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Isaan network hailed as model for faster cancer treatment

The National Health Security Office (NHSO) has joined forces with the Public Health Ministry to develop a network for cancer patients' care to boost access to treatment by cutting waiting time for radiation and chemotherapy.

The public health region 10 - covering Ubon Ratchathani, Si Sa Ket, Yasothon, Amnat Charoen, and Mukdahan - was hailed as a model for fast and complete cancer treatment.

NHSO chief Winai Sawasdivorn recently led a media tour to show care for cancer patients at Ubon Ratchathani Cancer Centre and Sunpasitthi Prasong Hospital. He also led a visit to a screening unit for cholangio-carcinoma, run in cooperation with Muang Si Sa Ket Municipality.

Winai said cancer had been the top cause of death in Thailand since 1999 and in 2011 alone there were 150 cancer patients per 100,000 people. While liver and lung cancer were found the most among Thai males, cervical and lung cancer were most common among women, he said.

The World Health Organisation (WHO) expects Thailand to have 148,729 new cancer patients with 95,804 cancer deaths by 2020. In 2030, WHO expects Thailand to have 176,301 new cancer patients with 120,689 deaths.

In view of this, the NHSO and the Health Ministry developed the cancer network among hospitals to treat patients close to their homes, starting from screening, initial diagnosis, patient referral and palliative care for the terminally ill, he said.

The current rate of chemotherapy treatment was at 90 per cent while patients could be referred and wait up to two months for radiation, Winai said. There were 35 tertiary hospitals for cancer treatment in the NHSO system, he said.

The Northeast suffers most from cholangio-carcinoma with 10,000 patients a year, but only 300 can get surgery because it can take up to eight hours. So, the network was necessary to boost the hospitals' strength and resources to heal patients, he said.

Sunpasitthi Prasong Hospital expert Dr Kanokwan Mingkwan said liver cancer and cholangio-carcinoma were the health region 10's top causes of death, and had increased every year from 33.5 deaths per 100,000 people in 2007 to nearly 43 deaths per 100,000 people in 2010.

Kanokwan said each treatment was complicated and needed high technology, tools, expensive drugs, and experts. Sunpasitthi Prasong Hospital was well equipped for surgery, chemotherapy and nuclear medicine, while Ubon Ratchathani Cancer Centre was well place for chemotherapy, radiotherapy, palliative care and surgery for some diseases.

So, to get complete treatment in one area, patients needed to be referred among hospitals. Ubon Ratchathani set up a cancer network in 2004, which expanded to the other four provinces, she said. The provincial network reduced the referral rate outside the province from 89 cases in 2011 to 55 in 2012 and cut waiting time for surgery from 7-14 days to two to three days.

Dr Pongsathon Soopa-atakon from Ubon Ratchathani Cancer Centre's radiotherapy department said cooperation with Sunpasitthi Prasong Hospital saw 30 patients get operations between January 1 and June 30. The patients could opt for some cancer surgery at a hospital near home with an expert before receiving chemotherapy and radiation treatment at the two facilities.

Medical services closer to home

There was also an emergency patient referral system for radiotherapy within one to three days, while the nuclear medicine treatment also had a "fast track" that reduced patients' waiting time from one month to 7 days.

Terminally ill patients also received palliative care near home, which was convenient, fast and cut the cost for patients, he said. In 2012, there were 900 patients getting palliative care, which also got cooperation from local administrative organisations.

Ubon Ratchathani Cancer Centre nurse Nantiya Keawwongsa said there were about 90 palliative-care patients under one hospital and this centre also did house calls within a 50km radius. She cited a 62-year-old patient who had breast cancer that spread to bones, so she had got morphine (liquid) and capsules at home when she was in pain.

Nantiya said that the hospital also lent oxygen cylinders, suction machines and beds to patients, while hospital staff also ensured that tools were used properly and provided basic health checks and blood pressure before submitting patients' information to the near-home hospital and the network's hospitals could get the patients' data.

Ubon Ratchathani Cancer Centre and Sunpasitthi Prasong Hospital also acted as the network's servers, supporting other hospitals in the network in terms of medicine, tools, modern technologies and experts.


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