The quality of Mercy

When Narong Suwattanapim was diagnosed with liver cancer slightly more than seven years ago, the prognosis was not hopeful. The disease was in the metastatic stage, his doctors told him, and neither surgery nor chemotherapy were likely to do much good.

The businessman didn’t give up and today, after undergoing four operations in as many years, the 64-year-old has been cancer-free for three years. 

“His case is exceptional,” says Dr Thiravud Khuhaprema, chairman of the National Cancer Institute Foundation.

Narong was diagnosed with hepatocellular carcinoma, the most common liver cancer in Thailand. Most often secondary to the viral infections of Hepatitis B or C, other causes include cirrhosis, regular high alcohol consumption, exposure to alfatoxins or chemical substances, as well as obesity and diabetes.

Because the disease presents no symptoms in the early stages, thus resulting in late diagnosis when the cancer is already in the metastatic stage, it is fatal in around 87 per cent of patients.

Narong refused to give up, insisting on surgery to remove the tumour. A few months later, the cancer was back, this time in the lymph node in the bronchus area. Another intervention followed but yet again the disease returned, spreading to his lungs. Along with a further two surgeries to remove the tumours, he underwent both conventional and alternative treatments and three years ago, a PET scan showed no sign of the cancer.

“Generally speaking, when the cancer is in a large stage, no treatment can help you live much longer. My approach was to remove the cancer every time we found it, then follow up with treatment,” says Narong, adding that battling HCC has so far cost him around Bt10 million. 

HCC is the most common type of cancer found in Thai men and ranks third highest among women after breast and cervical cancers. The World Health Organisation (WHO) reported 23,410 liver cancer patients in Thailand in 2010, with 55 of them dying every day – that’s two people every hour.

For patients diagnosed at the metastatic stage, the only therapeutic option is the oral medication known as sorafenib. Given the nod by the European Union back in 2007, the drug has been shown to prolong life and make the patient a little more comfortable.

Unfortunately, sorafenib is extremely expensive and the bill for a dose of two pills taken twice daily is around Bt2.4 million a year.

Assoc Prof Narin Voravud, an oncologist with the Department of Medicine at Chulalongkorn University’s Faculty of Medicine, explains that this targeted therapy blocks the growth and spread of cancer by interfering with specific genes or protein involved in tumour growth and progression. It also has fewer side effects than traditional chemotherapy, which also affects normal cells.

“It helps to prolong life of patients by anything from three months to a year and reduces the suffering from this very painful disease. But the patients and their families need to consider the expense very carefully because it can cripple budgets for the sake of a few months grace,” says Dr Thiravud.

Studies on sorafenib therapy in Asia have shown that the drug significantly extends the life of HCC patients by 47 per cent, making the decision even more difficult for families. They naturally want the cancer sufferer to live longer but even those with savings are likely to face financial problems if after a year on the treatment, the patient is stable but not cured.

To help such patients, the National Cancer Institute Foundation in cooperation with Bayer Thai, offers the Hepatocelluar Carcinoma Patient Assistant Programme (N-PAP), which cuts the cost of treatment from Bt2.4 million per year to between Bt200,000 to Bt600,000 per patient.

Launched in 2009, the programme has so far helped more than 400 hepatocellular carcinoma patients not treatable through surgery and intravenous chemotherapy.

It is not however totally free with each patient required to buy at least six packages or three month’s treatment of sorafenib, which will set them back between Bt200,000 to Bt600,000 depending on the prescribed dosage, after which they receive further medication at no cost. 

But while the project does ease the financial burden on the family, the doctors stress the importance of preventive self care. Hepatitis and cirrhosis, they emphasise can be avoided through having the hepatitis B vaccination and avoiding alcohol consumption as well as food contaminated with fungi or alfatoxin. 

For those who may already be infected with hepatitis B and C, living a clean and healthy life is vital as are annual check-ups to monitor the advancement of the disease.

 

 A HELPING HAND