKL Total 29 0.04 35 0.05 21 0.03Negeri Sembilan Public 1 - 1 - 0 -Negeri Sembilan Private 2 - 2 - 0 -Negeri Sembilan Total 3 0.03 3 0.03 0 0.00Melaka Public 0 - 0 - 0 -Melaka Private 3 - 3 - 0 -Melaka Total 3 0.04 3 0.04 0 0.00Johor Public 2 - 2 - 0 -Johor Private 1 - 2 - 0 -Johor Total 3 0.01 4 0.01 0 0.00Pahang Public 1 - 1 - 0 -Pahang Private 0 - 0 - 0 -Pahang Total 1 0.01 1 0.01 0 0.00Terengganu Public 0 - 0 - 0 -Terengganu Private 0 - 0 - 0 -Terengganu Total 0 0 0 0.00 0 0.00Kelantan Public 2 - 2 - 0 -Kelantan Private 0 - 0 - 0 -Kelantan Total 2 0.01 2 0.01 0 0.00Sabah & WP Labuan Public 1 - 1 - 0 -Sabah & WP Labuan Private 1 - 1 - 0 -Sabah & WP Labuan Total 2 0.01 2 0.01 0 0.00Sarawak Public 3 - 3 - 0 -Sarawak Private 0 - 0 - 0 -Sarawak Total 3 0.01 3 0.01 0 0.00


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Table 8.5 Number and Density of Oncology Trained Nurses, Radiation Therapists and Physicists in Malaysia by State and Sector, 2010

STATE SECTORONCOLOgY TRAINED NuRSES RADIATION THERAPISTS PHYSICISTS

NO.PER 10,000

POPuLATIONNO.


NO.PER 10,000



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Table 8.6 Number and Density of CDR Pharmacists and CDR Assistant Pharmacists in Malaysia by State and Sector, 2010

STATE SECTORCDR PHARMACISTS CDR ASSISTANT PHARMACISTS

NO.PER 10,000

POPuLATIONNO.


Malaysia Public 47 - 38 -Malaysia Private 31 - 140 -Malaysia Total 78 0.03 178 0.06Perlis Public 0 - 0 -Perlis Private na na na naPerlis Total 0 0.00 0 0.00Kedah Public 3 - 0 -Kedah Private 0 - 0 -Kedah Total 3 0.02 0 0.00Kedah & Perlis Public 3 - 0 -Kedah & Perlis Private 0 - 0 -Kedah & Perlis Total 3 0.01 0 0.00Pulau Pinang Public 4 - 6 -Pulau Pinang Private 10 - 38 -Pulau Pinang Total 14 0.09 44 0.28Perak Public 6 - 3 -Perak Private 4 - 39 -Perak Total 10 0.04 42 0.18Selangor & WP Putrajaya Public 6 - 9 -Selangor & WP Putrajaya Private 6 - 15 -Selangor & WP Putrajaya Total 12 0.02 24 0.04WP Kuala Lumpur Public 11 - 7 -WP Kuala Lumpur Private 4 - 10 -WP Kuala Lumpur Total 15 0.09 17 0.10Selangor & WP Putrajaya & WPKL Public 17 - 16 -Selangor & WP Putrajaya & WPKL Private 10 - 25 -Selangor & WP Putrajaya & WPKL Total 27 0.04 41 0.06Negeri Sembilan Public 2 - 1 -Negeri Sembilan Private 1 - 4 -Negeri Sembilan Total 3 0.03 5 0.05Melaka Public 1 - 2 -Melaka Private 3 - 5 -Melaka Total 4 0.05 7 0.09Johor Public 3 - 3 -Johor Private 1 - 20 -Johor Total 4 0.01 23 0.07Pahang Public 1 - 1 -Pahang Private 0 - 0 -Pahang Total 1 0.01 1 0.01Terengganu Public 1 - 0 -Terengganu Private 0 - 0 -Terengganu Total 1 0.01 0 0.00Kelantan Public 2 - 0 -Kelantan Private 0 - 0 -Kelantan Total 2 0.01 0 0.00Sabah & WP Labuan Public 1 - 2 -Sabah & WP Labuan Private 2 - 6 -Sabah & WP Labuan Total 3 0.01 8 0.02Sarawak Public 6 - 4 -Sarawak Private 0 - 3 -Sarawak Total 6 0.02 7 0.03


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Table 8.7 Number and Density of Megavoltage Machine, brachytherapy Machine and Simulators in Malaysia by State and Sector, 2010

STATE SECTORMEgAVOLTAgE MACHINES

bRACHYTHERAPHY MACHINES

SIMuLATORS

NO. PMP NO. PMP NO. PMPMalaysia Public 15 - 6 - 11 -Malaysia Private 24 - 9 - 18 -Malaysia Total 39 1.38 15 0.53 29 1.02Perlis Public 0 - 0 - 0 -Perlis Private na na na na na naPerlis Total 0 0.00 0 0.00 0 0.00Kedah Public 0 - 0 - 0 -Kedah Private 0 - 0 - 0 -Kedah Total 0 0.00 0 0.00 0 0.00Kedah & Perlis Public 0 - 0 - 0 -Kedah & Perlis Private 0 - 0 - 0 -Kedah & Perlis Total 0 0.00 0 0.00 0 0.00Pulau Pinang Public 0 - 0 - 0 -Pulau Pinang Private 6 - 1 - 5 -Pulau Pinang Total 6 3.84 1 0.64 5 3.20Perak Public 0 - 0 - 0 -Perak Private 1 - 0 - 1 -Perak Total 1 0.43 0 0.00 1 0.43Selangor & WP Putrajaya Public 0 - 0 - 0 -Selangor & WP Putrajaya Private 6 - 4 - 4 -Selangor & WP Putrajaya Total 6 1.08 4 0.72 4 0.72WP Kuala Lumpur Public 8 - 3 - 6 -WP Kuala Lumpur Private 4 - 1 - 3 -WP Kuala Lumpur Total 12 7.17 4 2.39 9 5.37Selangor & WP Putrajaya & WPKL Public 8 - 3 - 6 -Selangor & WP Putrajaya & WPKL Private 10 - 5 - 7 -Selangor & WP Putrajaya & WPKL Total 18 2.50 8 1.11 13 1.80Negeri Sembilan Public 0 - 0 - 0 -Negeri Sembilan Private 2 - 1 - 1 -Negeri Sembilan Total 2 1.96 1 0.98 1 0.98Melaka Public 0 - 0 - 0 -Melaka Private 3 - 1 - 2 -Melaka Total 3 3.65 1 1.22 2 2.44Johor Public 2 - 1 - 2 -Johor Private 1 - 0 - 1 -Johor Total 3 0.90 1 0.30 3 0.90Pahang Public 0 - 0 - 0 -Pahang Private 0 - 0 - 0 -Pahang Total 0 0.00 0 0.00 0 0.00Terengganu Public 0 - 0 - 0 -Terengganu Private 0 - 0 - 0 -Terengganu Total 0 0.00 0 0.00 0 0.00Kelantan Public 2 - 1 - 1 -Kelantan Private 0 - 0 - 0 -Kelantan Total 2 1.30 1 0.65 1 0.65Sabah & WP Labuan Public 0 - 0 - 0 -Sabah & WP Labuan Private 1 - 1 - 1 -Sabah & WP Labuan Total 1 0.30 1 0.30 1 0.30Sarawak Public 3 - 1 - 2 -Sarawak Private 0 - 0 - 0 -Sarawak Total 3 1.21 1 0.40 2 0.81

Abbreviation: na – not applicable; PMP – Per million population

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Table 8.8 Number and Density of Hospital with Physics Equipment and Treatment Planning System Devices in Malaysia by State and Sector, 2010

STATE SECTORHOSPITAL WITH PHYSICS EquIPMENT

HOSPITAL WITH TREATMENT PLANNINg SYSTEM DEVICES

NO. PMP NO. PMPMalaysia Public 7 - 7 -Malaysia Private 16 - 16 -Malaysia Total 23 0.81 23 0.81Perlis Public 0 - 0 -Perlis Private na na na naPerlis Total 0 0.00 0 0.00Kedah Public 0 - 0 -Kedah Private 0 - 0 -Kedah Total 0 0.00 0 0.00Kedah & Perlis Public 0 - 0 -Kedah & Perlis Private 0 - 0 -Kedah & Perlis Total 0 0.00 0 0.00Pulau Pinang Public 0 - 0 -Pulau Pinang Private 3 - 3 -Pulau Pinang Total 3 1.92 3 1.92Perak Public 0 - 0 -Perak Private 1 - 1 -Perak Total 1 0.43 1 0.43Selangor & WP Putrajaya Public 0 - 0 -Selangor & WP Putrajaya Private 4 - 4 -Selangor & WP Putrajaya Total 4 0.72 4 0.72WP Kuala Lumpur Public 3 - 3 -WP Kuala Lumpur Private 3 - 3 -WP Kuala Lumpur Total 6 3.58 6 3.58Selangor & WP Putrajaya & WPKL Public 3 - 3 -Selangor & WP Putrajaya & WPKL Private 7 - 7 -Selangor & WP Putrajaya & WPKL Total 10 1.39 10 1.39Negeri Sembilan Public 0 - 0 -Negeri Sembilan Private 1 - 1 -Negeri Sembilan Total 1 0.98 1 0.98Melaka Public 0 - 0 -Melaka Private 2 - 2 -Melaka Total 2 2.44 2 2.44Johor Public 2 - 2 -Johor Private 1 - 1 -Johor Total 3 0.90 3 0.90Pahang Public 0 - 0 -Pahang Private 0 - 0 -Pahang Total 0 0.00 0 0.00Terengganu Public 0 - 0 -Terengganu Private 0 - 0 -Terengganu Total 0 0.00 0 0.00Kelantan Public 1 - 1 -Kelantan Private 0 - 0 -Kelantan Total 1 0.65 1 0.65Sabah & WP Labuan Public 0 - 0 -Sabah & WP Labuan Private 1 - 1 -Sabah & WP Labuan Total 1 0.30 1 0.30Sarawak Public 1 - 1 -Sarawak Private 0 - 0 -Sarawak Total 1 0.40 1 0.40


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Table 8.9 Number and Density of Intensity Modulated Radiotherapy (IMRT) and Image guided Radiotherapy (IgRT) in Malaysia by State and Sector, 2010

STATE SECTORINTENSITY MODuLATED RADIOTHERAPY (IMRT)

IMAgE guIDED RADIOTHERAPY (IgRT)

NO. PMP NO. PMPMalaysia Public 5 - 3 -Malaysia Private 14 - 11 -Malaysia Total 19 0.67 14 0.49Perlis Public 0 - 0 -Perlis Private na na na naPerlis Total 0 0.00 0 0.00Kedah Public 0 - 0 -Kedah Private 0 - 0 -Kedah Total 0 0.00 0 0.00Kedah & Perlis Public 0 - 0 -Kedah & Perlis Private 0 - 0 -Kedah & Perlis Total 0 0.00 0 0.00Pulau Pinang Public 0 - 0 -Pulau Pinang Private 4 - 4 -Pulau Pinang Total 4 2.56 4 2.56Perak Public 0 - 0 -Perak Private 0 - 0 -Perak Total 0 0.00 0 0.00Selangor & WP Putrajaya Public 0 - 0 -Selangor & WP Putrajaya Private 4 - 5 -Selangor & WP Putrajaya Total 4 0.72 5 0.90WP Kuala Lumpur Public 3 - 3 -WP Kuala Lumpur Private 3 - 2 -WP Kuala Lumpur Total 6 3.58 5 2.99Selangor & WP Putrajaya & WPKL Public 3 - 3 -Selangor & WP Putrajaya & WPKL Private 7 - 7 -Selangor & WP Putrajaya & WPKL Total 10 1.39 10 1.39Negeri Sembilan Public 0 - 0 -Negeri Sembilan Private 1 - 0 -Negeri Sembilan Total 1 0.98 0 0.00Melaka Public 0 - 0 -Melaka Private 1 - 0 -Melaka Total 1 1.22 0 0.00Johor Public 0 - 0 -Johor Private 1 - 0 -Johor Total 1 0.30 0 0.00Pahang Public 0 - 0 -Pahang Private 0 - 0 -Pahang Total 0 0.00 0 0.00Terengganu Public 0 - 0 -Terengganu Private 0 - 0 -Terengganu Total 0 0.00 0 0.00Kelantan Public 1 - 0 -Kelantan Private 0 - 0 -Kelantan Total 1 0.65 0 0.00Sabah & WP Labuan Public 0 - 0 -Sabah & WP Labuan Private 0 - 0 -Sabah & WP Labuan Total 0 0.00 0 0.00Sarawak Public 1 - 0 -Sarawak Private 0 - 0 -Sarawak Total 1 0.40 0 0.00


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Table 8.10 Number and Density of Intraoperative Radiotherapy and Stereotactic Radiosurgery Equipment in Malaysia by State and Sector, 2010

STATE SECTORINTRAOPERATIVE RADIOTHERAPY

EquIPMENTSTEREOTACTIC RADIOSuRgERY

EquIPMENTNO. PMP NO. PMP

Malaysia Public 1 - 2 -Malaysia Private 0 - 7 -Malaysia Total 1 0.04 9 0.32Perlis Public 0 - 0 -Perlis Private na na na naPerlis Total 0 0.00 0 0.00Kedah Public 0 - 0 -Kedah Private 0 - 0 -Kedah Total 0 0.00 0 0.00Kedah & Perlis Public 0 - 0 -Kedah & Perlis Private 0 - 0 -Kedah & Perlis Total 0 0.00 0 0.00Pulau Pinang Public 0 - 0 -Pulau Pinang Private 0 - 2 -Pulau Pinang Total 0 0.00 2 1.28Perak Public 0 - 0 -Perak Private 0 - 0 -Perak Total 0 0.00 0 0.00Selangor & WP Putrajaya Public 0 - 0 -Selangor & WP Putrajaya Private 0 - 3 -Selangor & WP Putrajaya Total 0 0.00 3 0.54WP Kuala Lumpur Public 0 - 1 -WP Kuala Lumpur Private 0 - 1 -WP Kuala Lumpur Total 0 0.00 2 1.19Selangor & WP Putrajaya & WPKL Public 0 - 1 -Selangor & WP Putrajaya & WPKL Private 0 - 4 -Selangor & WP Putrajaya & WPKL Total 0 0.00 5 0.69Negeri Sembilan Public 0 - 0 -Negeri Sembilan Private 0 - 1 -Negeri Sembilan Total 0 0.00 1 0.98Melaka Public 0 - 0 -Melaka Private 0 - 0 -Melaka Total 0 0.00 0 0.00Johor Public 0 - 0 -Johor Private 0 - 0 -Johor Total 0 0.00 0 0.00Pahang Public 0 - 0 -Pahang Private 0 - 0 -Pahang Total 0 0.00 0 0.00Terengganu Public 0 - 0 -Terengganu Private 0 - 0 -Terengganu Total 0 0.00 0 0.00Kelantan Public 1 - 1 -Kelantan Private 0 - 0 -Kelantan Total 1 0.65 1 0.65Sabah & WP Labuan Public 0 - 0 -Sabah & WP Labuan Private 0 - 0 -Sabah & WP Labuan Total 0 0.00 0 0.00Sarawak Public 0 - 0 -Sarawak Private 0 - 0 -Sarawak Total 0 0.00 0 0.00


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CHAPTER 8 ONCOLOgY SERVICES IN MALAYSIAN HOSPITALS · 101 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS CHAPTER 8 | ONCOLOgY SERVICES IN MALAYSIAN HOSPITALS