Cancer Awareness Survey 2018 Report

Introduction

Cancer is the fourth leading cause of death in Malaysia and is on an increasing trend.  MySCan or Malaysian Study on Cancer Survival published in 2018, shows that cancer with the lowest survival was cancer of the lung.  This survival can be improved if patient receives treatment early, or better still if our youth are aware of the risk factor to developing this cancer.

We, the Society for Cancer Advocacy (SCAN), believed that early detection and prevention programme to combat cancer in Malaysia should be implemented in management of cancer care as the actual treatment of cancer is expensive.

SCAN carried out an online survey during the second half of 2018 to assess how aware the general Kuching community is of cancer risk factors, signs, symptoms, and other related issues.

You can also download the file here  Cancer Awareness Survey Report 2018

Objective

To help develop strategies to improve communication, advocacy, welfare, and other services related to cancer across Sarawak and Malaysia at large, SCAN decided to assess the current state of cancer awareness in Kuching and Sarawak.

This report attempts to analyze the survey results of 45 questions posed to 339 respondents.  The results will be shared with the public and any other interested societies on the current state of knowledge of cancer, its detection, potential causes, cancer healthcare and government facilities.

SCAN will also attempt to align our strategies of bringing awareness and advocacy with the results of this survey.

Methodology

A questionnaire was made available online from July to December 2018.  Participants were recruited from the public through word of mouth, during other of the society’s activities, via social media and through paid Facebook advertisements. The survey was available in English, Malay and Chinese.

45 questions were asked, investigating: current perceived level of cancer knowledge, current sources of information on cancer, interest, knowledge on cancer myths, awareness on cancer warning signs, awareness on cancer risk factors, fears and attitude regarding early detection, perceived quality of the Malaysia healthcare system, and the perceived areas that needs improvement.

The questions were based on similar surveys done by Cancer Research UK and the National Cancer Society Malaysia with additional questions added on.

A further 15 questions were asked to determine the participants demography.

Results

Demographic Analysis

Out of the 339 respondents, 70% are female, 60% are of the X and Y generations (aged 25 to 44), 86% are Sarawakians, while 68% are tertiary educated, of the middle and high income group.

Survey Analysis

Q1. How do you rate your knowledge on cancer?

47% of respondents rated themselves as average in terms of cancer knowledge while 38% rated themselves above average.

Q2. What are your main sources for information on cancers?

Sources of information vary as illustrated by the pie chart below.  It is alarming to note that online website and social media account for a total of 37% as the top 2 main sources of cancer information.  This could be worrying as a lot of articles shared via these sources may not be scientifically proven including some which are outright false.  Doctors is ranked the third main source (16%) followed by friends (14%).

Q3 Are you interested to learn more about cancer?

The respondents (83%) are somewhat interested and very interested to learn more about cancer.  Overall this is a good indication as knowledge in cancer is key for early detection and cure.

Q4. Are there any topics on cancer that interest you?

Cancer Prevention tops the list followed by Cancer Treatment and Diet. Respondents are also keen to hear about Cancer Survivors Stories.  Cancer Advocacy is ranked lower at 11%, probably due to it being a new area of interest.

Q5. Smoking is the single biggest cause of cancer in the world

69% of the respondents believe smoking is the single biggest cause of cancer.  For the record, smoking is the single biggest cause of cancer in the world. More education is needed to highlight this fact as one-third of the respondents are still uninformed over this.

Q6. You can infect other people if you have cancer

Almost all respondents know that cancer is not infectious.

Q7. Only old people get cancer

Almost all the respondents are aware that this is not the case.

Q8. I can reduce my cancer risks if I maintain a healthy lifestyle

The majority of the respondents are aware that a healthy lifestyle can reduce cancer risks.

Q9. Early Detection, Diagnosis and timely appropriate treatment improves chances of cancer cure/survival

Almost all are aware that early detection/diagnosis improves the chances of cancer cure and survival.

Q10-Q19. Do you think: –

  • an unexplained lump or swelling could be a sign of cancer?
  • persistent unexplained pain could be a sign of cancer?
  • unexplained bleeding could be a sign of cancer?
  • a persistent cough or hoarseness could be a sign of cancer?
  • a persistent change in bowel or bladder habits could be a sign of cancer?
  • persistent difficulty in swallowing could be a sign of cancer?
  • a change in the appearance of a mole could be a sign of cancer?
  • a sore that does not heal could be a sign of cancer?
  • unexplained weight loss could be a sign of cancer?
  • unexplained and recurrent fever could be a sign of cancer?

Analysis of Q10-Q19

A total of 10 questions above were fielded to the participants on their knowledge about cancer symptoms.  Answers of ‘Yes’ varies from 85% to 62%.  Those symptoms that are less commonly known to be associated with cancer (under 70%) are: –

Q13 – persistent difficulty in swallowing – 68%

Q14 – sore throat that does not heal – 64%

Q19 – unexplained and recurrent fever -62%

As such more education related to these symptoms of cancer could help the public.

Q10.

Q11.

Q12.

Q13.

Q14

Q15

Q16.

Q17.

Q18.

Q19.

Q20. If you had a symptom that you thought might be a sign of cancer, how soon would you contact your doctor to make an appointment to discuss it?

Based on the survey results, 52% will immediately make an appointment to discuss with a doctor, while 24% will do it within a week, and another 12% within a month. These indicate a fairly good awareness from the respondents to seek consultation to address their concerns.

Q21-Q29.  Sometimes people delay going to see a doctor even when they have symptoms.  Could you rate if any of these put you off going to the doctor?

  • I would be too embarrassed
  • I would be too scared
  • I would be worried about the medical expenses
  • It would be difficult to make an appointment with my doctor
  • I would be too busy to make time to go to the doctor
  • I have too many other things to worry about
  • It would be difficult for me to arrange transport to the doctor’s clinic/hospital
  • I would be worried about what the doctor might find
  • I wouldn’t feel confident talking about my symptom with the doctor

Analysis of Q21-Q30

Q21 – Q30 attempt to find out the reasons for not seeing a doctor/delay in seeing a doctor when having symptoms.

Q21. 54% of the participants rated ‘No’ while 33% rated ‘Yes sometimes’.  Depending on the seriousness of the symptom and other factors, the responses vary.

Q22.       A total of 49% responded ‘Yes Sometimes’ and 23% responded ‘Yes Often’.  Hearing from the doctor that one could be affected by cancer would be a ‘scary’ experience.

Q23.       77% of respondents are worried about the medical expenses (40% rated ‘Yes Often’ and 37% ‘Yes Sometimes’).  This warrants further study as to whether the perceived cost and actual cost match.

Q24.       Regarding difficulty in making appointments with a doctor, most of the participants responded ‘No’ (60%).  Only 29% responded ‘Yes sometimes’

Q25.       The responses are varied here. Busy lifestyle may have got in the way of seeing or consulting the doctor as more than half of the respondents said “Yes Often” (17%) or “Yes Sometimes” (41%).  This is alarming to note as many may lose the opportunity to detect their cancer early.

Q26.       The respondents have other worries in their life other than to seek out a doctor as indicated below.  ‘Yes sometimes’ is 45%’. ‘Yes often’ is 27%.  This needs to be addressed as early consultation is imperative for cancer diagnosis and cure.

Q27.      Most responded ‘No’.  The majority of the respondents are urban dwellers (based on the respondents’ demographic information) so transport is not a hindrance.

Q28        the ‘Yes’ score is 76%.  Most are worried what the doctor might find.

Q29.       More than half of the respondents (58%) are not confident in talking about their symptoms with their doctor. Only a handful (29%) feels somewhat comfortable talking to their doctors. This fear needs to be addressed.

Q30.       Almost all (93%) have no other reasons for not going to the doctor.

Others reasons (top 3) from the respondents are as below: –

Poor family support, unnecessary worry to loved ones.
Self-denial, self-pride, ‘do not’ bother attitude, ‘wait and see’ attitude.
Doc would give ‘unnecessary’ treatment which is stressful and costly.

Q31 – Q41.  How much do you agree that each of these can increase the chance of developing cancer?

  • smoking habit
  • Exposure to another person’s cigarette smoke
  • Drinking more than 1 unit of alcohol a day
  • Eating less than 5 portions of fruit and vegetables a day
  • Eating red or processed meat once a day or more
  • Being overweight (BMI over 25)
  • Getting sunburnt more than once as a child
  • Being over 70 years old
  • Having a close relative with cancer
  • Infection with HPV (Human Papillomavirus)
  • Doing less than 30 mins of moderate physical activity 5 times a week

Analysis of Q31 – Q41

Q31.      94% of the respondent ‘strongly agree’ and ‘agree’ that the smoking habit increases the chance of developing cancer.  This is true in relation to the potential of catching lung cancer.

Q32.      94% of the respondents agree that exposure to secondary smoke increases the chance of getting cancer.  Good awareness here.

Q33.       Based on the survey data below, 68% of the respondents regards drinking alcohol as a cancer risk factor.  Good awareness here.

Q34.      From a dietary standpoint of eating less fruits and vegetables, 35% agree and strongly agree that it can increase the chance of developing cancer. However, 46% of the respondents are neutral in their opinions. There is lack of awareness here.  Eating less fruit and vegetable does increase the chance of developing cancer.

Q35.      Those who agree/strongly agree (48%) are more than those who remain neutral (41%).  The result is comforting though the public still needs more education to recognize this factor as a cause for cancer.

Q36.  On being overweight (potential of developing cancer), those who agree/strongly agree (51%) are more than those who remain neutral (36%).  This shows there is strong need to educate the public that obesity puts one on higher cancer risk.

Q37.       41% of the respondents are neutral in their opinion.  34% agree and strongly agree. More awareness is certainly required as getting sunburnt does increase the chance of developing cancer.

Q38.       Regarding the fact that being over 70 years means there is a higher chance of developing cancer, 38% of respondents are neutral in their opinion while only 35% agree and strongly agree. It is true that the probability of cancer increases with age, so awareness of this fact is definitely lacking.

Q39.       68% of the respondents are aware that having a close relative with cancer increases one’s chance of developing cancer.  This is true from a genetic standpoint.  This is a good indication of awareness on this fact.

Q40.       59% of the respondents agree and strongly agree that infection with HPV increases one’s chance of developing cancer.  However, 33% are neutral.  Certainly, there is a good degree of awareness; nonetheless, more education is required.

Q41.      On being physically inactive as a potential cancer developing risk factor, 37% of respondents agree/strongly agree to this, but a significant 43% remain neutral and another 10% respond negatively. Therefore, there is a clear lack of understanding that less physical activities increases the risk of developing cancer.

Q42.  Overall how would you rate the quality of healthcare in Malaysia?

49% of respondents think that our healthcare is good (46%) or excellent (3%).  Another 42 % of the respondents grade our healthcare as only fair with another 8% rating it poor.  We should be aiming for a good healthcare system and this indicates that there is room for improvement for the overall healthcare in Malaysia.

Q43. How would you rate the quality of healthcare for cancer in Malaysia?

There is a 10% drop in respondents that rated our cancer healthcare at a good or excellent level (from 49% to 39%) as compared to overall healthcare system. There is a strong indication here that cancer healthcare is in need of improvements.

Q44.  How would you rate the quality of healthcare for cancer in Sarawak?

Comparing the Sarawak cancer healthcare to Malaysia cancer healthcare, the ‘good and excellent’ are about equal (40% to 39%).  However, there is an increase of 5% of respondents that rate Sarawak’s cancer healthcare as poor.  There is also a drop in ‘fair’ from 44% to 37%.   This indicates that the Sarawak government needs to put in more effort to improve cancer healthcare to be on par with the rest of the country.

Q45. What issues do you think the government should be focusing their efforts on?

A total of 14 issues were given to the participants to choose whichever were applicable to them. From the analysis below, it can be seen that the top 6 issues are:

  • Early Screening & Diagnosis (296)
  • Cancer Awareness Education (270)
  • Increase funding for overall Cancer Care (253)
  • Financial Aid (239)
  • Counseling Care and Support (239)
  • Cancer Centre and Facilities (226)

The other next few issues for our government to focus on are Doctors & Nurses Training and Psychosocial support, Cancer Research & so forth.  Please see the chart below.

Discussion and Area of Improvements

           

General awareness of cancer is good among the respondents. The survey also shows that the participants want to learn more about cancer.  In addition, the respondents are very aware what are signs and symptoms of cancer.  Overall the respondents make time to consult a doctor when one detected signs of cancer.  Data also reveals that majority worries about medical expenses as most cite worry about cost as a reason to delay seeing a doctor. And respondents are very clear on the danger of smoking/second hand smoke which can increase of the chance of getting cancer. However, a significant portion does not know that smoking is the biggest cause of cancer in the world.

Areas of concerns to address would be the physio-social support for ‘would-be’ cancer patients.  This is evident in the results of Q22 (‘I would be too scared to see doctor when I have cancer symptoms’) where participants rated high on ‘yes sometimes’ and ‘yes often’.  Thus, a need for more established counseling, cancer journey sharing from cancer survivors would help reduce and alleviate such fears.

Respondents are highly worried (76% of them – Q30) on what the doctor might find. Likewise, for Q29, a total of 87% are not confident talking about symptoms with the doctor.  Thus, a need for a better and more cohesive doctor-patient relationship needs to be look into. Perhaps an established Doctor-Patient Handbook/Guide could help.

Thirdly there seem to be a lack of awareness related to diet/obesity/lack of physical exercise factors (Q34- Q36) which can increase the chance of developing cancer, even though 91% of respondent agreed on a healthy lifestyle (Q9).  A need for more sharing of facts and figures related to this and talks from dieticians could help.

Lastly the survey also shows that the Sarawak government needs to improve the cancer healthcare and services to be on par with Peninsula Malaysia, with the focus on Early Screening and Diagnosis, Cancer Education/Counseling, Financial Aids, and funding.

Conclusion and Future Plans

The cancer awareness survey shows that the public have a good and satisfactory general knowledge about cancer and its signs and symptoms.  The respondents have only fair/average knowledge on factors that can increase the chance of developing cancer, thus a need for more forums and education on this topic.

Areas of concern to address are the physio-social/counseling support for cancer patients, doctor-patient relationship to alleviate fear and embarrassment during the cancer journey.  And on the advocacy side, much needs to done by the government to improve on areas of ‘Early Screening and Diagnosis’, Cancer Education, Funding/Financial Aids for Cancer Care; and Counseling

This survey was done on-line and was mainly from those with internet access and are literate.  It will be interesting to see how the results will shift if we were to have a good mix of participants from different demographics, especially those without internet access.

The results obtained will be shared with the general public and interested parties. They will also be used to help SCAN and other related NGOs to develop strategies to improve communication, advocacy, welfare, and other services related to cancer across Sarawak and Malaysia at large.

Acknowledgement

Supported By

THIS PROJECT WAS PREPARED BY THE SOCIETY FOR CANCER ADVOCACY AND AWARENESS KUCHING WITH FUNDING PROVIDED IN PART BY ROCHE.

Copyright ©2019 Society for Cancer Advocacy and Awareness Kuching

 

You can also download the file here  Cancer Awareness Survey Report 2018