Thursday, November 29, 2007

Cancer treatment: Too little, too late

When someone dies, their loved ones may find consolation in the words "nothing more could have been done". But in some cases, this is not exactly true.
Many patients at Dharmais Cancer Hospital in West Jakarta died because they had advance stage tumors when they were admitted to the hospital, according to Roland A. Hukom, an internist and medical hematology and oncology consultant at the hospital.
"Patients die because they come here too late," he said.
Doctors struggle to save the lives of patients who are categorized as stage three or four as their chances of recovery are only 40-50 percent and 15 percent, respectively.
If a patient arrives at the hospital when they are at stage one, their chance of recovery is as high as 95 percent, while those at stage two have a 70 percent chance of recovery.
Stage one usually means the tumor is less than two centimeters across, stage two less than five cm; and stage three more than five cm, but there is no further spread. Stage four is when the cancer has spread to another organ, such as the liver, bones or lungs
"The earlier the cancer is detected, the greater the possibility of beating it," Roland said in a recent meeting with cancer survivors held by the Indonesian Cancer Foundation and Roche Indonesia in observance of Breast Cancer Month.
Therefore it is important for women to regularly check their breasts by themselves or through mammography, a service provided by the cancer foundation at a discounted rate.
Cancer also has a high recurrence level. After five years, only 70 percent of the cancer survivors who have recovered remain in good condition while the rest experience recurrence.
The recovery of cancer patients also depends on their own efforts to fight the disease as they cannot count on doctors alone.
A stage four cancer survivor, Tridanti Cahyomurti, said cancer patients needed to empower themselves, learning about their disease and discussing their cancer treatment with their doctor. "If a doctor recommends a medicine, I will find out about it through the internet first," she said.
Roland fully agreed, saying patients should learn as much as they could about their condition.
"I suggest they browse the net so they are not easily misled (by doctors)," he said.
He said sometimes doctors did not tell the truth or did not give their patients sufficient information. They learned to skim over the facts because they had too many patients.
In Indonesia, the income of doctors -- both in public and private hospitals -- has much to do with the number of their patients. It is common for doctors to practice at several hospitals and see patients until late at night.
According to Roland, the government had issued Law No. 2/2005 on Medical Practice, prohibiting doctors from practicing in more than three places.
But the impact remains to be seen. There are doctors who see dozens of patients in a day. The patients have to wait for hours before they can see a doctor, mostly for a brief period of around 10-15 minutes.
A doctor who used to work at a private hospital told The Jakarta Post that doctors received low basic salaries, making most of their money from the fees they charged patients.
More and more Indonesians are seeking healthcare abroad, particularly in Singapore and Malaysia. Earlier this year, it was reported that Indonesians who sought healthcare abroad spent around US$600 million a year. Most of them -- more than 100,000 in a year -- went to Singapore.
The government, hospitals, doctors and other medical workers should work to improve the system. Otherwise, more patients will seek healthcare abroad and more patients will die -- not only in Dharmais Center Hospital, but also in other hospitals in the country.

.photo credit: NUH

- I wrote the story for The Jakarta Post, printed on Nov.28, 2007 (without the picture).

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