We speak to Dr Anand Sachithanandan, Consultant cardiothoracic surgeon and founding president of Lung Cancer Network Malaysia (LCNM)
What led you to work in the field of lung cancer?
Upon graduation from medical school (RCSI, Dublin), I was fortunate to train at two renowned UK thoracic surgical units (Royal Victoria Hospital, Belfast and Heartlands Hospital, Birmingham) where a high volume of lung resections were being performed. Chest surgery, especially cancer work, is technically demanding but highly gratifying – particularly being able to ‘cure’ patients or render them cancer-free. I was privileged to have good mentors during my surgical training.
In 2018, I co-established LCNM – a not-for-profit, multidisciplinary NGO – to improve quality and outcomes for lung cancer care in Malaysia through advocacy, education and awareness.
What does an average workday look like for you?
I am an independent consultant to two tertiary private hospitals in greater Kuala Lumpur. A typical workday starts at 07:30 and often finishes 10–12 hours later! It begins and ends with clinical ward rounds – reviewing post-operative patients or seeing new referrals.
On average, I will operate twice a week and run outpatient clinics on Tuesdays and Thursdays. I attend various meetings (such as tumour board, governance and management) as required and enjoy teaching medical students. In between, I squeeze in NGO-related work meetings.
What is working well in Malaysia, and what could be improved?
In Malaysia, we have a very good, dichotomous healthcare network of public and private hospitals nationwide, supported by primary care general practitioners. There is, however, geographical (rural) discordance in terms of the medical expertise and facilities available. Hence the provision of services is variable.
Lung cancer is one of the most prevalent types of cancer here, and a leading cause of cancer-related mortality, but we do not have a national screening programme yet. Screening is opportunistic and done mostly in the private sector.
Optimal care for most patients with lung cancer is complex and costly, as it often requires a multidisciplinary and multi-modal approach, with meticulous post-therapy surveillance. Here, the majority of cases present too late, beyond curative intent. Apathy, poor awareness, fear of a cancer diagnosis, financial costs and traditional or cultural beliefs are all barriers to screening. These are the areas we must continue to address.
What motivated you to join the Lung Cancer Policy Network?
The aims of the Lung Cancer Policy Network to make lung cancer care a priority, with an emphasis on early detection, resonates deeply with me personally. It also aligns with what LCNM similarly seeks to do.
Lung cancer is a dreadful but curable disease that does not discriminate. For all the tremendous recent advances in the diagnostic and treatment landscape for lung cancer, I have no doubt that effective tobacco control and screening are the two most important strategies for impactful stage shift in the detection of earlier stage disease. The Network can play an instrumental role in shaping healthcare policy and priorities, and I am honoured to be invited to be part of this highly motivated and diverse network.
What would you like to see from the Network as it develops?
Having published several pragmatic and widely applicable documents, the Network should now engage with and leverage relevant local stakeholders (such as NGOs, charities, professional medical societies and even state or regional governments) to better understand domestic limitations to help actualise the proposals.
What changes would you like to see in lung cancer care on a global level?
Prevention is better than cure. More emphasis should be placed on preventative strategies like effective tobacco control and global environmental measures to mitigate worsening air pollution (a risk factor for lung cancer in non-smokers). Policymakers and governments need to be educated that it is far more cost-effective to treat early stage lung cancer. There must be the political will and budget to establish and sustain screening programmes where the disease burden is high, with a preponderance of late stage diagnosis. It is a common, dreadful disease but is inherently curable or, at the very least, associated with vastly better outcomes if detected early.
Another area is the real-world concern of financial toxicity. The various highly efficacious medicines that control the disease are prohibitively expensive to many. Naturally, pharmaceutical companies that have painstakingly invested much time, effort and billions of dollars in research and development should rightly expect appropriate returns. However, if these life-changing medicines are unfunded then financial catastrophe will ensue from unsustainable out-of-pocket payments. Taking economies of scale, we must find a workable ‘win-win’ mechanism to make such therapies more affordable and thus more widely available.
What recent research have you found the most interesting or exciting?
The diagnostic and treatment landscape for lung cancer has evolved considerably in the past five years – nothing short of a revolution! Low dose and ultra-low dose computed tomography imaging is now widely available for screening. This creates meaningful stage shift with proven reduction in lung cancer-specific mortality. Artificial intelligence (AI) deep learning algorithms will further enhance diagnostic accuracy and efficiency, with quicker turn-around times and more equitable access.
Genomic molecular profiling with next generation sequencing (NGS) testing can identify actionable mutations amenable to bespoke oral targeted therapies. Additionally, immunotherapy is a rapidly emerging as a potential gamechanger with good pathological response and impressive event-free survival in many cases. Of course, it remains to be seen if this will translate into a benefit in overall survival.
The surgeries we perform now are increasingly complex but less invasive, which is good for patients. Similarly, predictable biomarkers, navigational tools and robotics are all on the horizon. Most importantly, we recognise the need for a multidisciplinary approach to provide patients with the best care and outcomes, rather than working in silos. Technology must not replace the provision of evidence-based and value-driven care, underpinned by empathy and honest, clear communication.
Outside of work, what do you spend your time doing?
I enjoying reading (biographies and novels), writing amateur poetry, travel, photography, and evening neighbourhood walks at the weekends. I am an avid, long-suffering loyal Tottenham Hotspur fan and try to watch all their televised games. I try to spend meaningful time with my family: my wife, two young daughters (aged 6 and 11) and my dear, inspirational mother (aged 84) who I visit regularly.
The Lung Cancer Policy Network brings together a unique mix of experts in lung cancer from around the world, united in their passion to eliminate lung cancer as a cause of death.
We regularly share profiles of our members so that you can find out more about what led them to work in lung cancer and what changes they would like to see in lung cancer prevention and care on a global level.
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