Options for palliative care after terminal cancer diagnosis

[ArcticFox]

Let's say I'm speaking for a friend.  What option are their here in Thailand for palliative care for those with a terminal cancer diagnosis?  Returning to 'the home country' is out of the question due to not having health insurance or veteran's benefits (thanks for your service now go die a painful death grunt).  Medicare is out as said 'friend' hasn't lived in the US for a long time.  Between the cost of Medicare (premiums increasing at 10% per year if they could be obtained) and the cost of simply living in the US (the friend doesn't make enough money to rent a small apartment no less pay utilities and have any money feed himself and his wife - no less pay Medicare).  Going back "home" is out of the question.  And his wife has no desire either.

So - said friend is not seeking a cure or treatment - just a dignified death.  But?  Obtaining enough pain killing medication to keep from dying in agony?  That's my friend's worry.  And my friend is not destitute.  But my friend isn't going to spend his entire nest egg for hospital care either as he has a wife who he refuses to leave destitute and impoverished.  My friend has money set aside for her living expenses after his death as she will receive nothing from my friend's pensions and he isn't one of the "special US vets" whose wife will get some VA financial assistance after my friend's death.  My friend is not a "special US veteran."

So - what options are out there? 
What's the least expensive options to receive adequate palliative care?  And if adequate affordable palliative care can't be obtained, then what?

 

[ukrules]

Sounds like someone's looking for an early check out

 

I knew someone who was in a similar situation once but I'm not sure exactly how he did it as I hadn't seen him for a few years.

 

Edited November 23, 2022 by ukrules

[Lacessit]

I am not sure what medications are available in Thailand for palliative care, perhaps you could PM Sheryl to ask.

There is a network of retired nurses in Thailand who are happy to earn 10K - 15K baht/month for full-time care.

Assisted dying is available in more enlightened countries.

[scubascuba3]

If ever I'm in a similar situation i would  pull the plug, in as a dignified manner as possible. Doesn't have to be a miserable ending, do it so it's a positive ending 

[connda]

Compassion is lacking here.

Edited November 23, 2022 by connda

[scubascuba3]

11 minutes ago, connda said:

Compassion is lacking here.

Maybe you can offer help?

[Sheryl]

Where in Thailand do you live? 

 

There are palliative care specialists in Thailand (though not many) and the key is to get under their primary care.

 

They can ensure adequate pain control and control of other discomforts.

 

There aren't any good hospices here like in the west. Your options are die at home (with meds provided by palliative doc and maybe hired helpers for the basic nursing care)  or be admitted to a hospital towards the end under the care of a palliative specialist (possible in only some hospitals)

 

Please reply with location and I will advise further

[Lorry]

3 hours ago, Sheryl said:

Where in Thailand do you live? 

 

There are palliative care specialists in Thailand (though not many) and the key is to get under their primary care.

 

They can ensure adequate pain control and control of other discomforts.

 

There aren't any good hospices here like in the west. Your options are die at home (with meds provided by palliative doc an naybe hired helpers for the basic nursing care)  or be admitted to a hospitsl towards the end under the care of a palliative specialist (possible in only dome hospitals)

 

Please reply with location and I will advise further

I know of someone in a very similar situation with terminal cancer.

In Bangkok. 

Friends of his are looking for some way to help him. If you can recommend a palliative care specialist,  I would relate this information to his friends. 

Thx

[ArcticFox]

13 hours ago, Sheryl said:

Where in Thailand do you live? 

 

There are palliative care specialists in Thailand (though not many) and the key is to get under their primary care.

 

They can ensure adequate pain control and control of other discomforts.

 

There aren't any good hospices here like in the west. Your options are die at home (with meds provided by palliative doc an naybe hired helpers for the basic nursing care)  or be admitted to a hospitsl towards the end under the care of a palliative specialist (possible in only dome hospitals)

 

Please reply with location and I will advise further

My friend lives in the Chiang Mai region. 

[Sheryl]

11 hours ago, Lorry said:

I know of someone in a very similar situation with terminal cancer.

In Bangkok. 

Friends of his are looking for some way to help him. If you can recommend a palliative care specialist,  I would relate this information to his friends. 

Thx

There is a very good palliative care team at Bangkok Hospital, and also some good ones at Samitivej

 

I suggest:

 

Samitivej:

https://www.samitivejhospitals.com/doctor/detail/pongparadee-chaudakshetrin

(I have gotten very good feedback on her, described as very kind and caring. Trained in palliative care in both UK and US)

 

Bangkok Hospital:

https://www.bangkokhospital.com/en/doctor/dr-laksamee-chanvej

or

https://www.bangkokhospital.com/en/doctor/asst-prof-dr-pornpan-chalermkitpanit

Will need to think through where he will stay as his disease progresses. if at home, then will need to hire in caretakers.

 

It would also be advisable for him to pre-pay for cremation or burial etc, I recommend

Dao Micallef
Manager of the Asia Division
AMAR International Asia

Bio House Tower, 3rd Floor 55 Soi Phrompong, Sukhumvit 39 Klongtan Nua, Wattana Bangkok 10110

+(66)02 258 5946

Mobile: +66(0) 92 859 5616

Email: [email protected]  or  [email protected]

 

Do not be put off by the firm title, they can and will arrange simple no frills cremations if that is what is desired.  Perhaps most importantly they will help with contacting the Embassy and related paperwork,  and if necessary run interference with the police (if for example police try to insist on taking the body in for autopsy despite the deceased being under a doctor's care - I have known  that to happen)

 

 

 

[Sheryl]

2 hours ago, ArcticFox said:

My friend lives in the Chiang Mai region. 

In Chiang Mai, McKean hospital - a non-profit - provides excellent palliative/end of life care

 

https://mckean.or.th/dok-kaew-gardens/

 

There is also a pallative care center within CMU hospital (government facility) but I have no feedback on it.

https://www.facebook.com/suandokpal/

(it is only in Thai so open it in Chrome or other browser that translates)

 

See also my comments in above post re planning

[internationalism]

that page below is being now updated, might be back shortly

http://www.thethaicancer.com/Webpage/Palliative.html

 

if doctors don't want to help, check 

https://www.anticancerfund.org/en/redo-db

list of repurposed medicines used experimentally at all cancer stages.

There is always a chance of surviving or extending life for long.

That same organisation gives free advice, including on those medicines, clinical trials and everything else.

Many those medicines are in thailand OTC, cheap and readily available at each pharmacy.

 

Edited November 24, 2022 by internationalism

[ThaiPauly]

I had a friend  who died at McKean

Very peaceful end by all accounts.

 

 

[moogradod]

19 hours ago, internationalism said:

that page below is being now updated, might be back shortly

http://www.thethaicancer.com/Webpage/Palliative.html

 

if doctors don't want to help, check 

https://www.anticancerfund.org/en/redo-db

list of repurposed medicines used experimentally at all cancer stages.

There is always a chance of surviving or extending life for long.

That same organisation gives free advice, including on those medicines, clinical trials and everything else.

Many those medicines are in thailand OTC, cheap and readily available at each pharmacy.

 

I could image that if you have gone a long way and know for sure that this way will end soon you might not want to extend your journey as much as possible. Quite the opposite. I doubt that medicine to assist that is available OTC. I suspect that in Thailand it might be even unavailable if you are an inhouse patient. Maybe even if you would write that in your Living Will ? Or am I mistaken and you are forced by law to live as long as possible whatever that may mean ?

[The Fugitive]

51 minutes ago, ThaiPauly said:

I had a friend  who died at McKean

Very peaceful end by all accounts.

Thanks for that. 

[NancyL]

I live in Chiang Mai and can vouch for Sheryl's recommendation of McKean.  They have worked in conjunction with the palliative care center at CMU hospital for medications, etc.  

 

Your friend (and his soon-to-be widow) may be able to claim VA benefits if he served during a wartime period, even just for 90 days.  He didn't need to actually serve overseas to be able to claim under this program: https://www.va.gov/pension/eligibility/

 

If he did serve in Vietnam or Thailand and a few other select areas and his cancer is one suspected of being caused by Agent Orange, then his medical costs could be covered here in Thailand by the VA Agent Orange program.  He doesn't need to prove actual exposure to Agent Orange, just being in a certain location at certain dates.   https://www.va.gov/disability/eligibility/hazardous-materials-exposure/agent-orange/

[internationalism]

1 hour ago, moogradod said:

I could image that if you have gone a long way and know for sure that this way will end soon you might not want to extend your journey as much as possible. Quite the opposite. I doubt that medicine to assist that is available OTC. I suspect that in Thailand it might be even unavailable if you are an inhouse patient. Maybe even if you would write that in your Living Will ? Or am I mistaken and you are forced by law to live as long as possible whatever that may mean ?

I think thai doctors give up on treatments too easily. That's my personal impression. I have heard "you are old" even if doctor is just 10 years younger than myself - just because I have some symptoms and she hasn't got them. That's complete luck of doctor's and human compassion.

They don't have as many therapies, treatment and medicines, as what is available in the west, especially in the USA.

Also possible poorer training and lax attitude to patients needs. In that case he wasn't informed and offered palliative care and that's why he asking around about options.

That guy is stage 4, but without pain, looks mobile and otherwise symptom-less. Maybe not any therapy was tried on him at all. He will die from cancer (or related to it some infection, like covid or pneumonia) but might live many years, even without any therapy. With some cancer therapy he will live some longer and possibly without severe symptoms. There are patients who live long after their prognosed expiration date

 

I am talking about medicines, which would extend life, not to end it.

Even a placebo effect has a curing effect, but those repurposed medicines are used for cancers for tens of years.

That medicine below is officially used in thailand for different cancers associated with sex hormons, like prostate, female reproductive, breast, but also in clinical trials for some liver cancers. It's 3 baht per pill at all pharmacies.

http://www.thethaicancer.com/Webdocument/Onco_drug/Oncodrug_Item/Ketoconazole.html

 

from the link above to cancer foundation there are some 10 medicines (our of 470 in total) in bold fond, which are the most promising. They are in thailand OTC and cheap, from 1 baht per pill. Most thai doctors, as well as doctors around the world, don't know much about them, as they are not on an official drug lists, can't give prescriptions, but can give some guidelines to dosage for self-medication. There are doctors in Europe, who know about availability of them in Thailand and tell their patients about them.

 

 

 

Edited November 25, 2022 by internationalism

[connda]

On 11/23/2022 at 7:22 PM, scubascuba3 said:

Maybe you can offer help?

You missed my point.  Thailand isn't exactly the epicenter of human compassion especially when it comes to pain relief and palliative care. 
I wish I could help!  But like a lot of my fellow farangs here in Thailand, I know there is no such thing as hospice care.  Unfortunately if you're dying of a dread disease, as far as I know ending your own life is one of the few options.  Personally I'd like to know.  I don't particularly want to have to check myself out in order to escape pain that is easily treated in Western countries for the dying.  In fact, many of us older expats planning to simply die in Thailand probably want to know too. 

[Sheryl]

2 hours ago, moogradod said:

I could image that if you have gone a long way and know for sure that this way will end soon you might not want to extend your journey as much as possible. Quite the opposite. I doubt that medicine to assist that is available OTC. I suspect that in Thailand it might be even unavailable if you are an inhouse patient. Maybe even if you would write that in your Living Will ? Or am I mistaken and you are forced by law to live as long as possible whatever that may mean ?

 

Euthanasia/assisted suicide is not legal in Thailand.

 

But this is not what OP is asking about.

 

Nor is he asking for far-fetched cancer treatments.

 

He is asking about palliative care, to reduce pain and suffering. Please keep posts on topic accordingly.

[Sheryl]

On 11/25/2022 at 2:27 PM, connda said:

 Unfortunately if you're dying of a dread disease, as far as I know ending your own life is one of the few options.  Personally I'd like to know.  I don't particularly want to have to check myself out in order to escape pain that is easily treated in Western countries for the dying.  In fact, many of us older expats planning to simply die in Thailand probably want to know too. 

 

As I have previously posted, there are palliative care specialists in Thailand -- good ones -- who will provide adequate pain relief, either as outpatient or inpatient. And in Chiang Mai there is an excellent facility (McKean) which offers hospice type care very well.

 

The problem is that such services are pretty much limited to Bangkok and Chiang Mai (though Khon Kaen University hospital has opened a palliative care center;  I have not yet gotten feedback on it).  Hospitals elsewhere will often prescribe pain killers (including opiates) for people with terminal cancer but are not as skilled at palliation as the palliative care specialists, and  some will do so only as inpatient, a problem for those who want to die at home.

 

Certainly palliative care is still a weak spot in the Thai medical system but it is not as bad as you describe.

[Sheryl]

1 hour ago, internationalism said:

I think thai doctors give up on treatments too easily. That's my personal impression. I have heard "you are old" even if doctor is just 10 years younger than myself - just because I have some symptoms and she hasn't got them. That's complete luck of doctor's and human compassion.

They don't have as many therapies, treatment and medicines, as what is available in the west, especially in the USA.

Also possible poorer training and lax attitude to patients needs. In that case he wasn't informed and offered palliative care and that's why he asking around about options.

That guy is stage 4, but without pain, looks mobile and otherwise symptom-less. Maybe not any therapy was tried on him at all. He will die from cancer (or related to it some infection, like covid or pneumonia) but might live many years, even without any therapy. With some cancer therapy he will live some longer and possibly without severe symptoms. There are patients who live long after their prognosed expiration date

 

I am talking about medicines, which would extend life, not to end it.

Even a placebo effect has a curing effect, but those repurposed medicines are used for cancers for tens of years.

That medicine below is officially used in thailand for different cancers associated with sex hormons, like prostate, female reproductive, breast, but also in clinical trials for some liver cancers. It's 3 baht per pill at all pharmacies.

http://www.thethaicancer.com/Webdocument/Onco_drug/Oncodrug_Item/Ketoconazole.html

 

from the link above to cancer foundation there are some 10 medicines (our of 470 in total) in bold fond, which are the most promising. They are in thailand OTC and cheap, from 1 baht per pill. Most thai doctors, as well as doctors around the world, don't know much about them, as they are not on an official drug lists, can't give prescriptions, but can give some guidelines to dosage for self-medication. There are doctors in Europe, who know about availability of them in Thailand and tell their patients about them.

 

 

 

Please respect the OP's statement:

 

"said friend is not seeking a cure or treatment - just a dignified death"

 

 

[ArcticFox]

On 11/24/2022 at 4:43 PM, internationalism said:

There is always a chance of surviving or extending life for long.

That same organisation gives free advice, including on those medicines, clinical trials and everything else.

My friend has no plans to extend is life via high-priced pharmacology.  As I stated before, he has a wife that he chooses not to leave destitute.

[ArcticFox]

On 11/25/2022 at 12:07 PM, moogradod said:

Or am I mistaken and you are forced by law to live as long as possible whatever that may mean ?

No one can "make you live as long as possible." 

[ArcticFox]

On 11/25/2022 at 12:46 PM, NancyL said:

Your friend (and his soon-to-be widow) may be able to claim VA benefits if he served during a wartime period, even just for 90 days.

He did not.  He's a "Cold War Veteran" and essentially someone who the US VA throws under the bus.

[ArcticFox]

On 11/25/2022 at 1:22 PM, internationalism said:

I think thai doctors give up on treatments too easily. That's my personal impression. I have heard "you are old" even if doctor is just 10 years younger than myself - just because I have some symptoms and she hasn't got them. That's complete luck of doctor's and human compassion.

They don't have as many therapies, treatment and medicines, as what is available in the west, especially in the USA.

Also possible poorer training and lax attitude to patients needs. In that case he wasn't informed and offered palliative care and that's why he asking around about options.

That guy is stage 4, but without pain, looks mobile and otherwise symptom-less. Maybe not any therapy was tried on him at all. He will die from cancer (or related to it some infection, like covid or pneumonia) but might live many years, even without any therapy. With some cancer therapy he will live some longer and possibly without severe symptoms. There are patients who live long after their prognosed expiration date

 

I am talking about medicines, which would extend life, not to end it.

Even a placebo effect has a curing effect, but those repurposed medicines are used for cancers for tens of years.

That medicine below is officially used in thailand for different cancers associated with sex hormons, like prostate, female reproductive, breast, but also in clinical trials for some liver cancers. It's 3 baht per pill at all pharmacies.

http://www.thethaicancer.com/Webdocument/Onco_drug/Oncodrug_Item/Ketoconazole.html

 

from the link above to cancer foundation there are some 10 medicines (our of 470 in total) in bold fond, which are the most promising. They are in thailand OTC and cheap, from 1 baht per pill. Most thai doctors, as well as doctors around the world, don't know much about them, as they are not on an official drug lists, can't give prescriptions, but can give some guidelines to dosage for self-medication. There are doctors in Europe, who know about availability of them in Thailand and tell their patients about them.

 

 

 

As I stated at the beginning, my friends has no intention of extending his life via drugs and treatment.  All he wants is palliative care and death with dignity.

[NancyL]

40 minutes ago, ArcticFox said:

He did not.  He's a "Cold War Veteran" and essentially someone who the US VA throws under the bus.

According to Wikipedia, the "Cold War dates" are 12 March 1947 to 26 December 1991.  If you check the VA link I provided, you'll find that many of the years of the "Cold War" are considered as "Wartime Periods".

 

[ArcticFox]

On 11/26/2022 at 6:50 PM, NancyL said:

According to Wikipedia, the "Cold War dates" are 12 March 1947 to 26 December 1991.  If you check the VA link I provided, you'll find that many of the years of the "Cold War" are considered as "Wartime Periods".

 

Thanks Nancy.  RIP. 

[internationalism]

On 11/26/2022 at 6:02 PM, ArcticFox said:

My friend has no plans to extend is life via high-priced pharmacology.  As I stated before, he has a wife that he chooses not to leave destitute.

I gave you a link to a belgian fundation which offers free advice, that including on palliative care. Emailing them them some medical documents cost nothing.

Ketokonazole is 3b, some other repurposed anticancer OTC medicines are from below 1b, at each pharmacy.

Yes, there are anticancer medicines for $$$ per pill or shot, but there are alternatives 

[mokwit]

On 11/24/2022 at 12:52 PM, Sheryl said:

then will need to hire in caretakers.

I could have written the same OP but I suspect it is further out. Need to gather info/line up my ducks in advance regarding the logistics of dying in Thailand.

 

Anybody have any information on agencies or whatever for hiring caretakers (central BKK)?

 

 

Edited December 26, 2022 by mokwit

[Sheryl]

37 minutes ago, mokwit said:

I could have written the same OP but I suspect it is further out. Need to gather info/line up my ducks in advance regarding the logistics of dying in Thailand.

 

Anybody have any information on agencies or whatever for hiring caretakers (central BKK)?

 

 

There are soem but adds greatly to the cost at no added benefit.

 

Most people just put out word and arrange privately.

 

If skilled nursing or professional home health aide is needed, hospitals usually have staff interested in working extra shifts and can ask at hospital nursing office or just put word out among staff.