Prostate cancer ongoing treatments costs

[simple1]

I may need to return to Thailand for economic reasons. I have Stage 4 Prostate Cancer and due to commence chemo sometime in the coming six months in addition to ongoing Lucrin injection every three months, A few years after chemo likely to require Enzalutamide tablets until end of life. 

 

Anyone able to indicate current approx cost of chemo for prostate cancer, Lucrin injections Enzalutamide and quarterly PSA tests, ideally in Pattaya area. 

 

Thanks for your feedback.

[simon43]

Sheryl will correct me here if I'm talking complete rubbish. 

 

I understand that chemo therapy and Lucrin etc are to reduce the testosterone hormone level in your body. Is not a far cheaper and simple solution to have an orchietomy (remove of testicles under local anaesthetic)?   (I am undergoing prostate cancer diagnosis etc in the UK, and have spent several months researching my options at each stage, should the cancer return after prostatectomy, radiation treatment etc).

[simple1]

18 minutes ago, simon43 said:

Sheryl will correct me here if I'm talking complete rubbish. 

 

I understand that chemo therapy and Lucrin etc are to reduce the testosterone hormone level in your body. Is not a far cheaper and simple solution to have an orchietomy (remove of testicles under local anaesthetic)?   (I am undergoing prostate cancer diagnosis etc in the UK, and have spent several months researching my options at each stage, should the cancer return after prostatectomy, radiation treatment etc).

I am stage 4 prostate cancer. I have had a radical prostatectomy, but the cancer had already spread. Lucrin is utilised to suppress testosterone, but eventually usually will also require chemo to extend life exspectancy, as is my case..

[simon43]

1 hour ago, simple1 said:

I am stage 4 prostate cancer. I have had a radical prostatectomy, but the cancer had already spread. Lucrin is utilised to suppress testosterone, but eventually usually will also require chemo to extend life exspectancy, as is my case..

What I'm saying is that if hormone treatment is too expensive for you, a simple $50 operation achieves the same....

[riclag]

Im so sad to hear that you have this !

I hope you find answers that can help guide you !!!!!!

Best of Luck 

[simple1]

40 minutes ago, simon43 said:

What I'm saying is that if hormone treatment is too expensive for you, a simple $50 operation achieves the same....

Again kindly note I have Stage 4 prostate cancer. I had the operation you suggest at the same time I underwent radical prostatectomy. Hormone treatment usually only works to suppress the prostate cancer cell spread for some years. Once hormone treatment ceases to be sufficient one can progress to chemo. Chemo is effective for approx 18 / 24 months. One then progresses to the likes of Enzolutamide and eventually end of life, if not deceased from other causes.

[simon43]

57 minutes ago, simple1 said:

Again kindly note I have Stage 4 prostate cancer. I had the operation you suggest at the same time I underwent radical prostatectomy. Hormone treatment usually only works to suppress the prostate cancer cell spread for some years. Once hormone treatment ceases to be sufficient one can progress to chemo. Chemo is effective for approx 18 / 24 months. One then progresses to the likes of Enzolutamide and eventually end of life, if not deceased from other causes.

OK I understand that you already had an orchiectomy.  As you say, it helps to suppress cancer cell spread for a limited period of time.  Good luck with whatever treatment you have.  Sheryl can dertainly provide expert advice.

[Sheryl]

I akready answered you by PM.

 

You are looking at very, very, very expensive care . Millions of baht.

 

These are imported drugs so wil cost more than in say Europe. There us import duty applied. 

 

And if/when it comes to it, quality of palliative care here is not good. Especially if you cannot pay top dollar for private care.  You also pretty well have to be hospitalized once too weak to make frequent outpatient visits as no such thing here as getting a script for narcotics and filling them at a pharmacy. You have to come to a hospital and see a doctor for each and  every refill. If using a government hospital you may be required to pee in a cup each time for testing to prove you really take (as opposed to sell) the meds

 

Once at the point of not bring able to take -- or not getting enough relief from -- oral pain killers there is no option for morphine drip at home. Only in hospital. 

 

As I already told you by PM  it makes no sense at all to come here for financial reasons (assuming you have affordable health care access in your home country). whatever you save in living costs will be more than outweighed by health care costs.  

[simple1]

40 minutes ago, Sheryl said:

I akready answered you by PM.

 

You are looking at very, very, very expensive care . Millions of baht.

 

These are imported drugs so wil cost more than in say Europe. There us import duty applied. 

 

And if/when it comes to it, quality of palliative care here is not good. Especially if you cannot pay top dollar for private care.  You also pretty well have to be hospitalized once too weak to make frequent outpatient visits as no such thing here as getting a script for narcotics and filling them at a pharmacy. You have to come to a hospital and see a doctor for each and  every refill. If using a government hospital you may be required to pee in a cup each time for testing to prove you really take (as opposed to sell) the meds

 

Once at the point of not bring able to take -- or not getting enough relief from -- oral pain killers there is no option for morphine drip at home. Only in hospital. 

 

As I already told you by PM  it makes no sense at all to come here for financial reasons (assuming you have affordable health care access in your home country). whatever you save in living costs will be more than outweighed by health care costs.  

Thanks for reply, very useful info. Your PM must have been made after I posted query on the open forum. Again thanks for your guidance - best wishes…

[mokwit]

1 hour ago, Sheryl said:

And if/when it comes to it, quality of palliative care here is not good. Especially if you cannot pay top dollar for private care.  You also pretty well have to be hospitalized once too weak to make frequent outpatient visits as no such thing here as getting a script for narcotics and filling them at a pharmacy. You have to come to a hospital and see a doctor for each and  every refill. If using a government hospital you may be required to pee in a cup each time for testing to prove you really take (as opposed to sell) the meds

 

Once at the point of not bring able to take -- or not getting enough relief from -- oral pain killers there is no option for morphine drip at home. Only in hospital. 

This is the reality for all cancer sufferers here?. How likely are you to get a bed in a Government hospital? I looked at prices for Bangkok Hospital where you recommended a palliative care specialist. $500/night just for bed and base nursing services. Chula can be as cheap as base Bt900/night, but they have hardly any beds, and some in non aircon ward. Actually SEVEN beds in aircon ward.

 

https://www.chulacancer.net/services-list.php?gid=70

Edited March 9, 2023 by mokwit

[internationalism]

2 hours ago, mokwit said:

This is the reality for all cancer sufferers here?. How likely are you to get a bed in a Government hospital? I looked at prices for Bangkok Hospital where you recommended a palliative care specialist. $500/night just for bed and base nursing services. Chula can be as cheap as base Bt900/night, but they have hardly any beds, and some in non aircon ward. Actually SEVEN beds in aircon ward.

 

https://www.chulacancer.net/services-list.php?gid=70

governmental 1350-2000b, but they won't keep you on ward unless you are in a serious, comatose state.

I think that 900 is bed+food, probably add some 300b for nursing and 200b for medical service fee.

Chose a governmental hospital which is empty. It doesn't have to be specialised cancer hospital and in the town centre. An ordinary hospital anywhere within tens km radius from you home might do. If hospital is empty you have chances to stay longer, possibly giving a leading dr some presents.

Bear in mind that common wards with aircon can be icy cold, no way to regulate temperature.

For palliative care get a home carer for a few h a day and later live-in. It doesn't have to be a qualified nurse, just some nursing experience.

Edited March 9, 2023 by internationalism

[Scott]

A post with false or misleading information has been reported and removed.

 

[Sheryl]

12 hours ago, mokwit said:

This is the reality for all cancer sufferers here?. How likely are you to get a bed in a Government hospital? I looked at prices for Bangkok Hospital where you recommended a palliative care specialist. $500/night just for bed and base nursing services. Chula can be as cheap as base Bt900/night, but they have hardly any beds, and some in non aircon ward. Actually SEVEN beds in aircon ward.

 

https://www.chulacancer.net/services-list.php?gid=70

 

Once near end stage - the point where you can't take pain meds by mouth,a government hospital will admit you but if in the public wards nursing care is poor and rushed and may have long waits for pain meds.  Private rooms are often available at higher cost but not always, and you usually need to have an attendant with you at all times in those.  I don't know of any government hospital using patient controlled analgesia or continuous drips, it is still the old fashioned call a nurse every few hours which usually means suffering breakthrough pain first.  There are a few  private hospitals which do have PCA machines.

 

There are people who have managed to get decent palliation here, they did so by (1) being under the primary care of a palliative care specialist  (2) having a spouse or other care taker who was well informed and assertive, and willing/able to provide or arrange round the clock care  (3) staying at home until the end or near end and (4) usually, using private hospitals as with few exceptions that is where you will find palliative specialists and the only place you can get PCA (and that, mainly in Bangkok).

 

Palliative care is a real weak spot in Thai medicine, a fact widely acknowledged.

[mokwit]

5 minutes ago, Sheryl said:

I don't know of any government hospital using patient controlled analgesia

I had one of these at Chula after surgery but I get the impression they have very few of them. Second surgery was call nurse.

[internationalism]

get treatments in AU as fast as possible and then travel every 3 months for the next ones.

Airfare might be reasonable priced if bought many months in advance. Possible some budget or charter airlines will start flying.

Read about repurposed medicines in oncology, for example google "prostate repurposed" to find medical research papers. Those medicines are cheap and over the counter in thailand. Some of them might be also available OTC in AU. 

For example one of them, which is used in hormonal cancers is listed on an official list of medicines used in thailand, website run by the society of clinical oncologists  http://www.thethaicancer.com/Webdocument/Onco_drug/Oncodrug_Letter/Oncodrug_Letter_K.html

Fundation in Belgium, which pioneers them, has some 400 of those in their database

https://www.anticancerfund.org/en/drug-repurposing

but subject is know for 30 years, including hopkins insitute in the usa, Care Oncology Clinic in London.

 

 

Edited March 10, 2023 by internationalism

[giddyup]

On 3/10/2023 at 8:53 AM, Sheryl said:

 

Once near end stage - the point where you can't take pain meds by mouth,a government hospital will admit you but if in the public wards nursing care is poor and rushed and may have long waits for pain meds.  Private rooms are often available at higher cost but not always, and you usually need to have an attendant with you at all times in those.  I don't know of any government hospital using patient controlled analgesia or continuous drips, it is still the old fashioned call a nurse every few hours which usually means suffering breakthrough pain first.  There are a few  private hospitals which do have PCA machines.

 

There are people who have managed to get decent palliation here, they did so by (1) being under the primary care of a palliative care specialist  (2) having a spouse or other care taker who was well informed and assertive, and willing/able to provide or arrange round the clock care  (3) staying at home until the end or near end and (4) usually, using private hospitals as with few exceptions that is where you will find palliative specialists and the only place you can get PCA (and that, mainly in Bangkok).

 

Palliative care is a real weak spot in Thai medicine, a fact widely acknowledged.

So the bottom line is that you may die in excruciating pain? No wonder people look for exit bags, Nembutal etc.

[internationalism]

33 minutes ago, giddyup said:

So the bottom line is that you may die in excruciating pain? No wonder people look for exit bags, Nembutal etc.

I think strong painkillers are available OTC in cambodia. 

I have seen also a pharmacist in cambodia serving some medicine from under the table (no displayed on shelves). Looks like her client was her regular, he just put money on table and she handed medicines without saying anything. Having such pharmacist and asking for small monthly letters to thailand might be a solution.

[giddyup]

1 minute ago, internationalism said:

I think strong painkillers are available OTC in cambodia. 

I have seen also a pharmacist in cambodia serving some medicine from under the table (no displayed on shelves). Looks like her client was her regular, he just put money on table and she handed medicines without saying anything. Having such pharmacist and asking for small monthly letters to thailand might be a solution.

India is possibly another source, but it would be nice to know in advance where to buy.

[Sheryl]

Cambodia only sells codeine and tramadol OTC. Mot stronger opiods. Tramadol is also available OTC in Thailand.

 

If brnging codeine from Cambodia  need to get FDA petmit in advance. This is do-able but hardly necessary for cancer pain as for thay ulu can certainly get codeine or even morphine (oral) prescribed here.

 

As I have explained tbe difficulty comes when oral meds no longer suffice or patient is unable to take them.

[Sheryl]

49 minutes ago, giddyup said:

So the bottom line is that you may die in excruciating pain? 

That is a considetable exaggeration and not what I said. Palliative care here is weak but it would be unusual to "die in excrutiating pain". More accurate to say that one may have to die in a hospital in order to get parentetal pain relief and if in a government hospital will likely experience some breakthrough pain between doses, and pain management will be less than optimal. 

[giddyup]

11 minutes ago, Sheryl said:

That is a considetable exaggeration and not what I said. Palliative care here is weak but it would be unusual to "die in excrutiating pain". More accurate to say that one may have to die in a hospital in order to get parentetal pain relief and if in a government hospital will likely experience some breakthrough pain between doses, and pain management will be less than optimal. 

I think the Peaceful Pill might be a better option.

[simple1]

20 minutes ago, giddyup said:

India is possibly another source, but it would be nice to know in advance where to buy.

It would be illegal to import painkiller meds, unavailable in Thailand,  from India.

[gargamon]

Most men with prostate cancer can avoid or delay harsh treatments, long-term study confirms.

https://edition.cnn.com/2023/03/11/health/prostate-cancer-surveillance-survival/index.html

 

CNN — 

Most men who are diagnosed with prostate cancer can delay or avoid harsh treatments without harming their chances of survival, according to new results from a long-running study in the United Kingdom.

Men in the study who partnered with their doctors to keep a close eye on their low- to intermediate-risk prostate tumors – a strategy called surveillance or active monitoring – slashed their risk of the life-altering complications such as incontinence and erectile dysfunction that can follow aggressive treatment for the disease, but they were no more likely to die of their cancers than men who had surgery to remove their prostate or who were treated with hormone blockers and radiation.

“The good news is that if you’re diagnosed with prostate cancer, don’t panic, and take your time to make a decision” about how to proceed, said lead study author Dr. Freddie Hamdy, professor of surgery and urology at the University of Oxford.

 

[simple1]

Not relevant to my circumstances