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By LENNOX WESTON
The Cabinet of Antigua and Barbuda issued a statement indicating that it will decide on governments policy for the treatment of cancer on Wednesday the 17th of January.
The Cabinet of Antigua Barbuda had received an offer from Doctor Joey John and a group of American investors to purchase the Cancer Center in Antigua and provide cutting edge cancer services to both locals and international clients.
The Joey John investment group advised the cabinet that locals would be charged at a lower rate than international clients.
The Government of Antigua and Barbuda had recently forcibly acquired the Cancer Center from the private majority shareholder after they failed to reach an agreement for the purchase of the Cancer Center, with government valuation quoting a figure of nine million dollars and the investor requesting up to 40million dollars as purchase price for the facility.
The previous private operators closed the Cancer Centre citing lack of profitability.
The Cabinet of Antigua Barbuda deferred making a final decision for one week presumably to allow the government to study the proposal and to allow public reaction to this offer.
This is an extremely important decision since the privatization of Cancer care could be a death sentence to many Antiguans afflicted by the disease who would not be able to afford access to the treatment facilities and could easily bankrupt Medical Benefits and the Government Treasury if government covers the cost of citizens treatment at the private facility.
The Antiguan and Barbudan Government first attempt to provide cancer treatment through a private entity ended with the closing of that operation because of its unprofitability.
Clearly any new private operator would have to both increase the price of the services provided as well as increase the client base.
The Joey John investment group says they will provide cancer treatment at a lower price point than that offered to international clients, most of whom presumably would come from North America and from other individuals who can afford the service.
No information was made public on the nature of the investor group offer, including the price offered for the facility, payment terms, the services that will be provided, the cost of those services, and the nature of the cutting-edge treatment that will be offered, their timing and the cost of those services.
No information was also provided of the personnel numbers and expertise that would be available at the facility and any sense of the breakeven number of international clients required to allow Government and the public the opportunity to assess the viability and sustainability and technical competence of the services that would be provide by the Joey John group.
To properly assess this offer it is essential that the relevant information be provided and made public.
No government or the Antiguan Barbudan public can afford to agree to buy a pig in a bag proposal, operating on blind faith, or swayed by glitzy sweet talk with little substance.
A hungry man will grab at a straw, a cash strapped government could jump at shifting investment cost to the private sector without due care and analysis. As a fisherman son I prefer the analogy that sharks come around when there is blood in the water.
Privatization of cancer care in Antigua and Barbuda could be a death sentence to many citizens because of its inaccessibility, due to the high cost of the service, the high costs of having insurance to pay for the service, and the high cost to government for paying for the service on behalf of its citizens.
Cancer care is one of the most expensive diseases to treat in the world, in North America upwards of 46% of individuals diagnose with cancer or other major health issues even with insurance are forced to declare bankruptcy.
Cancer care is expensive because of the cost of the drugs used to treat cancer, because of the expertise required to diagnose and provide treatment, and because of the capital infrastructure and equipment to provide treatment.
Cutting edge cancer treatment is astronomically expensive and beyond the reach of many insurance policies and Governments to finance.
Cost of Cancer Treatment
Radiation and Radiography are the two more affordable treatment options for cancer. Most public hospitals in the Caribbean provide these services and the Government of Antigua and Barbuda accessed these services from the privately owned Cancer Center at a cost that proved to be affordable.
There is no indication what the cost of these services would be if supplied by the Joey John investor group currently and in the future.
Surgery is another treatment option for cancer and there are eight types of surgeries that can be provided in the treatment of cancer; surgery to diagnose cancer or biopsies surgery; surgery to stage cancer that is to check out how much cancer there is and how far it has spread.
During the surgery the area of the cancer including lymph nodes and nearby organs is examining this information helps to guide future treatment decisions and predict how people will respond to treatment; then you have curative surgery; curative or primary surgery is usually done when cancers occur in only one part of the body and all the cancer can be removed; it’s called curative because the purpose of the surgery is to remove all of the cancer completely; then you have surgery to debulk cancer; debulking surgery is used to remove some but not all the cancer it’s called debulking because the tumor being treated is a large bulky object and might be very close to important organs or tissues so debulking the tumor can help make it smaller; this surgery is done when taking out the entire tumor would cause too much damage to nearby organs or tissues; then you have palliative surgery, this surgery is used to treat problems caused by advanced cancer.
Palliative surgery can be used with other treatments to correct a problem that’s causing discomfort or disability or to treat pain.
Then you also have supportive surgery; supportive surgeries done to help make it easier for people to get other types of treatment, for example a vascular access device.
Then you have restorative or reconstructive surgery; reconstructive surgery is used to improve the way a person looks after major cancer surgery it’s also used for restorative function on our body part after surgery examples include breast reconstruction after mastectomy or the use of TCF labs bone graphs or prosthetic materials after surgery for head and neck cancers.
Then you have preventative prophylactic surgery; preventative or prophylactic surgeries even though there are no signs of cancer sometimes an entire organ is removed when a person has a condition that puts them at a very high risk for having cancer.
These surgeries are usually provided by government employed surgeons at SLBMC; Some countries have sent their publicly employed surgeons for specialized training in surgical procedures such as HEPATOBILIAR AND PANCREATIC SURGEON DR GREG PADMOR in Barbados a surgeon in the Queen Elizabeth Hospital to Calgary to become a specialist in resection techniques with large chunks of the liver and pancreas can be successfully removed.
These resection operations cost usd$250,000 to usd$500,000 U.S. in private facilities in the United States.
It is not known whether the Cancer Center proposal from the Joey John group would provide surgical services and at what rate or cost. Clearly it would be move financially feasible for government to provide these surgeries as they have done in the past through SLBMC surgeons and through specialized training of these surgeons and through health diplomacy with friendly governments like in Trinidad Barbados Cuba Jamaica, with the cost of these specialized services negotiated at a small fraction of the total commercial cost.
CUTTING EDGE CANCER TREATMENT
The most promising cutting-edge cancer treatments including new types of immunotherapies, radiation therapy, and experimental targeted drugs. These tend to be astronomically expensive.
In 20 11 US Food and Drug administration approved several new exciting classes of drugs including the immune checkpoint inhibitor IPILIMUMAB (YERVOY) for malignant Melanoma. By 2014 the average cost of a new oral medication exceeded 135000 U.S. dollars. in 2018 TISAGENLECLEUCEL (KYMRIAH) a chimeric antigen receptor CAR T-CELL therapy for the treatment of adolescent and young adults’ acute lymphoblastic leukemia became the most expensive cancer therapy ever at US $475,000
The following is the cost of the most powerful drugs for treating cancer.
Table Showing: Costs of selected Drugs Used in cancer therapy.
Type of Cancer
Total us one year cost ($)
4 doses every 3wks
3 doses every month
0nce every 3 weeks
3 times a month
multiple daily 3 weeks per month
7-9 doses per treatment
Year supply of tablets
ALEMTUZUMAH for chronic leukemias OFATUMUMAB chronic lymphoid e-mail and BRENTUXIMAB for Hodgkin lymphoma and DASATIONIB for chronic MYELOID all these drugs cost between 70 thousand U.S. dollars to 120000 US
DENYELZA approved for medical use in United States November 2020 is used to treat a certain type of cancer neuroblastoma in bone or bone marrow. it belongs to a class of drugs known as monoclonal antibodies its price tag is just over usd1,000,000 dollars.
The strongest cancer drug is DOXORUBICIN. This is the most powerful chemotherapy option for a wide range of cancers because of the way it works this drug can kill cancer cells at any point in their life cycle.
Commonly used for sarcoma, multiple myeloma, thyroid, stomach cancer and ovarian cancer. The cost of the course for doxorubicin liposomal intravenous dispersion 2 milligram per milliliter is around $469 for supply of 10 milliliters s intravenous solution.
Incidence of cancer in Antigua Barbuda.
In Antigua Barbuda, a PAHO report indicated that cancer mortality from tumors in 2019 from prostate cancer was 52.9 per 100,000 men lung cancer 9.9 per 100,000 colorectal cancer 11 per 100,000,
In women these values were 42.1 deaths per 100,000 for breast cancer 2.6 per 100000 for lung cancer and 16.9 for 100,000 for colorectal cancer
IN the National Library of medicine and the official website of United States Government this study on Antigua published way back in 1991 June the top-ranking cancers diagnose in 114 males were skin 26.3% prostate 22.8% and upper respiratory alimentary tract 10.5%.
in 130 females the three main cancers were breast 23.1% cervix uteri 22.3% and skin 15.3%
the main cancers causing deaths in 157 males were stomach 22.3% and prostate 17.8%
in 149 females the main cancers causing deaths were breasts 18.2% and cervix uteri 14.1%
In 2014 cancer incidence study by Simon et al of 130 females the three main cancers were breasts 23.1%, cervix uteri 22.3% and skin 15.3%.
In 157 males the main cancer-causing deaths were stomach 22.3% and prostate 17.8% in 149 females the main cancers causing death breast 18.2% cervix uteri 14.1%
IN PAHO PUBLICATION IN 2019 the adjusted cancer mortality from tumors in 2019 from prostate cancer was 52.9 per 100,000 men lung cancer 9.9 per 100,000 and colorectal cancer 11 per 100,000 in women these values were 42.1 deaths per 100,000 for breast cancer 2.6 per 100,000 for lung cancer and 16.9 for 100,000 for colorectal cancer.
Effectiveness of Cancer Treatment
cancers can be divided into those whose treatments have proven to be quite effective and those whose treatment have so far being ineffective resulting in high death rates.
The following cancers are the ones that have been successfully treated in most hospitals and Cancer Centers both in the Caribbean and in North America, the technology is well established, and the treatment is quite effective.
The seven most curable cancers meaning a high survival rate after five years include breast cancer, prostate cancer, testicular cancer, thyroid cancer, Melanoma, cervical cancer, Hodgkin lymphoma.
Five-year relative survival rates compare people with a specific disease to those in a general population without the disease they consider the fact that other factors can impact survival.
The seven types of cancer have the highest five-year relative survival rates breast cancer five-year survival rates the stage zero and stage one breast cancer is 99 to 100%
Prostate cancers have a 99% survival five-year relative survival rate at stages one and two.
Testicular cancer has a five-year relative survival rate at 99% for localized tumors in the testicles and 96% for regional tumors which have spread to tissues or lymph nodes closer testicles.
thyroid cancer has a five-year interval rate of 92 to 100% stages one and two Melanoma has a five-year relative survival rate of around 99% of stage 1 Melanoma skin.
cervical cancer has a 92% five-year relative survival rate.
For localized stages Hodgkin lymphoma has a five-year relative survivability of around 92 to 95% at stage one and two.
This second list of cancers are the ones that are difficult to treat with the following mortality rates and levels and which clearly would be the ones that would require innovative Cutting-edge technologies to treat.
A cancer diagnosis is never good news but there are five types that are particularly deadly; pancreatic ovarian lung Glioblastoma and triple negative breast these cancers are often diagnosed late can be difficult to remove surgically and rebuff most therapies. Around 18% of lung cancer patients survive five years Thank you percent approximately 8% of pancreatic patients survive more than five years 46% of ovarian cancer patients survive five years Glioblastoma MULTIFORME five years survival peaks at 10%
The institutions in North America which take on the challenge of fighting these five deadly diseases are usually National Cancer institute such as SALKSs with a large compliment of specialize research staff for example SALKS institute for cancer has a compliment of 32 faculty members 119 post-doctoral researchers 41 graduate students and 101 research assistants and the focus on the following areas of research to generate cutting edge treatments for cancer.
SALKS focus on five ways to eliminate the disease cutting the metabolic supply lines that provide fuel to tumors disrupting the inflammatory barriers protecting cancer cells decoding cancers genomics Jenna mix to reprogram Malignant cells themselves back to normal mobilizing the immune system to recognize attack cancer and developing sophisticated methods to strike cancers many vulnerabilities simultaneously.
It is not known whether the Joey John group will be engaged in similar type research, or the application of the latest treatment developed by institutes like Salk’s.
Based on the above data most cancers occurring in Antigua Barbuda have high survivability percentages with their treatment well established, A program encouraging early detection could increase the survivability of most cancer patients in Antigua.
BASED ON THE FORE GOING analysis Government could consider buying radiation and radiography services from a private group if the price is right and guaranteed over a long period.
The interconnected nature of cancer treatment makes it a better policy option for the government to not only provide chemotherapy and surgical treatment for cancer but also radiation and radiography treatment. Cancer is the third leading cause of death in Antigua after coronary heart failure and cerebrovascular disease.
Refusal of insurance companies to issue insurance coverage after age 70 years would leave elderly individuals with no access to cancer treatment or the means to afford cancer treatment through insurance coverage unless supplied by the government in a socially funded manner.
The increased incidence of cancer in elderly individuals whose expected life span is 79 years in Antigua Barbuda and who make up 11% of the population and the lack of access to cancer treatment if not socially funded would amount to a death sentence to that group.
The cost of private insurance robust enough to finance the high cost of cancer treatment is beyond the means of most workers and their family members given the level of wages and salaries in the country.
Most workers would therefore not be able to finance the cost of cancer treatment and would also be dependent on government-financed cancer treatment programs. Without such a program a cancer diagnosis for most young people and workers without private insurance would be equivalent also to a death sentence to these individuals
Life is precious; one of the basic responsibilities of a government is to protect the lives of its citizens. Government should ensure it is able to guarantee access to a cancer treatment program by all citizens.
Private investors focus is best targeted to the international medical tourism market, always providing high quality internationally competitive cancer care and protecting the good name of Antigua Barbuda.
A shark can smell when there is blood in the water. Let it not be the spilt blood of our citizens. OH JAH JAH; To you JAH, the Holy Father I pray.