SS (E345) is a 55-yer-old lady. Her problem started around October 2013 when she started to have coughs with a bit of phlegm. There was no blood. She consulted a GP who gave medication but the problem persisted on and off. At last she requested her GP to do an X-ray of her chest. There was “something” in her lung. SS was referred to a hospital in her hometown for a CT scan.
CT scan done on 18 October 2013 showed a lobulated mass at the right hilar region. It measures 2.9 x 3.2 cm. SS was asked to consult a lung expert in a private hospital in Penang.
Bronchoscopy and Surgery Failed
SS did a bronchoscopy. In this procedure the doctor inserts a bronchoscope into the nose or mouth. This allows him to view the inside of the airways and lungs. Unfortunately for SS, the bronchoscope could not penetrate the passageway deep enough and the doctor saw nothing! Fluid taken from the lung during the procedure did not show presence of malignant cells.
The doctor suggested a better option would be to do an open surgery. SS agreed but she was asked to do a PET scan first. The PET scan results on 30 October 2013 showed:
- No intracranial lesion is seen.
- Few small 5- 7 mildly active hypodense lymph nodes are seen in the right and left side of the neck.
- A 42 mm metabolic active mass is seen in the middle of the right lung. Multiple smaller 2-7 mm nodules are seen in the rest of the right lung.
- Few metabolic active lymph nodes measuring 14-26 mm are seen in the right para-trachea, subcarinal and right hilar region of the mediastinum are noted.
Based on the PET scan results the doctor was optimistic that surgery would provide good “success.” SS proceed with the surgery as recommended by the doctor. Unfortunately it was an open-close job – failed. The doctor took some tissue samples for biopsy.
The result of the biopsy indicated:
- right pleural node biopsy: no malignancy seen.
- right lower lobe biopsy: well differentiated adenocarcinoma.
- right medial lobe: metastatic adenocarcinoma.
- right paratracheal node: metastatic adenocarcinoma.
The tissue is positive for EGFR (meaning oral drugs such Iressa or Tarceva is indicated).
Consultation with Oncologist
SS was referred to the in-house oncologist for further management. The following are excerpts of our conversation.
Daughter: The oncologist said it is better to take oral medication than undergoing chemotherapy (infusion). Chemo has more bad side effects. My mother can take either Iressa or Tarceva.
Chris: Did you take the drug?
D: No. I asked the oncologist the following questions:
a) Are there side effects of the oral drug. His answer: Yes, patients may become itchy and have pimples or sores.
b) Can the oral drug cure my mother? His answer: Cannot cure. It is just to control.
c) Control for how long? His answer: It all depends on the patients.
d) From your experience, how long does the control last? His answer: For some patients the control lasted for one year. After one year, the drug was not effective anymore. But for some other patients the control lasted for 2 years before becoming ineffective.
e) After Iressa becomes ineffective, what do we do next? His answer: Go for chemotherapy (injection).
D: The cost of Iressa is more than RM 200 per tablet. It comes to about RM 8,000 per month. Why take it when it is not going to be effective?
C: After 1 or 2 years on the drug, you will then have to go for chemo. Did you ask if chemo is going to cure your mother?
D: No, chemo cannot cure her. Each chemo costs about RM 2,000 per cycle. Later cycles would cost more – RM4,000 to RM5,000. She needs to do 4 to 6 cycles first and then we will see what happen after that.
Reluctant Q & A Session at RM 100
C: When you ask such questions, did you see if the oncologist was happy to answer you?
D: He seemed very reluctant and uneasy. Appeared like he had the answer and he did not have the answer. Also appeared like wanting to answer and not wanting to answer.
C: How long was your consultation?
D: About an hour and his consultation cost RM 100.
C: Wow, that’s great! One hour! I am indeed very surprised that he gave you so much time. You as patient, need to ask and ask the doctor such questions before undergoing any treatment. Be empowered and don’t be dumb. Now, go home and read this comic book::
I have written many books but many people find reading difficult. Some people don’t want to read. Now, I make comic books instead so that you don’t have to read too much. You can finish reading this book within an hour. So go home and read this. Learn from the stories of these people. Be empowered – be smart. Example, if you take Iressa and this cost you RM 8,000 per month. So, for a year, that would come to about RM 90,000. But can it cure you? No! In addition you have to suffer from itchiness, etc.
Opted for Chemo at Government Hospital
C: Your head – bald? Why?
D: She had chemo at the government hospital in January 2014. She completed 4 cycles – each cycle at 3 weeks interval.
C: Did you suffer?
Patient: Not very bad. I was constipated. My head and some parts of my body became itchy.
C: Did you have to pay for the chemo?
D: Yes, RM 50 per cycle. They used Gemcitabine (Gemzar) + Cisplatin. After the fourth cycle, the CT scan showed stable result.
C: Okay, at least you did it at the GH and did not have to pay so much. If you were to do it at a private hospital, it could cost you anywhere from RM 4,000 to RM5,000 per cycle. (Note: For comparison, a patient from Indonesia has 12 cycles of chemo (same drugs – Gemcitabine + Cisplatin) in a private hospital in Singapore. The total bill came to RM 0.5 million. And the treatment also failed. See: https://cancercaremalaysia.com/2014/04/24/two-billion-rupiah-chemo-and-surgery-failed-oncologist-said-more-chemo-you-just-have-to-trust-me/ ).
Do more chemo, and more chemo – until you die?
Patient: The tumour did not grow bigger. It did not get small either.
D: The doctor said my mother had to take Iressa or Tarceva as a follow up. I again asked how long must my mother need to be on this oral drug. The answer: It all depends on the patient. When Iressa becomes ineffective, she will go for chemo again. So we decided not to take the drug.
C: It seems that you are going round and round the same road.
D: You do the chemo. Then you take oral medication. Then go for chemo again. Then take oral drug again.
C: Did you ask when can you stop the treatment?
D: No, no idea.
C: Oh, see how long can you stand the treatment? Then until you die?
C: So they are being honest with you. You need to know that there is no cure for lung cancer – even with chemo!
Take Home Lessons From This Case
1. There is no cure of lung cancer. The oncologist acknowledged that.
2. But of course, there is treatment (provided you have the money to pay for it, or are willing to endure the side effects).
3. According to the oncologist, take oral drug – Iressa or Tarceva. You will suffer less side effects.
4. Iressa or Tarceva does not cure. It may cost you RM 8,000 per month. And it may be effective for one or 2 years only.
5. When you have reached the dead end with oral drug, go for i/v (injection) chemo which also cannot cure.
6. Then, if you are still alive and still have the money to spend, go for oral drug again.
Have plenty of money to splurge?
You have an option to go to Singapore — go to the best and the famous. There they may also give the same stuff, chemo with Gemcitabine (Gamzar) + Cisplatin. That seems to be the gold standard.
A patient from Indonesia paid about RM 500,000 (half a million ringgit!) for 12 cycles of that stuff. Result: miserable failure. https://cancercaremalaysia.com/2014/04/24/two-billion-rupiah-chemo-and-surgery-failed-patient-said-ill-die-not-because-of-my-cancer-its-because-of-the-chemo/
Another Indonesian, was treated with one oral drug after another interspersed with chemo, over a period of about 3 years. He spent about half a million ringgit as well. Result: just the same failure and the cancer got worse. https://cancercaremalaysia.com/2013/11/29/lung-cancer-chemo-experiments-that-failed-and-failed/
Yet another Indonesia had chemo after chemo and spent about one million Singapore dollars and he died after about 2 years of treatment.
I have learned something interesting from this case study. If you wish to try your luck with chemotherapy but do not have the money to splurge, you still have a chance! Go to the (Malaysian) government hospital. This patient (SS) paid only RM 50 for a cycle of chemo with Gemcitabine + Cisplatin. For 4 cycles she only paid RM 200 — compared to half a million ringgit in Singapore! After all they use the same toxic drugs anyway! And the result is just the same, FAILURE – wherever you go!
If you want to opt for less hefty medical bills, then go local. Only that you don’t get to become the patient of the best and the famous. The husband of one lung cancer told me he spent about RM 300,000 over 2 years on his wife’s treatment. HIs wife took Iressa and had chemo after chemo. She died just after her husband came to see us.