ISSUE 02/2016
THE REASON I’M PROUD TO BE A NURSE…
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DREAM COMES TRUE FOR A DAY
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Content Issue 02/2016 page
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01 From the President’s Desk News & Happenings 05 Celebrating A Noble Profession
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INTERNATIONAL NURSES DAY 2016
05 The Reason I’m Proud to be a Nurse… 06 Cancer: Body, Mind and Soul 07 Cancer in Asia: Rising Challenges Require Rising Resources
09 Battling Cancer and More Feature Story 11 Flashback MAKNA in Vietnam 13 Vietnam – National Cancer Control Strategy
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Volunteers
14 Volunteers, Survivors and Best Bowlers 15 Dream Comes True For A Day Cover Story 17 Much More Than Financial Aid Research 23 Blood Vessels: How They Aid Tumour Networking
25 Stem Cell-based Gene Therapy for Chronic
Myeloid Leukaemia
27 An Aspiring Researcher’s Hands-on Experience Life Goes On 28 Kasih Ibu Tiada Ganti
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EDITORIAL
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PENASIHAT / ADVISORS Dato’ Mohd Farid Ariffin Farahida Mohd Farid EDITORIAL Geraldine Teoh Prema Ramasamy
BATTLING CANCER
AND MORE
This article is written by Tan Sri Dzulkifli Abdul Razak, a member of the MAKNA Board of Trustees and Chair of the Islamic Leadership Office First published in The Sun Daily (http://www.thesundaily.my)
IMPORTANT MESSAGE: The content here is general in nature and is provided for information purpose only. It is not a substitute for professional medical advice. Please consult your physician on any questions or concerns you may have regarding your health.
PENYUMBANG / CONTRIBUTORS Camilo Cupitre Cheng Wei Kang Tan Sri Dzulkifli Abdul Razak Liew Lee Chuen Loo Hui Qui Nhan TB Dinh Noriffan Bin Rosli Dr Oon Chern Ein Priyadarshini Subramaniam Ratnawati Abu Bakar Sharifah Sakinah Suhaila Nik DITERBITKAN OLEH / PUBLISHED BY National Cancer Council (MAKNA) BG 03A & 05, Ground Floor, Megan Ambassy, 225 Jalan Ampang, 50450 Kuala Lumpur. Tel: +603-2162 9178 Fax: +603-2162 9203 Email: makna@makna.org.my www.makna.org.my www.facebook.com/maknacancer www.twitter.com/makna_malaysia DICETAK OLEH / PRINTED BY Percetakan Jiwabaru Sdn Bhd No.2 Jalan P/8, Kawasan MIEL Fasa 2, Bandar Baru Bangi, 43650 Bangi, Selangor Darul Ehsan. Tel: +603-8925 6688 Fax: +603-8925 1688 REKACIPTA / DESIGN SG Global Support Services Sdn Bhd Level 18, Axiata Tower, No. 9 Jalan Stesen Sentral 5, KL Sentral, 50470 Kuala Lumpur. Tel: +603-2260 1717 Fax: +603 2260 2211 www.sgglobalsupport.com
PRESIDENT’S DESK
‘HOW TO MULTIPLY A MIRACLE’
Dear friends, If someone had told me when I was fifteen, that one day I would be leading one of the largest cancer not-for-profit organisations in the region – I would have been skeptical. Had they told me that over two decades, the organisation would have directly touched the lives of hundreds of thousands of disadvantaged cancer patients and an even greater number of caregivers, families and members of the public – I would have found it admirable but hard to believe. “How? In what way?” I would have asked. “MAKNA would reach as far and wide as the most rural nooks in Sabah and Sarawak even up to Vietnam. It would be served by over 100 staff and volunteers locally, fund cancer research and even have a 40-foot trailer that would deliver mammogram screening services even in remote locations. Cancer patients would be visited in their own homes and with the MAKNA bursary assistance, they would be able to continue supporting their family members, access treatment and medical supplies, even receive travel allowances and accommodation at a halfway home if they were coming to a nearby city for hospital treatment, so they wouldn’t need to make arduous journeys back and forth. There would be a support group run by cancer survivors themselves where patients and caregivers would be able to receive emotional support and practical advice. Anyone would be able to dial in with a question about cancer Mondays to Fridays, 9 to 5 on a helpline. Exhibitions, events and talks would be held across the country to raise awareness. Young cancer survivors would be able to compete for a university scholarship to pursue tertiary education where few organisations would invest in their future. The public would come forward in throngs to participate in fundraising marathons and 4,000 metre mountain climbs. MAKNA would even collaboratively run a cancer centre at a university hospital.” “That would be nothing short of a miracle,” I would have uttered in reply. Yet, the miracle is real. It was no easy task getting MAKNA to where it is now but I can tell you in all honesty that throughout our journey, it was always you, MAKNA donors, who made it happen. You made this impossible phenomenon, possible. The cancer cause is considered niche. It doesn’t help that there is a stigma associated with it and society shies away from it. However, we know that early detection saves lives and the more awareness there is, the more lives we can help save. For those who are already faced with the cancer fight, the match is on and winning is a question of access to treatment, timing and chance. We don’t have control over chance but we can help with timely detection and access to treatment. We have to keep going and keep the miracle happening for those who think there is no hope, because there always is hope – it’s just up to us to give.
01
NEOPLASIA { ISSUE 02/2016 }
Farid
SATU PENGALAMAN YANG LUAR BIASA
PRESIDENT’S DESK
Saudara saudari yang saya hormati, Kalau dulu, pada zaman remaja saya, ada orang yang memberitahu yang saya akan menerajui sebuah pertubuhan bukan berasaskan keuntungan berkaitan kanser, antara yang terbesar di rantau ini – saya mungkin tidak percaya. Malah, jika mereka memberitahu saya bahawa sepanjang dua dekad yang lalu, pertubuhan ini berjaya membawa perubahan kepada ribuan pesakit kanser yang kurang bernasib baik, serta dapat meringankan beban kepada ramai penjaga, keluarga serta orang awam di mana sahaja mereka berada – tentunya saya tumpang bangga tetapi mungkin saya sukar untuk mempercayainya. “Betul ke? Macam mana tu?” saya akan bertanya. “MAKNA akan menabur jasa ke serata tempat termasuk pendalaman Sabah dan Sarawak sehinggalah ke Vietnam. Pertubuhan ini akan disertai oleh seramai 100 kakitangan dan sukarelawan tempatan, membiayai penyelidikan kanser dan memiliki sebuah treler berukuran 40 kaki panjang yang menawarkan perkhidmatan mamogram secara bergerak ke seluruh pelosok negara. Para pesakit kanser menerima kunjungan di rumah mereka sendiri dan melalui bantuan derma MAKNA, mereka dapat meneruskan kehidupan untuk menyara keluarga, selain menerima rawatan dan bekalan ubat. Para pesakit akan turut diberikan elaun perjalanan dan disediakan rumah persinggahan sekiranya mereka perlu ke bandar untuk rawatan, supaya mereka tidak perlu berulang alik menempuh perjalanan yang jauh. Sebuah kumpulan sokongan akan ditubuhkan yang dianggotai oleh bekas pesakit kanser. Mereka memberikan sokongan moral dan emosi serta nasihat yang berguna kepada para pesakit serta mampu untuk menjaga pesakit. Sesiapa sahaja boleh menghubungi talian khidmat yang disediakan dan bertanyakan soalan tentang kanser dari hari Isnin sehingga hari Jumaat, dari jam 9 pagi hingga jam 5 petang. Pelbagai pameran, aktiviti dan ceramah akan dianjurkan di seluruh negara bagi meningkatkan kesedaran tentang penyakit ini. Bekas pesakit kanser yang masih muda berpeluang menerima biasiswa untuk meneruskan pengajian di peringkat tinggi di mana tidak banyak organisasi yang mahu melabur untuk masa depan mereka. Seluruh rakyat Malaysia akan berlumba-lumba untuk menyertai acara maraton bagi mengutip derma termasuklah acara mendaki gunung setinggi 4,000 meter. MAKNA akan turut bekerjasama menguruskan sebuah pusat kanser di hospital universiti.” “Kalau begitu, tentulah ajaib namanya,” saya akan membalas. Hari ini kita dapat lihat bahawa keajaiban ini menjadi satu realiti. Usaha untuk membawa MAKNA ke tahap yang ada sekarang bukanlah mudah. Mujurlah dengan bantuan tuan-tuan dan puan-puan sebagai penderma, MAKNA dapat berdiri teguh dan menjadi sebuah pertubuhan yang terulung seumpamanya di rantau ini. Pertubuhan berkaitan kanser tidak banyak dibentuk. Stigma yang dikaitkan dengan penyakit ini membuatkan orang ramai menjauhkan diri. Walau bagaimanapun, kita tahu bahawa langkah awal mengesan kanser dapat menyelamatkan nyawa. Lebih tinggi kesedaran tentang kanser, maka lebih banyak nyawa yang dapat diselamatkan. Bagi mereka yang berdepan dengan penyakit ini, perjuangan untuk sembuh bermakna peluang untuk mendapat rawatan dengan segera. Kita tidak dapat menentukan takdir hidup tetapi kita boleh membantu dengan mengesan penyakit lebih awal dan menyediakan akses kepada rawatan. Kita perlu terus berjuang dan berusaha mencipta keajaiban. Inilah yang kita mahukan, sebuah harapan di mana kita boleh membantu untuk menjadikannya satu kenyataan.
Farid
www.makna.org.my
02
PRESIDENT’S DESK
如何让奇迹倍增 亲爱的朋友们， 若有人在我15岁时告诉我，有一天我会领导着区域内其中一个最大的 非营利癌症机构，我可能会质疑。 若他们告诉我，该非营利机构会在20多年来直接影响几十万名的贫困 癌症病患，以及更多看护者、家庭和公众人士的人生，我会深感钦佩 但还是难以置信。 我可能会问：“如何能做到？以什么方式呢？”“MAKNA将会把其服务 延伸到沙巴和砂拉越最偏远的乡区甚至越南。它将由当地超过100的职 员和义工提供服务、资助癌症研究，甚至拥有一辆40尺长用来提供流 动式乳房X光检查服务到偏远地区的拖车。癌症病患将会获得家访服 务，而通过MAKNA的援助金计划的帮助，他们将能继续支持他们的家 人、获得治疗和药物供应，甚至如果他们前往邻近城市的医院接受治 疗，也能获得旅费津贴，以及可暂时入住MAKNA的中途之家，让他们无 需劳碌奔波地往来两个城市。” 此外，还将会有由癌症幸存者运行的支援组，让病患和其看护人能够 获得精神上的支持和实用建议。任何人都能在周一至周五，早上9点到 傍晚5点，致电咨询热线询问有关癌症的问题。在全国各地举办展览、 活动项目和讲座来提高公众对癌症的醒觉和认知。年轻的癌症幸存者 也能在愿意投资在他们未来的少数机构帮助下，参与大学奖学金的角 逐来继续升学。公众会挺身而出，踊跃地参与马拉松和4,000公尺的攀 山筹款活动。MAKNA甚至会在一家大学医院里联合经营一个癌症中心。 我可能会回答说：“这简直是一个奇迹。” 然而，这个奇迹确实发生了。MAKNA能达到今时今日的成就，并不是一 个简单的任务，但我能坦诚地告诉您们，在这整个旅程中，您们这些 MAKNA捐赠者一直都是让这个奇迹发生的功臣。您们将这个不可能的任 务变成了可能。 引发癌症的原因可以被当作是特殊的。若社会把它当作是污点并回避 它，这无法带来任何助益。尽管如此，我们知道及早检测到癌症能挽 救生命，而醒觉程度越大，我们就能协助挽救更多的生命。对于那些 已经正在与癌症搏斗的人士，竞赛已经开始了，而获胜的关键在于获 得治疗、抓紧时机和机会。我们无法控制机会，但是我们能协助您们 及早检测和获得治疗。我们必须为那些觉得无望的人继续前进，把这 个奇迹延续下去，因为希望永远存在—全看我们愿意付出多少。
法立 03
NEOPLASIA { ISSUE 02/2016 }
PRESIDENT’S DESK
அற்புத்தங்களை எப்படி பலமடங்காகியது அன்புள்ள நண்பர்களே, இந்த வட்டாரத்தில் ஏழை புற்றுந�ோயாளிகளுக்கு ஒரு சமூக நிறுவனத்தை வழி நடத்துவேன் என்று என் பதினைந்தாவது வயதில் யாராவது ச�ொல்லி இருந்தால் நான் நம்பியிருக்கமாட்டேன். இருபது ஆண்டுகளில் இந்த நிறுவனம் பல நூற்றுக்கணக்கான, ஆயிரக்கணக்கான புற்றுந�ோயாளிகளின் இதயத்தையும் அதற்கும் மேலாக பல குடும்பங்கள் ப�ொதுமக்கள், இவர்களின் இதயத்தையும் நிச்சயம் த�ொடும் என்று அவர்கள் என்னிடம் ச�ோல்லியிருந்தால், அதைக்கேட்டு வியந்திருப்பேன், நம்புவதற்கு சிரமப்பட்டிருப்பேன். “உண்மையாகவா? அது எப்படி?” என எனக்குள் கேள்வி கேட்டிருப்பேன். MAKNA, சபா, சரவாக்கில் கிராம மூலை முடுக்கெல்லாம் சென்று, வியட்நாம் (Vietnam) வரை அடைந்திருக்கிறது. உள் நாட்டிலுள்ள 100 பணியாளர்கள், சமூக சேவையாளர்கள், புற்றுந�ோய் ஆராய்ச்சி நிதிவளம் ப�ோன்றவர்கள் செவையாற்றிவருகிறார்கள். மேலும் 40 அடி நீளமுள்ள நடமாடும் வாகனம் மூலமாக த�ொலைவிலுள்ள இடங்களுக்குச் சென்று மார்பக ச�ோதனை ப�ோன்ற சேவைகள் செய்துவருகிறார்கள். MAKNA சேவையாளர்கள் புற்றுந�ோய் ந�ோயாளியின் இல்லத்திற்கு சென்று அவர்களுக்கு நிதியுதவி செய்வதின் மூலம், அவர்களின் குடும்பத்தினரை த�ொடர்ந்து கவனித்துக் க�ொள்வதுடன் சிகிச்சை பெறவும், மற்ற மருத்துவ உபகரணங்கள் பெறவும் முடியும். மேலும் ப�ோக்குவரத்து செலவுக்கு நிதி அளிப்பத்தோடு, மருத்துவமனையில் தங்கி சிகிச்சை பெற வேண்டியிருந்தால் அவர்களுக்கு தங்கும் வசதியும் செய்து தரப்படுகிறது. புற்றுந�ோயிலிருந்து விடுபட்டவர்களால் நடத்தபடும் அரவணைப்பு குழுவால், ந�ோயாளிகள், உணர்ச்சிபூர்வ அரவணைப்பும், நடைமுறை ஆல�ோசனையும் பெறுகிறார்கள். திங்கள் முதல் வெள்ளிவரை 9.00லிருந்து 5.00 மணிவரை த�ொலைபேசி மூலம் புற்றுந�ோய் சம்பந்தப்பட்ட விபரங்களை பெறலாம். விழிப்புணர்வை ஏற்படுத்துவதற்காக, பல நிகழ்ச்சிகள், மற்றும் ச�ொற்பொழிவுகள், நடத்தப்படுகின்றன. மற்றும் புற்று ந�ோயிலிருது விடுபட்ட இளைஞர்களின் வருங்கால வாழ்விற்கு MAKNA கல்வி உதவித் த�ொகை வழி அவர்கள் பல்கலைக்கழக உயர்கல்வியை முடியும். ப�ொதுமக்கள் திரளாக வந்து நிதி சேர்க்கும் நிகழ்வுகளை தூர ஓட்டம், 4000 மீ ட்டர் உயர மலை ஏறுதல் ப�ோன்ற வற்றில் பங்கு க�ொள்ளமுன் வர வேண்டும். MAKNA, பல்கலை கழகத்துடன் இணைந்து புற்றுந�ோய் மையம் ஒன்றை அமைக்க முடியும். “இது வெல்லாம் ஒரு அற்புதமா,” என எனக்குள் நானே கேட்டிருப்பேன். இருந்தாலும் அற்புத நிகழ்வுகள் உண்மையே. MAKNA – வை இந்த நிலைமைக்கு க�ொண்டு வந்ததில் MAKNA நன்கொடையாளர்களுக்கு பெரும் பங்குண்டு. ஆரம்ப நிலையிலேயே புற்றுந�ோயை கண்டு பிடிப்பதால், அவர்களுக்கு விழிப்புணற்ச்சி ஏற்படுத்துவதன் மூலமாகவும், பல உயிர்களை எங்களால் காப்பாற்ற முடியும் என நம்புகிற�ோம். புற்று ந�ோயால் பாதிக்கப்பட்டவர்கள், அதிலிருத்து மீ ண்டு வெற்றி பெருவது, அவர்கள் எடுத்து க�ொள்ளும் சிகிச்சை முறை, நேரம் மற்றும் வாய்ப்பை ப�ொருத்தது. வாய்ப்பை எங்களால் கட்டுப்படுத்த முடியா விட்டாலும், உரிய நேரத்தில் கண்டுபிடிப்பதிலும், சிகிச்சைக்கு ஏற்பாடு செய்வதிலும் விடுபட முடியாதென்று நம்பிகை இழந்தவர்களுக்கு ஒரு வழியில் நல்லது நிகழும் வண்ணம் நாங்கள் முயற்சி செய்து க�ொண்டே இருப்போம். ஏனென்றால் நம்பிக்கை என்பது ஒன்று உண்டு, அதைக் க�ொடுப்பது நம்மலைப் ப�ொறுத்தது.
ப்ஹாரிட் www.makna.org.my
04
NEWS & HAPPENINGS
CELEBRATING A NOBLE PROFESSION
INTERNATIONAL NURSES DAY 2016 By Sharifah Sakinah, MAKNA Staff Nurse
12 May, the anniversary of Florence Nightingale’s birth, was also International Nurses Day (IND). The International Council of Nurses commemorates this important day, which is celebrated around the world, each year with the production and distribution of the IND Kit. The IND Kit 2016 contains educational and public information materials, for use by nurses everywhere. Themed Nurses: A Force for Change: Improving health systems’ resilience, IND activities will continue for much of the year, although they were planned mainly around 12 May each year. The International Council of Nurses celebrates this event with the aim to increase public awareness about nursing and nurses’ contribution towards healthcare innovation.
Just like other parts of the world, International Nurses Day was also celebrated in Malaysia, organised by the Malaysian Nurses Association and the Nursing Division of the Ministry of Health. Apart from celebrating nurses and the nursing profession the event, attended by the Minister of Health, Datuk Seri Dr S. Subramaniam, also sought to provide opportunities for nurses to exchange and gain new knowledge. One of the key emphasis of the event was to underscore the integral role nurses play in developing a strong, resilient health care system and in leading change through personal core values as well as by applying fresh approaches to improve current thinking and capabilities. I feel grateful to have chosen this profession and as a nurse, this has been an informative, eye-opening event for me. I have gained better understanding of how a nurse’s resilience is crucial to how we cope and manage challenges, and contribute to the overall durability of our country’s healthcare system.
The Reason I’m Proud to be a Nurse… By Noriffan Bin Rosli, MAKNA Staff Nurse
I joined MAKNA as a staff nurse at Hospital Universiti Kebangsaan (now known as Hospital Canselor Tuanku Muhriz) in 2015. I took up this profession because of my late mother, who passed away 3 years ago due to cervical cancer.
I felt helpless, seeing her condition and not knowing how to care for her. She grew weaker as the days passed, to a point where she couldn’t even recognise me. Not much later, she passed away.
It is not an easy path. And it’s more than just the training. To be a nurse, one needs patience, empathy, kindness and most of all, the heart to help others. This is because as a nurse you will encounter patients who are in pain, scared, confused and some could be emotionally fragile. Being a nurse can also take an emotional toll on you, but I have always reminded myself that the patients I see and care for every day go through a lot worse than us; all they have is their trusts in their doctors and nurses. Our job is to build that trust with our patients, to ensure that they feel safe with us and because of that, we need to be stronger every day, mentally and physically.
Seeing the suffering that my mother went through and not being able to do anything to help really gave me new perspective and inspired me to want to help others who are
I am proud to have pursued a career in nursing, to have cared and to still care for many patients. I know that my mother would have been proud of me too.
I was devastated when she was diagnosed with stage 4 cervical cancer and the doctor explained the seriousness of her condition. No one could bear knowing that their parents are ill and that they could be gone any time. At that time, I could not accept the hand that fate dealt us.
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going through the same thing. That’s why I chose to become a nurse.
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NEWS & HAPPENINGS
Cancer: Body, mind and soul By Dr Oon Chern Ein, Institute for Research in Molecular Medicine, Universiti Sains Malaysia
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positive mindset aids recovery – that was the key message of a three-day workshop themed “Cancer: Body, mind and soul”, conducted by international speaker/motivator, Jessica Lim, that brought a whole new level of mind-over-matter therapy to all participants. The workshop, jointly organised by MAKNA and the Division of Industry Community Network (BJIM), Universiti Sains Malaysia from 29 April to 1 May 2016 at the Institute for Research in Molecular Medicine (INFORMM USM), saw participation from 30 cancer warriors from Perak, Pulau Pinang and Kedah who came together to share experiences and support one other. Throughout the workshop, Jessica consistently emphasised on the importance of a strong mind in the battle against cancer, reiterating that love, peace and happiness are the three main pillars of living. Among her recommendations to cancer patients were to focus their minds to aid relaxation and removal of negative energy, and the use of dietary aids such as lemon grass, ginger and pandan leaves to enhance the body’s wellbeing. The workshop also provided an avenue for participants to take part in numerous interactive group activities, including self-realisation, positive evaluation and appreciation, aerobic dance to better blood circulation, in addition to sharing sessions and offering support to each other. Workshop organising chairperson, Dr Oon Chern Ein touched on an important point when she highlighted
that many cancer patients experienced depression following their treatment. Side effects such as hair loss could contribute to patients’ loss in self-esteem and increased their fear of being stigmatized. Due to this, Dr Oon was pleased that the workshop was able to offer cancer patients a platform to open up and hopefully help them overcome such negativity. Azlina Abdullah or Mama Ina, MAKNA Volunteer Leader in the Northern Region, echoed Dr Oon’s sentiments, stating that the workshop could not only lighten the emotional burden faced by cancer patients, but could also help raise public awareness towards cancer and the needs of those afflicted by cancer. www.makna.org.my
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NEWS & HAPPENINGS
C NCER IN ASIA:
Rising Challenges Require Rising Resources By Camilo Cupitre, MAKNA International Division
The state of breast cancer control can offer an estimate of the health and well-being of a country’s healthcare system. Those were the words of Dr Ophira Ginsburg, Medical Officer, Management of Non-Communicable Diseases (NCDs) of the World Health Organization during the Health Care Forum 2016: War on Cancer, a one-day forum held in Singapore on 17 March 2016.
cancer prevention and treatment, especially in developing countries where resources are limited. Among the main topics discussed was the situation of breast cancer incidence growth especially in developing countries. “1.7 million women globally are diagnosed with breast cancer each year, with around 400,000 in Asia alone,” stated Masum Hossain, Regional President of Pfizer Oncology, before the discussion shifted into high gear. Farahida Mohd Farid (centre), MAKNA General Manager with Charles Goddard (left), Editorial Director, Asia-Pacific, The Economist Intelligence Unit and VivekMuthu (right), Chief Health Adviser, The Economist Intelligence Unit
Policymakers and cancer-care specialists from Asia and the world converged to discuss the situation and challenges of cancer prevention and treatment in the region. MAKNA was represented at the forum by General Manager, Farahida Mohd Farid and the International Division team. The day started with an overview of the current situation of cancer prevention and care in Asia and the world. “There are no silver bullets,” said Charles Goddard, the forum’s Chairman and Editorial Director of The Economist Intelligence Unit in the Asia Pacific, acknowledging the complexity of the challenges faced by the world’s healthcare systems in approaching 07
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On one side of the discussion were government representatives from different countries explaining the reasons behind the existing problems in cancer care and prevention despite the progress many other countries have achieved in the last 20 years. “There are a lot of basic health issues that we have to deal with first, such as infant mortality,” said Dr Myint Han, DirectorGeneral, Ministry of Health of Myanmar, as he tried to put into context the difficult process of prioritising healthcare efforts in developing countries. On the other side were cancer specialists emphasising the importance of making cancer prevention and care a priority in national budgets. How much is needed? Dr Richard Sullivan, Director of King’s Institute of Cancer Policy, suggested that, “As a baseline, 5-6% of GDP needs to be spent on health care … or at least $100 per capita … with two-thirds of these funds coming from public finances.” This is a huge target,
NEWS & HAPPENINGS
considering that healthcare spending accounts for less than 3% of GDP in most parts of the world, according to the World Economic Forum (WEF).
However there is a general consensus regarding the social importance and benefits of cancer care and prevention. “It is important to make clear that cancer control can be costsaving, and it is vital to persuade politicians to support national cancer control programmes,” said Shu-TiChiou, DirectorGeneral of Health Promotion Administration, Ministry of Health and Welfare, Taiwan. Later on the agenda, the discussion turned to the role of civil society and NGOs, particularly in cancer treatment and prevention, first in terms of facilitating more efficient training and allocation for the talent that is needed in developing countries’ healthcare systems. Regarding this, Sanchia Aranda, President-Elect of Union for International Cancer Control (UICC) and Chief Executive Officer of Cancer Council Australia said “There’s a lack of recognition that there’s a whole army of nurses that can be mobilised to improve cancer care”. The second point was regarding the importance of NGOs, patient associations and other community organisations in cancer advocacy. On this matter
Percentage increase, estimated number of breast cancer cases in Asia between 2012 and 2025. The challenge and response, report from The Economist Intelligence Unit
VivekMuthu, Chief Health Adviser, The Economist Intelligence Unit chairing the government panel with Gerardo Bayugo, Assistant Secretary of Health, the Philippines, Pannet Pangputhipong, Deputy Director-General of the Thai Ministry of Public Health, and Myint Han, Director-General of the Ministry of Health, Myanmar.
Dr Soo Khee Chee, Director of the National Cancer Centre Singapore, was of the opinion that, “Cancer advocacy groups can become reliable sources of information in the healthcare field where gaps in data continue to be an issue.”And about the topics that should be prioritised when investing in advocacy Dr Ravi Mehrotra, Director at the Cytology and Preventive Oncology Institute of the Indian Council of Medical Research said, “The most obvious place to put one’s money is in tobacco awareness.” His statement all but underscored the worrying trends of tobacco use around Asia. To conclude the forum, the speakers broadly agreed that the adoption of the four P’s – patient, public, private partnerships (as coined by Brigitte Nolet, Head of Global Policy, Roche) – are critical in developing effective and comprehensive responses to the challenges that Asian countries will face in the next decades with the expected rise in cancer incidences due to issues such as urbanisation and climate change.
Health Care Forum 2016 | War on Cancer www.makna.org.my
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NEWS & HAPPENINGS
BATTLING CANCER AND MORE
This article is written by Tan Sri Dzulkifli Abdul Razak, a member of the MAKNA Board of Trustees and Chair of the Islamic Leadership Office First published in The Sun Daily (http://www.thesundaily.my)
LAST week was a traumatic one for my family. The youngest uncle in the family passed away after a long and agonising episode of lung cancer. He had been in and out of hospital for “relief” or symptomatic treatment since he was too old and fragile for any form of aggressive therapy such as chemotherapy. In other words, he just had to wait for his time – hastened by the lung cancer no doubt – as testified by the medical fraternity. It came on Friday last week, sadly. Our last visit, a couple of days earlier, was heartwrenching. The image of an aged and helpless person, who is practically skin and bones seated on a wheelchair with a tube supplying “pure” oxygen attached to him as a lifesupport system, remains a vivid one. Even then he struggled to stay alive, the agony of which was obvious on his convoluted face as he tried hard to breathe. We have taken breathing for granted as a Godgiven right throughout our lives, doing it with ease without even thinking, not until our lungs are crushed by fatal ailments to the point of no return as a result of inhaling carcinogenic substances. 09
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This agonising image is not an isolated one, however. My association with MAKNA, the National Cancer Council, alerted us that cancer patients are left to suffer on their own away from public eyes. They can be in the longhouses of Sarawak or the backwaters of the east coast in the peninsula, or in posh hospitals. Their misery does not touch us at all because as they say out of sight, out of mind.
Most of all we just don’t care, although we know for a fact that millions are dying in this way due to a variety of cancers the cause of which is mostly avoidable as established by several world health authorities. The MAKNA volunteers are acutely aware of this because they are constantly in touch with patients physically and virtually. Many of the volunteers have had the rare experience of living with the patients and looking after them until the end. They often realise that it does not have to be a tragic end if only we are more proactive, more morally conscious about how “sacred” life is and that it is not to be bought and sold for the material comfort of a few.
NEWS & HAPPENINGS
That aggression is not just limited to the war on terror in the battlefields as we see every day through the “idiot box”, because “terror” can happen clandestinely in the most pretentious of places inhabited by hypocrites.
In other words, the commitment to ensure that all Malaysians are protected from all forms of cancer must also be the fight against corruption and collusion with those whose business is to spawn the deadly disease. This can be an uphill call unless we are also prepared to fight the addiction to cigarettes. With some four decades of experience in education locally and internationally, the writer believes that “another world is possible”.
After all, they have no qualms in trading the life of another for their own material convenience and extravagance using whatever legal coverage that they can hide under. Hence the fight for cancer has been a longstanding and precarious one. For each life saved, if at all, there are a million others in the pipeline waiting to be saved. In other words, for a meagre ringgit that MAKNA raises for its noble lifesaving activities in the fight against cancer, there is a far more unproportional amount spent to induce cancer almost ubiquitously.
Laugh Together lah
What is more obscene is that in the latter case dividends are even declared for their “shareholders” and yet they still have enough to mount awardwinning Corporate responsibility projects, including providing scholarships, as a smokescreen to camouflage their ruthless identities. This of course is not new as much has been well-documented scientifically for those who are interested in seeking the “truth” and deriving honest policy decisions to protect and promote public health worldwide. As such cancer is not just about a health issue but more so a moral one to safeguard the lives of millions from being wasted away. This is imperative especially involving innocent children who unknowingly are being seduced to a lifestyle that will surely end in a premature and agonising death.
source: lizclimo.tumblr.com
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FEATURE STORY
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VOLUNTEERS
VOLUNTEERS, SURVIVORS AND BEST BOWLERS By Priyadarshini Subramaniam, MAKNA Volunteer Coordinator In a dazzling display of skills, talents and indomitable spirit, Brown Vest Volunteer Jacob Mathews, his wife and Blue Vest Volunteer Sally Jacob, together with fellow Blue Vest Volunteer Daisy Woo knocked down all competition to win the Overall Best Bowler (Daisy) and Best Survivor Bowler (Jacob) at the Inter Team Unity Bowling Carnival, which was held at the Sunway Mega Lanes on 24 April 2016. The carnival, organised by the Breast Cancer Welfare Association, saw 48 teams participating. MAKNA was represented by three teams, namely MAKNA Crusader, MAKNA Periwinkle and Ninja Turtles. More than their winning, it was each participant’s enthusiasm and competitive spirit that brought much pride to MAKNA. Thank you to all bowlers and not forgetting the band of supporters who were cheering the teams on throughout the day!
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VOLUNTEERS
Dream Comes True FOR A DAY
By Ratnawati binti Abu Bakar, MAKNA Volunteer, Pahang
For Mohd Amirul Mat Zaki, age 7, nothing brings him more joy than playing with his toy fire engine. It was hardly surprising then to hear him say that his dream is to be a fireman when he grows up. Even though he wasn’t able to speak fluently and despite his condition, it was obvious to me that he held high hopes of being able to fulfil his dream one day. Unlike most boys his age who spend a majority of their time at school or playing with friends, Amirul’s life has revolved around hospital visits or being sick at home. As a baby he had been frail and he also appeared to be a slow learner. It wasn’t until 2014 when he was diagnosed as having early stage brain cancer that the severity of his condition became apparent. His health became even more erratic and he was constantly down with fever. At times, the fever even led to epileptic episodes. When we visited Amirul at home, he had just recovered from another bout of fever that caused him to miss a week of school. Although physically weak, I could tell that Amirul was happy to have a visitor at home. 15
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VOLUNTEERS
It was in between playing with his toy fire engine that he told me about his dream. It was seeing his enthusiasm that made me determined to help him realise his dream. I decided to convey Amirul’s wish to the Pahang Branch of the Fire and Rescue Department Malaysia. Much to my surprise, the department readily agreed to have Amirul over for a visit. On top of that, they even organised a small ceremony in honour of Amirul in conjunction with the International Firefighter’s Day. For Amirul, the day of the visit couldn’t come sooner. According to his mother, Puan Asimah, Amirul had been looking forward to the day. At about the same time however, his health took a downward turn. All of us were worried that he would not feel well enough to make the visit. When the day came, Amirul surprised everyone when he woke early and in good spirits. The was no question that he was going to make it to the fire station. Once there, Amirul’s adventure began. First, he was given a fireman’s uniform, specially tailored to his size. Then he was taken on a tour around the fire department and to get to know some of the firemen on duty. After that came the highlight of the visit and a much-waited-for moment for Amirul – a ride around town in a fire engine which ended at the East Coast Mall where the ceremony awaited.
Director of the Pahang Branch Fire and Rescue Department, Dato’ Abdul Wahab bin Mat Yasin, was there personally to welcome Amirul to the event. Apart from a cake-cutting ceremony, much to Amirul’s delight, he was also presented with a bicycle painted in the colours of the firemen’s uniform and fitted with a mini replica of a fire extinguisher. Although tired, Amirul was obviously overjoyed that he was able to experience being a fireman even if it was just for a day. The biggest reward for all of us who were there to witness his joy was knowing that the day would be a cherished memory for Amirul for a long time to come. MAKNA would like to say a big thank you to Dato’ Abdul Wahab bin Mat Yasin and all personnel of the Pahang Branch Fire and Rescue Department for their unstinting support in fulfiling the dream of a young boy. www.makna.org.my
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COVER STORY
More Than
FINANCIAL AID
Sejak 22 tahun, MAKNA terus berkembang sebagai sebuah organisasi yang bukan berasaskan keuntungan malah menawarkan pelbagai perkhidmatan kepada pesakit kanser yang kurang bernasib baik supaya mereka mempunyai akses kepada rawatan berkualiti dan berpeluang untuk terus hidup.
超越财务援助的支持 逾22年来，国家癌症理事会 （MAKNA）逐渐演变成一个非营利组 织(NPO)，不只提供财务援助，还提 供多元化的服务予贫困的癌症病患 们，让他们也能享有优质的医疗服 务及生存的机会。
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BUKAN SEKADAR BANTUAN KEWANGAN
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Over 22 years, MAKNA has evolved as a not-for-profit organisation (NPO) that offers not only financial aid via its Bursary Assistance Programme, but also diversified services to underprivileged cancer patients, to enable access to quality treatment and a chance at survival.
நிதி உதவிக் கு ம் மேலாக
கடந்த 22 ஆண்டுகளில் MAKNA ஒரு இலாப மற்ற அமைப் பாக வளர்சசி ் யடைந்திருக்கிறது. வசதியற்ற புற்றுந�ோய் ந�ோயாளிகளுக்கு ப�ொருல் ளாதார சேவை வழங் குவத�ோடு, அவர்களுக்கு தரமான மருத்துவமும் , உயிர்பிழைப் பதற்கான வாய் ப்பு ஏற்படுவதற்கும் வழிவகுத்து க�ொடுக்கிற�ோம் .
READ ON TO FIND OUT ABOUT MAKNA’S COMPREHENSIVE SERVICES.
这些就是MAKNA的关键服务。
BERIKUT ADALAH PERKHIDMATAN UTAMA YANG DISEDIAKAN OLEH MAKNA.
இத�ோ MAKNA –வின் முக்கிய சேவைகள் :
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COVER STORY
AWARENESS & EXHIBITIONS MAKNA conducts campaigns and exhibitions for cancer patients and the public. We travel across the country to give talks and exhibitions at community centres, schools, universities, private companies and hospitals, among other venues.
KEMPEN KESEDARAN & PAMERAN MAKNA cuba meningkatkan kesedaran melalui kempen dan pameran bagi pesakit kanser dan orang ramai. Kami menganjurkan ceramah dan pameran, antaranya di pusatpusat komuniti, sekolah, universiti, syarikat persendirian dan hospital di seluruh negara.
MOBILE MAMMOGRAM MAKNA emphasises the importance of early detection. In 2011, we launched a 40foot trailer equipped with a mammogram machine manned by qualified radiographers and nurses, to provide free mammogram screenings to women in rural areas who have no access to the facility or are unaware of breast cancer, still the #1 cancer subduing women in Malaysia.
MAMOGRAM BERGERAK MAKNA menekankan betapa pentingnya pengesanan awal. Pada tahun 2011, kami telah melancarkan sebuah treler berukuran 40-kaki yang dilengkapi dengan mesin mamogram yang dikendalikan oleh juru X-Ray dan jururawat yang bertauliah bagi menyediakan perkhidmatan imbasan mamogram percuma di kawasan-kawasan pedalaman kepada wanita yang tidak mempunyai akses kepada kemudahan tersebut atau tidak menyedari bahawa kanser payudara merupakan kanser nombor 1 dikalangan wanita di Malaysia.
醒觉和展览 MAKNA通过为癌症病患们和 公众举办宣传活动和展览来 推广癌症醒觉活动。我们在 全国各地的社区中心、学 校、大学、私人企业、医院，以及其他种 种场合举办讲座会和展览。
விழிப் புணர்வு மற் றும் கண்காட் சி செயல் கள் புற்றுந�ோய் ந�ோயாளிகளுக்கும் ப�ொதுமக்களுக்கும் எல் லையைக் கடந் து, MAKNA கண்காட் சிகள் மற்றும் விழிப் புணர்வு செயல் களை நடத்துகிறது. கடல் கடந் து, சமூதாய மையம் , பள் ளிகள் , பல் கலைக்கழகங் கள் . தனியார் நிறுவனங் கள் , மருத்துவமனைகள் ஆகியவற்றில் ச�ொற�்பொழிவுகள் நடத்துகிற�ோம் .
流动式 乳房X光检测 MAKNA强调及早检测的重要性。在2011年， 我们推介了一辆具备流动式乳房X光检测仪 的40尺长拖车，并拥有合格放射线技师和 护士们负责操作，以便向偏远乡区那些无 法接触此类设备或对乳癌毫无认知的女性 提供免费的乳房X光检测；乳癌一直都是马 来西亚女性的头号威胁。
நடமாடும் மார்பக ச�ோதனை ட்ரேலர் ஆரம் பநிலையிலேயே கண்டுபிடிக்கும் முக்கியத்துவத்தை MAKNA வலியுறுத்துகிறது. 2011 – ல் மார்பக புற்றுந�ோய் பற்றி தெரியாத கிராமப் புர பெண்களுக்காக 40 அடி நீ ளமுள் ள வாகனத்தில் , தேவையான கருவிகள�ோடும் , அதை கையாளும் நிபுணர்கள் , தாதிகள�ோடும் , மார்பக புற்றுந�ோய் இலவச ச�ோதனையை துவங் கின�ோம் .
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COVER STORY
HOME VISITS The MAKNA Home Visit Team follows up on every patient receiving bursary assistance, by visiting them in their homes. The team ensures patient well-being; observes their living conditions; encourages patients to continue with treatment or checkups; and most importantly, develops a better understanding of their lives through direct interaction.
LAWATAN KE RUMAH Pasukan Lawatan ke Rumah MAKNA membuat lawatan susulan untuk setiap pesakit yang menerima bantuan derma dengan melawat mereka di rumah. Pasukan MAKNA akan memastikan kesejahteraan pesakit; memeriksa keadaan kehidupan mereka; menggalakkan pesakit untuk meneruskan rawatan atau pemeriksaan; dan yang penting sekali, mempunyai pemahaman yang lebih jelas tentang kehidupan mereka melalui interaksi secara langsung.
CANCER SUPPORT GROUP Social and emotional support is vital in bearing the psychological burden of cancer. MAKNA has its very own cancer support group led by trained staff and volunteers to provide counselling to patients, family members, caregivers and anyone interested in cancer care, to help them cope better with the emotional demands of the disease.
KUMPULAN SOKONGAN KANSER Sokongan sosial dan emosi adalah penting dalam meringankan beban psikologi kanser. MAKNA mempunyai kumpulan sokongan kansernya sendiri yang diketuai oleh kakitangan terlatih dan sukarelawan untuk memberi kaunseling kepada pesakit, ahli keluarga, penjaga dan sesiapa yang berminat dalam penjagaan kanser, bagi membantu mereka menghadapi beban emosi akibat penyakit ini. 19
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家访 MAKNA家访团队通过亲自上 门拜访的方式，来跟进每位 接受援助金计划的病患。该 团队确认病患的健康状态； 观察他们的生活状况；鼓励病患们持续进 行治疗或检测；而最重要的是能通过直接 互动的方式，来更进一步了解病患们的生 活。
ந�ோயாளி வீட்டிற் கு வருகை தருவது ப�ொருளாதார உதவி பெரும் ந�ோயாளிகளின் வீடுகளுக்குச் சென்று MAKNA அதிகாரிகள் கண்கானிக்கிறார்கள் . ந�ோயாளிகளின் நலம் . வாழ் ககை ் முறைகளை கண்டறிவத�ோடு, அவர்கள் த�ொடர்ந் து சிகிச்சை பெறவும் . பரிச�ோதனை செய் து க�ொள் ளவும் ஊக்குவிக்கப் படுகிறார்கள் . மேலும் நேரடி கருத்து பரிமாற்றத்தின் மூலம் நல் ல புரிந் துணர்வு ஏற்படுகிறது.
癌症支援组 对那些笼罩在癌症阴影下承 受着沉重心理负担者而言， 社会和精神上的支持极为重 要。 MAKNA拥有由经受训的职员和自愿者 带领的癌症支援组，向病患和其家属们、 看护者，以及任何对癌症看护方面有兴趣 者提供咨询服务，以帮助他们能更好地应 对该疾病所带来的情绪诉求。
புற் றுந�ோய் ஆதரிப் பு குழு மனரீதியாக புற்றுந�ோய் பிரச்சனைக்கு சமுதாய மற்றும் உணர்சசி ் பூர்வ ஆதரவு க�ொடுப் ப து முக்கியம் . MAKNA – வில் உள் ள ஆதரிப் பு குழு தேர்சசி ் பெற்ற பணியாளர்களாலும் , த�ொண்டர்களாலும் நடைபெருகிறது. அவர்கள் மக்களுக்கு வேண்டிய ஆல�ோசனைகளைக் க�ொடுப் ப துடன், அவர்களின் மனரீதியான தேவைகளையும் பூர்ததி ் செய் கிறார்கள் .
COVER STORY
CANCER HELPLINE The MAKNA Cancer Helpline (1800-88-62562) is managed and handled by trained oncology personnel to provide support and information not only for cancer patients, but also family members, caregivers and the general public.
TALIAN BANTUAN KANSER Talian Bantuan Kanser MAKNA (180088-62-5-62) diurus dan dikendalikan oleh kakitangan onkologi yang terlatih untuk memberi sokongan dan maklumat bukan sahaja kepada pesakit kanser, malah kepada ahli keluarga, penjaga dan masyarakat umum.
HALFWAY HOUSE Many patients are unable to afford the travel costs or may not be physically fit to undertake the journey between hospital and their homes repeatedly, thus opting out of cancer treatment prematurely. Since 2008, the MAKNA Halfway House has been providing short-term accommodation to patients and their caregivers for the duration of their hospital treatment.
RUMAH PERSINGGAHAN Ramai pesakit tidak mampu menanggung kos perjalanan atau mungkin tidak mampu daripada segi fizikal untuk berulang-alik antara rumah dan hospital – maka ada diantara mereka akan memberhentikan rawatan kanser lebih awal. Sejak tahun 2008, Rumah Persinggahan MAKNA telah menyediakan tempat tinggal sementara kepada pesakit dan penjaga mereka semasa dalam tempoh rawatan hospital mereka.
癌症咨询热线 MAKNA癌症咨询热线 (180088-62-5-62) 是由经培训的 肿瘤科专才负责管理和经 营；他们的服务对象不只限 于癌症病患们，同时还包括向病患家属、 看护者和公众提供支援和资讯。
புற் றுந�ோய் HELP LINE MAKNA புற்றுந�ோய் HELP LINE தேர்சசி ் பெற்ற மருத்துவ நிபுணர்களைக் க�ொண்டு புற்றுந�ோய் ந�ோயாளிகளுக்கு மட் டுமல் லாமல் , குடும் ப உறுப் பினர்கள் , கவனிப் பாளர்கள் , ப�ொதுமக்களுக்கும் வேண்டிய ஆதரவும் , ப�ொதிய தகவலும் க�ொடுத்து நிர்வாகம் செய் கிறார்கள் .
中途之家 很多病患无法承担治疗所需 的旅费或可能身体无法负荷 重复往来医院和住家的旅 程，而在未完成疗程前选择放弃治疗。自 2008年起，MAKNA的中途之家就已经为癌症 病患和其看护者提供治疗期间的短期住宿 服务。
MAKNA – வின் த�ொலை தூர இல் லங் கள் பெரும் பாலான ந�ோயாளிகள் , பண வசதி இல் லாமல�ோ அல் லது உடல் ரீதியான நிலை சரியில் லாமல�ோ த�ொலை தூரத்தில் உள் ள மருத்துவமனைக்குச் சென்று வர முடிவதில் லை. அதனால் சிகிச்சையை பாதியிலேயே நிறுத்திவிடுகிறார்கள் . 2008 – லிருந் து மருத்துவமனை சிகிச்சை நாட் களில் அவர்களுக்கு குறுகியகால தங் கும் வசதி செய் து தரப் படுகிறது.
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COVER STORY
CANCER CENTRE MAKNA runs a cancer centre CANCER in collaboration with Hospital Universiti Kebangsaan Malaysia (HUKM), which compromises an oncology ward, a sub-basement radiotheraphy unit and stem cell transplant ward. Since 1999, the cancer centre has served over 16,000 patients at subsidised rates.
PUSAT KANSER MAKNA mengendalikan sebuah pusat kanser dengan kerjasama Hospital Universiti Kebangsaan Malaysia (HUKM), yang terdiri dari wad onkologi, unit radioterapi dan wad tranplantasi sel stem. Sejak tahun 1999, pusat kanser ini telah memberi khidmat kepada lebih 16,000 orang pesakit pada kadar subsidi.
SCHOLARSHIP
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癌症中心 MAKNA与马来西亚国立大学 (HUKM) 联合经营一个癌症中 心；此中心涵盖一个肿瘤科 病房、一个地下室下层的放 射线疗法单位和一个干细胞移植单位。自 1999年起，该癌症中心已经以补贴价为超 过16,000位病患提供服务。
CENTRE
MAKNA புற் றுந�ோய் சிகிச்சை மையம் MAKNA புற்றுந�ோய் சிகிச்சை மையம் Hospital Universiti Kebangsaan Malaysia (HUKM) மருத்துவமனையுடன் இணைந் து பல மருத்துவ நிபுணர்களைக் க�ொண்டு செயல் பட் டு வருகிறது. 1999 – லிருந் து 16,000ந�ோயாளிகளுக்கு குறைந்த கட் டணத்தில் சேவையாற்றியுள் ளது.
奖学金
The Young Cancer Survivor Scholarship Programme launched in 2005 lessens the financial burden on families and improves the quality of patients’ lives by providing them the opportunity to pursue their tertiary education. Cancer survivors aged 25 or younger from lower income groups with potential and interest are eligible to apply.
在2005年推出的年轻癌症幸 存者奖学金计划 通过提供这 些年轻癌症幸存者机会取得 大学文凭资格，来减轻他们家庭的财务负 担及改善病患们的生活素质。那些有潜质 及有兴趣升学，并且年介25岁及以下的贫 困癌症幸存者皆合格申请。
BIASISWA
கல் வி உதவித் தொகை
The Young Cancer Survivor Scholarship Programme yang dilancarkan pada tahun 2005 bertujuan mengurangkan beban kewangan keluarga dan meningkatkan kualiti kehidupan pesakit dengan menyediakan peluang kepada mereka untuk mendapatkan pendidikan di universiti atau institusi pengajian tinggi. Bekas pesakit kanser yang kurang mampu, berusia 25 tahun ke bawah yang berpotensi dan berminat digalakkan untuk memohon.
2005 – ல் புற்றுந�ோயிலிருந் து குணமடைந்த இளைஞர்களுக்கு கல் வி உதவித் தொகை திட் டத்தை ஆரம் பித�்தோம் . இதன் ந�ோக்கம் அவர்களின் குடும் பத்தினரின் செலவை குறைப் பதற்கும் , வாழ் ககை ் மேம் பாட் டிற்கும் , பல் கலைக்கழக தகுதி பேறுவதற்கும் . வசதியற்ற 25 வயதுக்கும் கீழ் உள் ள புற்றுந�ோய் குணமடைந்த, ஆர்வமுள் ளவர்கள் விண்ணப் பிக்கலாம் .
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COVER STORY
CANCER RESEARCH CANCER HELPLINE To advance knowledge in the treatment of cancer, a portion of funds raised goes towards supporting young scientists conducting cancer research via the MAKNA Cancer Research Award. MAKNA continues to expand its services and fulfil its mission of reducing cancer incidence in the country and enabling patients to have a better quality of life and/or cancer-free future.
癌症研究
为了深入研究癌症治疗方面 的知识，MAKNA通过MAKNA癌 症研究奖提供研究基金来 资助研究人员在本地各个大学进行癌症研 究。 MAKNA将继续拓展其服务来达成其减低国内 癌症发病率的任务，并让癌症病患们能拥 有一个更好的生活素质及/或摆脱癌症威胁 的未来。
புற் றுந�ோய் ஆராய் ச்சி KAJIAN KANSER MAKNA terus meluaskan perkhidmatan sedia ada dengan menggalakkan penyelidikan di kalangan saintis muda melalui Anugerah Penyelidikan Kanser MAKNA. Ini adalah bertujuan untuk mengurangkan insiden kanser di negara ini dan membolehkan pesakit mendapat kehidupan yang lebih berkualiti dan/atau masa depan yang bebas daripada kanser.
புற்றுந�ோயை குணப் படுத்துவதற்கான திறமையை மேம் படுத்துவதற்காக, ஆராச்சியாளர்களை ஊக்குவிப் பத�ோடு, MAKNA புற்றுந�ோய் ஆராய் சசி ் விருதும் பண மூலமாக வழங் கப் படுகிறது. நாட் டி லுள் ள புற்றுந�ோய் நிகழ் வுகள் குறைப் பதற்கும் , ந�ோயாளிகளின் வாழ் ககை ் முறையை மேம் படுத்துவதற்ககு ் ம் , புற்றுந�ோய் அற்ற ஏதிர்காலத்தை உறுவாக்குவதற்கும் , MAKNA த�ொடர்ந் து தன் சேவையை விரிவுப் படுத்துவத�ோடு தன்திட் டத்தை பூர்ததி ் செய் யும் .
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RESEARCH
BLOOD VESSELS:
HOW THEY AID TUMOUR NETWORKING By Cheng Wei Kang and *Dr Oon Chern Ein
Cancer cells are abnormal cells that undergo uncontrolled division, forming living clumps of actively dividing cancerous cells. In order for tumour growth to proceed, the cells need nutrients and oxygen as well as the ability to transport carbon dioxide and excrete metabolic wastes. Without blood vessels to transport the necessary nutrient, the tumour cannot grow beyond its limited size. Angiogenesis, the growth of new blood vessels can help the tumour address these needs. The balance of pro-angiogenic and anti-angiogenic chemical signals in the body is responsible for controlling angiogenesis which determines the outcome of vessel formation. Under normal circumstances, there is balance in both stimulating and inhibiting effects of these chemical signals. Blood vessels only form when they are needed and at the specific site where they are needed. However in the presence of tumour progression, pro-angiogenic molecules are activated and remain turned on whereas inhibitors signal are switched off.
Increase in tumour size beyond 1-2 mm3 will cause the surface area to volume ratio to decrease, causing the nutrient diffusion efficiency to decrease because the cancer cells cannot directly absorb nutrients from extracellular environment. The formation of new blood vessels are required for nutrient to reach the inner part of tumour mass. During angiogenesis, vasculature continue to sprout and form new blood vessels to support the increasing tumour mass. Figure 1 depicts tumour angiogenesis. Recent studies have proven that tumour will secrete chemical stimuli such as vascular endothelial growth (VEGF) to induce angiogenesis. VEGF gene expression is upregulated through cancer signalling pathways. Unlike normal blood vessels, blood vessels from tumour angiogenesis are irregularly shaped. Angiogenesis promotes the spread of tumour known as metastasis. The formation of new blood vessels serve as pathways for cancer cells that separated from the tumour mass to travel to distant site where the cancer cells lodge to form a new secondary tumour. Scientists are currently targeting angiogenesis to treat cancer. Tumours with receding vessels receive less nutrients. This will cause the cancer cells to “starve” and eventually die. Hence drugs targeting the vessels may be able to control the size of tumour as well as preventing the spread of tumour to other body parts. Figure 2 demonstrates the action of angiogenesis inhibitor on tumour mass.
Tumour Pro-angiogenic growth factors
Blood vessel 23
A
B
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C
Figure 1: A schematic diagram of the basic steps in tumour angiogenesis. A - Tumour releases pro-angiogenic cues which are recognised by the endothelial cells (cells that form blood vessels). B - Pro-angiogenic growth factors stimulate sprouting of new blood vessels. C – Vessels feed tumour with nutrients and oxygen to promote tumour growth.
RESEARCH Angiogenesis inhibitors
Tumour
Blood vessel
A
B
C
Figure 2: A simplified diagram on the mode of action of anti-angiogenic drugs on tumour vessels which subsequently inhibit tumour growth. A- Tumour with blood vessels. B- Drug is released to inhibit the action of pro-angiogenic factors. C. Tumour will ‘starve’ and eventually shrink.
Angiogenesis inhibitors are drugs that stop and prevent angiogenesis. They can be administered as stand-alone or as adjunct to chemotherapy or another drug depending on tumour type, tumour aggressiveness and patient response to the particular anti-angiogenic drug. Below are some examples of common drugs used to treat the cancer by inhibiting tumour angiogenesis.
Drugs
Type of cancer
Axitinib (Inlyta)
Kidney cancer
Bevacizumab (Avastin)
Bowel cancer, non small cell lung cancer, kidney cancer, ovarian cancer, fallopian tube cancer, peritoneal cancer, breast cancer and cervical cancer
Ziv-aflibercept (Zaltrap)
Bowel cancer
Sorafenib (Nexavar)
Kidney cancer, liver cancer and thyroid cancer
Data from http://www.cancerresearchuk.org
*Corresponding author: Dr Oon Chern Ein Institute for Research in Molecular Medicine Universiti Sains Malaysia Minden 11800 Penang Email: chern.oon@usm.my
Dr Oon’s research area of interest includes investigating the use of novel therapeutic agents to target tumour angiogenesis (formation of new blood vessels in cancer) and overcoming tumour resistance, with emphasis on targeting cancer pathways to modulate the downstream signalling pathways in cancer cells and the tumour microenvironment. Cheng Wei Kang is a MSc student at the Institute for Research in Molecular Medicine, USM.
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RESEARCH
STEM CELL-BAS FOR CHRONIC M By Liew Lee Chuen, Ph.D candidate at the Department of Pathology, Immunology & Microbiology,Graduate School of Medicine, University of Tokyo.
Chronic Myeloid Leukaemia (CML) is a slowly progressing cancer of the blood and bone marrow, which accounts for approximately 20% of all diagnosed leukaemia cases. It is characterised by the overproduction of abnormal white blood cells in the body. The disease generally progresses through three distinct phases. About 90% of patients with CML are diagnosed at chronic phase of the disease. During this phase, the disease may have few or no symptoms and will remain for a number of years. Without effective treatment, it may progress to an accelerated phase where common symptoms such as fever, loss of appetite, weight loss, fatigue, bone pain and swollen spleen can be observed. Ultimately, it will transform to a terminal phase known as blast crisis, in which bleeding and infections may occur and can be life-threatening.
consumption of the drug has not only caused adverse events that affect patients’ quality of life, but has also imposed financial burden to the patients. On top of that, growing resistance to TKI treatment has also restricted its therapeutic index as well as the overall efficacy. To date, the only curative therapy for CML is allogeneic stem cell transplantation (ASCT), where the patient’s diseased bone marrow (hematopoietic) cells are replaced with healthy ones from a donor. However, the outcome of ASCT in CML is not always as good as expected as it is influenced by many factors, such as the phase of disease, age of the patient, type of donor used and etc. In addition, the morbidity and mortality associated with the transplant procedure and the shortage of matched donor also exclude it as a viable option for most CML patients. Therefore, the lack of one definite curative treatment for CML has urged the need to search for an alternative approach that can at least complement current treatments as a combination therapy.
CML is a well-characterised disease as the molecular mechanism behind the disease has been revealed: A translocation About 90% of patients between the long arms of with CML are diagnosed chromosomes 9 and 22, known as the In recent years, the rapid advances at chronic phase of the Philadelphia (Ph) chromosome. This in biomedical research have brought disease. translocation results in a BCR-ABL about new excitement and form fusion gene, which is translated into the basis of potential therapeutic an abnormal BCR-ABL protein that approaches for treatment of human has de-regulated tyrosine kinase diseases. Therapeutic gene delivery is one of these activity and causes increased and uncontrolled growth advances that are relatively new and promising for of white blood cells. This discovery is considered a disease treatment. The concept of therapeutic gene breakthrough in the modern treatment of CML and has delivery refers to the introduction of a gene into the cells made tyrosine kinase inhibitor (TKI) a gold standard and subsequently delivered to patients for therapeutic treatment for CML; a drug that targets and supresses purposes. Our laboratory, PPUKM-MAKNA Cancer the abnormal protein, preventing cancer cells from Centre, led by Professor Emeritus Dr Cheong Soon continue growing. Keng, is focusing on the research of cell-based gene therapy for treatment of cancers. One of the studies All of the available TKIs (imatinib, dasatinib, nilotinib in our laboratory is to utilise bone marrow-derived and etc) are able to achieve long-term control of Mesenchymal Stem Cell (BM-MSC) as the cellular CML in the majority of patients at all stages of the vehicle for targeted therapy in the treatment of blood disease. Although these drugs do provide impressive cancer. In this project, we genetically engineered BMresults, most of the patients still experience minimal MSC with interferon-gamma gene (IFN-γ) and evaluated residual disease and relapse will often occur upon their efficacy in targeting human chronic leukaemia cell drug withdrawal. Furthermore, the need for long-term lines. We demonstrated that genetically engineered BM25
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RESEARCH
SED GENE THERAPY MYELOID LEUKAEMIA MSC was capable of secreting the cytokine products (IFN-γ protein) as well as retaining their intrinsic properties. Most importantly, the cytokines produced were shown to inhibit the growth of chronic myeloid leukaemia cells in an in vitro setting. Our findings highlighted bone marrow-derived mesenchymal stem cell as a powerful cellular vehicle in targeted gene delivery and the importance therapeutic role of interferon-gamma in the treatment of CML. IFN-γ engineered BM-MSCs could be further explored as another treatment option in additional to the currently available ones, particularly targeting patients with minimal residual disease (MRD) or relapse upon withdrawal or resistant against TKIs. On the other hand, the use of this genetically engineered BM-MSC could also be developed as a combination therapy in conjunction with TKI treatment for all CML patients, with the hope to achieve complete molecular remission. Be it a back-up treatment or combination therapy, the ultimate aim of this IFN-γ engineered BM-MSC-based therapy is to provide an optimal treatment to prolong patients’ survival or even to offer a possible cure for the disease. We acknowledge the funding support from MAKNA and thank the following research team members for providing insight and expertise that greatly assisted the research.
PPUKM -MAKNA Cancer Centre, MSC Team
Differentiation potential of bone marrow-derived mesenchymal stem cell (BM-MSC)
A
B
C
D
MSCs derived from bone marrow of all the patients were able to differentiate into lineage-specific cell types when induced in respective induction medium. (A) BM-MSCs without induction (B) Accumulation of lipid droplets that stained positive with Oil Red O in cytoplasm of MSCs after adipogenic induction. (C) Red precipitates represent the calcium deposits of matrix formation produced by BM-MSCs after osteogenic induction. (D) Spheroid formation which stained intensely dark blue with Alcian Blue indicate the presence of cartilage extracellular matrix under chondrogenic induction.
A
B
C
• Professor Emeritus Dr Cheong Soon Keng (Principal Investigator) • Professor Dr S. Fadilah Abdul Wahid • Associate Professor Dr Leong Chooi Fun • Associate Professor Dr Maha Abdullah • Associate Professor Dr Chong Pei Pei • Dr Mok Pooi Ling • Dr Teoh Hoon Koon
GFP-expressed BM-MSCs indicate successful transfection of a positive control vector pmaxGFP into BM-MSC. Images were view under (A) Phase contrast (B) Fluorescent microscope (C) Merged image. www.makna.org.my
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RESEARCH
AN ASPIRING RESEARCHER’S HANDS-ON EXPERIENCE By Loo Hui Qi I decided to participate in the VRVP(Vacation Research & Volunteer Programme)after my SPM examination. The research component of my VRVP was carried out at the UTAR Faculty of Medicine and Health Science from 11 January to 26 February 2016. At the start of the programme, I was introduced to laboratory practices and protocols. For the first month, I spent most of the time observing and learning about stem cell research as well as using common laboratory instruments and techniques. One of the main research works I observed was cell culture, from the thawing of cells to cell passaging and freezing of cells. Other than laboratory basics like the use of biosafety cabinet and micropipette, I also learned the protocols of DNA and RNA extraction, as well as laboratory techniques like Polymerase Chain Reaction and ELISA Assay. In addition, I had the opportunity to attend journal club presentations and talks on new laboratory instruments, which are all eye-opening experiences. Before the end of my research attachment, I was given the chance to carry out hands-on laboratory works. Working with bone marrow mesenchymal stem cells, I carried out activities like cell culture, differentiation of MSCs into adipocytes cells, RNA extraction and Reverse Transcription Polymerase Chain Reaction (RT-PCR). The hyphen one-and-a-half month of experience in the research laboratory was very rewarding. Other than getting exposed to new knowledge, I was able to have a glimpse into a researcher’s life. I am more certain now of my aspiration to become a research scientist in the field of life science. Following the research component was a one-month attachment with MAKNA from 8 March to 8 April 2016. Mostly involved in admin work in the volunteer department of MAKNA, I helped with preparation work 27
NEOPLASIA { ISSUE 02/2016 }
Microscope imaging of MSCs cells (40X)
for several MAKNA events for volunteers, including the MAKNA Introductory Programme, Basic Nursing Care, and the Quarterly Volunteer Leaders’ Meeting. I also went on a home visit together with MAKNA staff where we called on cancer patients who were receiving aid from MAKNA in their homes. From this aspect of the programme, I was able to hone my skills in communication and planning, while learning to work as a team and to become more patient. Witnessing the pain and suffering of cancer patients who were financially challenged also made me more grateful for what I have and made me cherish my health more. Needless to say, the VRVP has been an enriching experience with many intangible benefits. I have no doubt that the knowledge I have gained throughout this programme can be put to good use in the future. Hui Qi is a secondary school graduate from Pulau Pinang. She plans to pursue a degree in life science after she finishes her Pre-U studies. Her dream is to become a science researcher working on the frontier of biological research. Following her SPM exam, Hui Qi participated in the VRVP with MAKNA to get a firsthand exposure to life as a researcher. In her free time, she likes to play the piano, engage in outdoor activities or simply lay on the bed watching Sci-Fi movies.
LIFE GOES ON
Kasih Ibu Tiada Ganti By Suhaila Nik, MAKNA Home Visit Executive Menyusuri perkampungan Parit Ali Kalang yang terletak di Bagan Serai, Perak telah mempertemukan kami dengan seorang ibu tunggal yang begitu cekal hatinya dalam membesarkan anak-anak. Norfazilah Yaakob berusia 42 tahun merupakan ibu kepada tujuh orang cahaya mata berusia antara 18 hingga 12 tahun yang mana kesemuanya masih lagi dalam alam persekolahan. Berbekalkan kudrat wanitanya beliau sebelum ini bekerja sebagai pembantu kedai makan dengan memperoleh pendapatan yang tidak menentu terpaksa berhenti bekerja setelah salah seorang puteri kembarnya (triplets) iaitu Aina Khadeeja Roslan disahkan menghidap Chronic Myeloid Leukemia semenjak Februari 2015 yang lalu. Keadaan ini menuntut beliau untuk berulang alik ke Hospital Kuala Lumpur setiap bulan bagi memastikan anaknya menerima rawatan sepertimana yang disyorkan oleh Pegawai Perubatan. Selain HKL, Khadeeja juga perlu mendapatkan rawatan di Hospital Pulau Pinang. Bagi adik-beradik yang lain, mereka seolah-olah telah memahami rutin ibu dan adiknya untuk berulang-alik ke hospital maka mereka akan membantu dan menjaga antara satu sama lain sewaktu ketiadaan ibunya. Pengalaman ibunya menceritakan detik Khadeeja untuk melakukan transplant pada Julai 2015 yang lalu, kesemua adikberadiknya beria untuk mendermakannya bagi
memastikan adik mereka kembali sihat seperti sedia kala. Ternyata hubungan yang terjalin antara mereka adik-beradik begitu erat dan sanggup berkorban untuk adik tersayang mereka. Tambah ibunya lagi beliau dan Khadeeja juga pernah melalui detik sukar yang mana sewaktu dalam perjalanan ke Hospital Pulau Pinang dengan menaiki motosikal mereka berdua telah terlibat dalam kemalangan. Mujurlah kecederaan yang dialami tidak begitu serius. Namun selepas daripada kejadian tersebut beliau serik untuk ke hospital lagi dengan menunggang motosikal. Dengan bekerja sebagai pembuat kuih-muih, Norfazilah gigih dalam membesarkan tujuh orang cahaya matanya. Selain itu beliau juga merupakan penerima bantuan kewangan daripada Jabatan Kebajikan Masyrakat. Nasib keluarga ini beruntung apabila turut mendapat sokongan yang baik daripada nenek dan juga ibu saudaranya yang tinggal berdekatan dengan kediaman mereka. Ibu adalah wanita yang paling berjasa dalam kehidupan seorang anak. Amat besar kasih sayang dan pengorbanan ibu kepada anak-anaknya.
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