Chemotherapy Needed

[wallacern]

My colon cancer has advanced to stage 4 since surgery 18 months ago. I did not have chemo at that time. Cancer has now spread thoughout the abdomen and into the liver.

One oncologist told me I might live a year with no treatment or two years with six months of intense chemo treatments. This was at the large Bangkok hospital the Thais call Chula.

Anyone had chemotherapy at a any of the Bangkok hospitals? I already know it costs about 150,000 Baht every two weeks for up to six months. I think my tri-care insurance will pay 80%.

Comments please.

Mike

[Prakanong]

Sorry to hear of your situation

I just heard from a pal last week with stage 3 who has had to return home from Thailand to the UK due to this.

I had another pal with stage 4 as wel who sadly passed on in May 2006 - he was treated at Bumrungrad for this - the onco treatment was not available in the UK on the NHS and it was cheaper for him in Thailand - plus he had 3 private nurses in Thailand. He was treated very well there and his survival rate was longer than if he remained in the UK on the NHS treatment avaialble.

I am 99.999% sure the drug in question was Avastin

My best pal at work is an Oncologist and I could ask him but I will not see him until next week at the earliest - he is in India and I will be in Thailand for a few days - I will ask him but I know for pal number 1 above we were were discussing Avastin for this only last week

[cmsally]

If it's Avastin, you might want to do a search on some of the local UK news sites (presuming you are thinking of returning to the UK). There were stories of the NHS being more like a pot luck system, due to the fact that only some hospitals were prescribing it (and I'm not sure if the NHS was paying for the drug at all).

There were stories of some people coming up with the evidence that they could lead a much longer life if they received the drug (I'm pretty sure it was Avastin - but you should be able to check from these stories) but their hospital wasn't receiving the funds to prescribe it.

So sorry to hear of your situation.

[Prakanong]

If it's Avastin, you might want to do a search on some of the local UK news sites (presuming you are thinking of returning to the UK). There were stories of the NHS being more like a pot luck system, due to the fact that only some hospitals were prescribing it (and I'm not sure if the NHS was paying for the drug at all).

There were stories of some people coming up with the evidence that they could lead a much longer life if they received the drug (I'm pretty sure it was Avastin - but you should be able to check from these stories) but their hospital wasn't receiving the funds to prescribe it.

So sorry to hear of your situation.

I think the OP may be from the USA due to tri-care insurance comment

I have to admit I have not had the time to research properly but I thought NICE had refused to add it to the list and that Roche (who market the drug outside the USA for Genentech) were appealing - that is what the NICE site lead me to believe - I was looking for my pal with stage 3 in my above post

It can be used in the UK of course as its avaialbe privately - 2200 GBP a mont or something I read - and of course like you point out it might be a post code pot luck where some health authorities or hospitals will pay for it too.

My pal is off to see his Oncology prof armed with info I supplied - I supplied but am not at all convinced it will go down well - Dr's know patients have more info now and it puts pressure on them but sometimes they do not like it

[FBN]

My colon cancer has advanced to stage 4 since surgery 18 months ago. I did not have chemo at that time. Cancer has now spread thoughout the abdomen and into the liver.

One oncologist told me I might live a year with no treatment or two years with six months of intense chemo treatments. This was at the large Bangkok hospital the Thais call Chula.

Anyone had chemotherapy at a any of the Bangkok hospitals? I already know it costs about 150,000 Baht every two weeks for up to six months. I think my tri-care insurance will pay 80%.

Comments please.

Mike

Mike,

Tricare has selected providers for different services in Thailand. The appointments and advice is managed by a medical assistance company in Bangkok. For commercial reasons and forum rules I can't mention the name here but can give you the address and contact details if needed. They may be able to assist with scheduling appointments, payments etc.

Good Luck!!

[Sheryl]

Dear Mike,

I'm so sorry to hear of your situation.

TV members have had very positive things to say about their chemo tratments at both Bumrungrad and Samitivej Hospitals. However it sounds like your choice of hospitals may be limited by insurance rules. Among government hospitals, the two best are Chulalonghorn (where you were) and Siriraj.

HOWEVER, the real issue is not where you get treatment -- any of the major hospitals in Thailand can competently provide chemo -- but what treatment you get. Survival time varies with the specific chemo regimen used. In addition, as several posters mentioned, Avastin (bevacizumab) is a new (and costly) drug which has been shown to increase survivasl in metastatic colon cancer when given in combination with chemo. Avastin itslef is not considered chemotherapy, it is a biologic agent (a type of antibody). It increases the average survival time by about 30% when compared to chemo alone.

I don't know if your insurance will cover the cost of Avastin nor what it would cost to pay for it yourself. I'd be surprised if the drug is not available at least at Bumrungrad and Samitivej, though.

The following site gives the median survival times from clinical trials of several different chemo drugs alone and with Avastin:

www.gene.com/gene/information/pdf/avastin-prescriving.pdf

Note the difference between overall survival and progression free survival.

I'm afraid that in any case you are not looking at much time. You'll note that even with Avastin the median survival rates fall under 2 years. I think the 2 years mentioned by your doctor are a best case scenario - possible but not necessarily most likely. Whether or not it is worth going through 6 months of chemo under these circumstances is something only you can decide.

Feel free to PM me if I can be of any help.

[Tammi]

Avastin is available at Bumrungrad. It is expensive but you can arrange to have it delivered privately to the hospital and pay less than hospital rates. The same could be true of the other hospitals - speak with your oncologist.

[gunnyd]

With Tricare they will reimburse the 80% of the cost if you have proper documentation. Keep in mind that they dertermine how much a procedure or medication should cost and there may be a large difference between what the hospital wants and what Tricare thinks they should be paid. Outside of the U.S. you will be responsible for any difference.

I have CHAMPVA coverage for my wife and they use the same rulebook. I am always amazed at what doctors charge and what CHAMPVA pays. CHAMPVA=CHAMPUS=Tricare

I really sounds like you should return to the US or it's territories and be treated by a network hospital. There is a catastrophic cap of $3000 per year. So after you pay $3000 your care will be paid 100% for the rest of the calender year.

Take care