Role of interdisciplinary research when considering UHC for cancer in Malaysia - The road toward Asia Cancer Barometer

SONODA Shigeto noted that the aim of the lecture series is to provide students with a variety of knowledge about what has been done to prevent/cure/care for cancer in Asia through collaboration with UICC (Union for International Cancer Control) Asia Regional Office (ARO) and the National Cancer Society of Malaysia (NCSM). The class takes the form of omnibus style, inviting guest speakers, including medical doctors, experts on cancer studies, and so on. Students come to understand cancer as a “social disease” which has many dimensions to be considered in Asia. For this semester, the case of Malaysia will be explored and Malaysia-Japan collaboration (namely the BEAUTY and Health Project) will be discussed.

KAWAHARA Norie, coordinator for the lecture series, noted that the rising incidence of cancer in Asia is not just a medical concern. It reflects a deeper issue in structures and coordination among various sectors in society. As we strive for a sustainable society, learning from such issues is crucial. Central to this lecture series is the BEAUTY Project, which is an acronym for “bringing education and understanding to you.” This innovative project taps into the expertise of beauty professionals to raise community awareness about cancer. Through this course students will delve deeper into the concept of beauty. The BEAUTY project itself aligns with the goal of achieving universal health coverage (UHC) by integrating fields beyond medicine. Since its launch the BEAUTY project has made significant strides with materials now available in four languages and the portal registry is set to launch from autumn 2023.

This Cross-boundary Cancer Studies course is rooted in interdisciplinary exchange between Japan and Malaysia. As was the case with the course last year, it will be aligned with the progress of the BEAUTY Project in Malaysia. Consultation with experts is part of the curriculum, and students are encouraged to actively propose new ideas for the project. The ultimate goal is to offer a learning experience where students don’t just absorb knowledge. But actively contribute to social improvement.

Malaysia is a diverse and complex nation undergoing rapid lifestyle changes due to digital transformation. The aim of the course is to contribute to UHC by enabling people to build data sharing systems in their daily lives. With that in mind, this year, the lecture series will focus, in particular, on the various obstacles to implementing data sharing.

However, connections are not just digital. Another question is how can human societies best collaborate? From last year’s lecture series, we learned that in Malaysia, there are challenges in how public private-partnerships operate. Globally, given the high cost associated with cancer care, the relationship between cancer treatment and government is significant.

Throughout this lecture series the aim is to learn together about the various barriers to overcoming today’s social challenges and how to solve them. 

Prof. Sonoda noted that the BEAUTY Project will be studied to understand how collaboration takes place and how cooperation is bringing about some research outcomes as well as project results. While there might be several difficulties in promoting the BEAUTY Project, these difficulties might give a clue to understand how to overcome various challenges and common issues that are being faced.

The lecture series will comprise live and on-demand lectures that will run from October 2023 through to February 2024.

The next live lecture is planned to be provided by MURALLITHARAN M., Managing Director of NCSM, who will discuss the road to realization of UHC and what it means for cancer care in Malaysia. Dr. Murallitharan is also managing the BEAUTY Project in Malaysia.

  Other speakers are from international organizations such as UICC, and from the private sector and academia, as well as various key persons from NCSM.

Prof. Sonoda encouraged all students auditing the course to speak up in the live sessions and ask questions to stimulate discussions. In terms of evaluation, 40% is from attendance, short reports submitted after each lecture, and 60% from a final report. 

It was noted that the students will be asked to write short reports in response to a question posed by the lecturer in a format of the student’s choosing. As the course is in an omnibus format, these short reports are important for demonstrating understanding of each lecture and ensuring that students have given thought to how the contents of each lecture relate to each other as individual parts of the overall course. The content of the short reports will not affect grading of the course; evaluation is based on whether a report is submitted or not. These short reports may be considered as notes in preparation for compilation of the final report.

Prof. Sonoda asked students to read through the booklet that had been published containing the lectures from the previous year’s series:

https://gas.ioc.u-tokyo.ac.jp/outreach/booklet-gas-teaching-global-asia/

Videos from each of the lecture series will also be available: 

https://sites.google.com/view/acf-2023-en/

Dr. Sonoda noted that that many areas of research, including cancer studies, are said to be in need of interdisciplinary approaches. He asked students how they evaluated this statement.

A student agreed that cancer problems should be solved with interdisciplinary approaches, noting that in his own lab the support of hospitals and surgeons is critical for implementing experiments. He noted that solving problems also relates to social aspects, and this will require an interdisciplinary approach from all stakeholders.

Prof. Sonoda asked about the challenges of working with people from different disciplines. A student noted that it is important to share information and provide mutual assistance when people are from different research areas and backgrounds.

Another student noted that true interdisciplinary approach requires involvement from all sectors of society, from local communities to the latest high-tech developments, such as the use of nanomaterials to treat cancer, or the use of surgical robots, for example.

Another student referred to the issue of radiation damage, which damages DNA, and in some ways is similar to cancer. When studying cancer, it is therefore essential to bring multiple areas of expertise together. Prof. Sonoda noted that there can be many obstacles that can prevent interdisciplinary approaches from running smoothly. 

This lecture has its origins in the “Surviving cancer in Asia” lecture series that was implemented from 2013 by Prof. AKAZA Hideyuki. His main concept was “Cancer as a Mirror.” The reason he used this metaphor is that if you look at cancer, you can see a variety of conditions.

Dr. Akaza was an expert in prostate cancer research, and he worked together with Dr. Kawahara, an expert of humanities, to devise and implement the “Surviving Cancer in Asia” lecture series. Dr. Akaza and Dr. Kawahara came from different backgrounds, but they shared a strong aspiration to realize a cross-disciplinary approach and cultivate young talents. They published Surviving Cancer in Asia in 2013, which details the inaugural lecture series, which brought together many people from many different areas of expertise.

Dr. Akaza’s concept of “cancer is a mirror” was based on the view that the cancer of the individual person often mirrors the culture of the country. The figures reflected in the “mirror” may not always be the same, and to understand what lies behind the mirror is the critical challenge if cancer medicine is to be advanced and improved. It is the sheer complexity of cancer treatment that inspired Dr. Akaza and Dr. Kawahara to launch the lecture series.

In terms of clinical judgment when treating cancer, Dr. Akaza identified three factors that are important: 1) Evidence, 2) Patient/physician factors, and 3) Constraining factors (See below). As can be seen in the figure above, the three factors are also influenced by knowledge, guidelines, and ethics, all of which inform the clinical decision.

Back in 2013, when the lecture series began, it was incredibly innovative in nature, in that it included the insights and knowledge of people from various backgrounds (including Dr. Sonoda). 

As noted above, it was very unusual for non-clinical experts to discuss cancer and there were rarely opportunities for scholars from different disciplines to discuss the concept of “cancer as a mirror.”

The series was therefore a pioneering initiative on “global Asian studies,” particularly since cancer is a common issue for all societies in Asia.

Notwithstanding the innovative nature of the lecture series, there were still some difficulties in managing a cross-disciplinary class. It is sometimes challenging to identify the common issues to be tackled, or identify incentives for social scientists to join discussions.

Another area that needs attention is the importance (and current lack) of developing international collaborative networks. This is one of the reasons why the series was established in English, but it still needs to adopt a greater degree of internationalization. It is this imperative that has led to the focus on the BEAUTY Program and collaboration with Malaysia.

First and foremost, the importance of a collaborative approach lies in the fact that one researcher cannot get sufficient data alone, neither can one researcher cover all aspects of a certain phenomenon or topic, or gain a total picture on their own.

For example, in the case of cancer research, the topic of social capital and human connections is an area that may be beyond the scope of clinical researchers, but is nonetheless a critical aspect of cancer research.

When engaging in an interdisciplinary approach, some researchers try to create who new areas of research by combining their expertise and elucidating new research questions. Through collaborations with scholars from different disciplines, researchers can find solutions to issues.

However, collaboration brings its own challenges, in that each research has their own research interests and it may take time to adjust and coordinate them. It may also be the case that integrating findings among disciplines may not necessarily produce the expected results, resulting to disappointment or further challenges, rather than identifying solutions.

These and other challenges combine to mean that it can be very difficult to find an interdisciplinary research partner. It is very important, however, to make the efforts to work collaboratively with a view to approaching challenges from an interdisciplinary approach. In this lecture series every lecturer has consistently emphasized the importance of just such an interdisciplinary approach. 

The official concept of universal health coverage (UHC) by the WHO is “All people have access to the health services they need, when and where they are where they need them, without financial hardship.”

The reality on the ground varies significantly from country to country, depending on the status of medical science, economy and finance, education, public policy, and engineering.

Education, in particular, is a very important area, particularly in the area of cancer care and cancer prevention. The BEAUTY and Health Project is aiming at educating people through local interactions. Cancer care, treatment and prevention is not simply an issue of technology, but also of people-to-people interactions, education, and awareness.

All countries have different challenges, different realities, and different ideas, but in terms of the level of technology in cancer care, gaps are gradually decreasing. Where differences remain, however, is how cancer is perceived and social reactions to cancer.

In this lecture series, students will hear lectures from various Malaysian experts about the situation of cancer prevention, care, education, and treatment in Malaysia.

All students are requested to speak up and make observations about the various information that will be shared during the course.

The following was set as a topic for the short report to be submitted by the next lecture: What are merits and demerits of interdisciplinary approach to promote Malaysia-Japan collaboration for cancer prevention?