Woes of cancer care: Scarce treatment facilities keep patients wait for months

Nahar Begum, 51, from the capital's Dhupkhola area received chemotherapy in eight cycles in due time after a surgery for breast cancer over a year ago. But her cancer care faced a setback after that.

Even though radiation therapy is required to start three-four weeks after chemotherapy is finished, Nahar had to wait about seven months to obtain a schedule for radiotherapy at the National Institute of Cancer Research and Hospital (NICRH) – the country's lone full-fledged cancer hospital.

Nahar finally got her turn last month and has since undergone 14 sessions of radiotherapy, paying Tk6,200. She needs four more radiotherapy sessions.

And yet Nahar Begum can consider herself lucky because several hundreds of cancer patients wait their turns for radiotherapy every day at the cancer research institute hospital.

On a visit to the hospital last week, The Business Standard learned that five of the hospital's six radiotherapy devices were out of order. Moreover, only one among the four linear accelerators for radiotherapy was working, with another having become inoperative recently while the remaining two declared decommissioned as they had reached the end of their lifespan.

Two cobalt 60s – the most common form of pituitary radiation used medically for radiation therapy as implants and as an external source of radiation exposure – have been declared inoperative, while one machine is functional to carry out brachytherapy, a type of internal radiation therapy in which seeds, ribbons, or capsules that contain a radiation source are placed in one's body, in or near the tumour.

Officials of the National Cancer Institute told TBS that the hospital reached the present stage after machines went out of order one after another in the past 2-3 years.

Now 105-110 people are given radiotherapy a day with the only operational radiotherapy machine, they said, adding that completing a radiotherapy course at the institute costs Tk12,000-15,000 while private hospitals charge around Tk2 lakh for the same treatment. Normally, cervical cancer requires 25 radiotherapies, breast cancer 15, and brain cancer requires 25 radiotherapies, the officials said.

This situation prevails not just at the cancer research institute. Radiotherapy machines have also gone out of order in five of the nine government medical college hospitals that provide the treatment. Not all of these facilities provide chemotherapy either. Patients are also dissatisfied with their diagnoses.

Ultimately, patients are forced to go abroad for cancer treatment, said stakeholders.

Sources said 500-600 patients receive outdoor service at the cancer institute every day. Patients report to the medical board of the cancer hospital after doing the required medical tests either at the hospital or at private diagnostic centres. After seeing the report, the medical board decides whether a patient needs surgery, or radiotherapy and chemotherapy, or all of them.

If surgery or chemotherapy is required, the board gives a date instantly. But in the case of radiotherapy, the board tells the patients that they will not be able to provide the treatment at the hospital anytime soon, not within 6-7 months, due to equipment shortage.

A technologist of the Radiation Oncology Department of the institute, who did not wish to be named, said the advanced technology equipment used to find out where the radiation will be given has also gone out of order, so they give radiation therapy on the basis of X-ray or CT scan reports.

But there is always a risk of damaging healthy cells outside of cancer cells, the technologist said.

Wishing anonymity, a doctor told TBS that a cancer patient needs radiotherapy at some point in his or her life.

"We have one [radiotherapy] machine in operation. Dhaka Medical College and Bogura Medical College have one each. So, cancer care in the country is mostly private hospital-centric. Well-off people are going to private hospitals or going abroad. But those who can't afford it come here. A patient who came here today may get a serial after six months."

The doctor also said 60%-70% of patients come to see doctors when their cancer is at the last stage and their primary treatment is chemotherapy.

Growing patients vs little capacity

According to the Bangladesh Cancer Society, there are approximately 13 lakh to 15 lakh cancer patients in the country. More than 2 lakh new patients are diagnosed every year. Besides, about one and a half lakh cancer patients die annually.

Dr Golam Mohiuddin Faruque, president of the Cancer Society, said the delayed treatment due to equipment shortages at government facilities is a key reason for the rapid spread of cancer.

Around 700,000 Bangladeshis travel overseas for medical care each year. Although there is no specific information on how many patients go abroad for cancer treatment, experts say that most of the patients who go abroad for treatment are cancer patients.

India tops the list of medical tourism destinations, followed by other countries like Singapore, Thailand, Malaysia, and the UAE.

According to the Bangladesh Bank, Bangladeshis spent $2.2 million in FY19, $1.6 million in FY20, $1.6 million in FY21, and $0.5 million during the July-September period of the current FY23 on treatment abroad.

Bangladesh has made remarkable progress in improving the quality of treatment for various diseases, including heart diseases, but the state of cancer treatment is very poor in the country.

According to the World Health Organization, one cancer centre is needed for every 1,00,000 people and the centre must be equipped with a linear accelerator (LINAC), cobalt, a brachytherapy machine, a chemotherapy department, and a surgery department.

In terms of the size of the population of Bangladesh, about 200 cancer centres are needed here.

'Efforts on to resolve crisis'

Professor Dr Nizamul Haque, director of the National Institute of Cancer Research and Hospital, also admitted to the equipment going out of order.

He took office two months ago, he mentioned, adding that he is working to solve all the problems.

A radiotherapy machine that is repairable will be repaired quickly but the reparation process is delayed because the company assigned to do the task has changed.

Besides, the institute will get another brachytherapy machine from the health directorate soon. It will procure a LINAC through the CMACD and a tender has been floated in this regard. Also, the institute will float another tender to procure a LINAC within the next two weeks with its own funds, said Nizamul.

The national cancer institute director also said that four operation theatres, alongside the existing four, will be launched soon at the hospital.

"Our 300-bed hospital has been enhanced to a 500-bed one, but the manpower has not increased. The government has taken an initiative to set up eight cancer centres in eight divisions. If they are completed, the pressure on us will decrease and the rate of patients going abroad will also drop."

Today, 4 February, is World Cancer Day. The theme for the day this year is "Close the care gap".