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Tamil Nadu

Tamil Nadu

Meeting the high cost of cancer treatment

Sarah Hiddleston

Having to sell most of what they have and with hidden costs, it is a struggle for low-income families

CHENNAI: Three years ago the Ramakrishna* family were waiting for their life to end in their village on the outskirts of the city. It was not just that their young son had cancer. It was that in trying to meet the cost of his treatment, the family had sold everything they owned and run themselves deep into debt.

The head of the family, a poor priest, could not hope to pay back what he had borrowed. Luckily for them, a cancer hospital and a patient support group stepped in and the boy got treatment for free.

How many of those diagnosed at the Varomon Kappom Thittam, will be able to afford treatment?

“The Tamil Nadu government has undertaken to cover the cost of treatment for all cancers through medical college hospitals and the speciality hospital in Kancheepuram,” Health Secretary V.K. Subbaraj told The Hindu.

This includes diagnosis, radiation and therapy regardless of the severity of the cancer or the expense.

But patients must be able to prove the BPL status, Dr. T.P. Kalaniti, Dean Madras Medical College, clarified. He said that radiology departments had been established in all centres and chemotherapy drugs would be supplied when necessary.

According to the Directorate of Medical Education, 40,350 patients were treated for cancer in the State between January and November 2007. Dr Balu David, head of the State’s speciality hospital in Kancheepuram, estimates that the average cost of treatment for each of the 2,500 patients treated last year was Rs.12-16,000 a patient, not including extras for prolonged therapy.

At a minimum, the government would spend Rs. 48.42 crore on cancer treatment.

Need for improvement

But what if a patient’s family is just enough above the poverty line? “We could do more. We need to improve,” Mr. Subbaraj said.

With cancer, the price of life is so high that low-income patients become dependent on organisations such as the Cancer Institute, Adyar, where 40 per cent of patients receive free treatment. That treatment costs the hospital roughly Rs.1.5-2 lakh, not including the Rs.2 lakh required for therapy, according to Chairperson Dr V. Shanta. “Whatever the treatment, the cost is above that which the common general ward patient can afford,” she said.

Girija Sudheendran, a cancer survivor and founding member of Sahaayika, an organisation that has funded Rs.20 lakh worth of treatment across India over three years, said that by the time patients come to her they have literally sold everything – jewellery, hearth, home. Most of their beneficiaries are from families of agricultural labourers. But, says husband and trustee K.K. Sudhendhran, “People with higher incomes should get at least subsidised treatment… What is Rs.5,000 when it comes to cancer treatment? The bar has to be raised.”

“The poor struggle to travel back and forth from their villages. There are a lot of expenses we don’t see. Some are turned away because there aren’t enough drugs. So they give up,” said Dr Vijaya Bharathi Rangarajan who founded the patient support group CanStop. “They usually come to us at the full blown stages, by which time treatment is expensive. It’s a vicious cycle,” she said. “If we are looking at preventive action, continuity of treatment is important.”

“It would be great if some expensive foreign medicines could be manufactured indigenously,” Dr Rangarajan said. “Given the situation facing the government and NGOs, we need to make drugs available at lower prices.”

The Mumbai-based Cancer Patients Aid Association this week sent a petition to the Ministry of Health and Family Welfare asking the government to sanction low-cost locally-made copies of 20 lifesaving cancer drugs that are priced out of reach through a legal mechanism called compulsory licensing.

A stigma?

“When families have sold their heart and soul for earlier treatment they are asked pay for something that may be as much as Rs.1 lakh a month,” Dr. Shubha Maugdal, Executive Director, CPAA. YK Sapru, CPAA President, is beginning to ask whether the needs of patients with non-infectious diseases are seen as less urgent. “Is this,” he writes, “a stigma of a different kind?”

*Name changed to protect identity.

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