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Today is National Cancer Survivors Day and what better way to celebrate with survivors of this deadly disease than by highlighting a new avenue of treatment that will bring hope to many liver cancer patients.
Called SIR-Spheres Y-90 resin microspheres, these microscopic resin beads contain the radioactive isotope Yttrium-90 (Y-90) and emit radiation to kill cancer cells.
Due to their small size (1/3 the width of a human hair), they travel easily with the bloodstream directly to the liver tumours. The microspheres become lodged inside the microvasculature that supplies the tumour and kills the cancer cells through radiation.
Discovery Health has been given the green light to cover this treatment under its medical aid scheme, which will bring hope to many liver cancer patients in the country who would otherwise not have had access to treatment.
The actual radioembolisation particles cost about R140 000 and the additional products and actual procedural cost add an extra R50 000 to R100 000 – so it is very expensive. But it is worth mentioning that this is a once-off procedure, hence the cost is comparable to or even less than certain chemotherapy medications, which are required on a regular basis.
The treatment is an effective method of using radiation to treat inoperable colorectal cancer that has spread to the liver, and is often used in conjunction with chemotherapy.
Currently, only Vincent Pallotti Hospital in Cape Town, Entabeni Hospital in Durban and Donald Gordon Medical Centre in Johannesburg offer the specialised treatment as it can only be performed by interventional radiologists.
The treatment lasts between 60 and 90 minutes. Patients can sometimes be treated a second time, however, that is dependent on other factors, such as spread outside the liver and liver function.
When Health Minister Aaron Motsoaledi presented his budget speech in Parliament a month ago, he made a point of talking about the devastating effects of cancer, saying that there is an “exploding prevalence of cancer around the world and in our country”.
Dr Waldemar Szpak, radiation oncologist at Rainbow Oncology Centre in Durban, says: “This technology allows us to administer high doses of radiation directly to liver tumours without affecting other organs.”
Interventional radiologist Dr Gareth Bydawell, from Lake Smit & Partners, has performed multiple radioembolisation procedures at Entabeni Hospital in Durban since 2012, but patient numbers have been limited due to a high rate of reimbursement rejection.
“It is such a relief that we’ve overcome that hurdle because this treatment can improve the lives of so many people. The procedure targets primary and metastatic liver cancer and can offer significant symptom relief and survival benefit. Being able to offer a patient more time is priceless,” he says.
Primary liver cancer is the 10th most common form of cancer in South Africa, with 2 000 new cases diagnosed annually, according to Globocan data for 2012.
The treatment was developed by the Australian company Sirtex Medical. South-African born CEO of Sirtex for Europe, the Middle East and Africa, Nigel Lange, says the company strives to improve outcomes for people with cancer.
“I am proud that patients in my native country now also have easier access to this technology, which has helped patients across the world.”
What view does this treatment mean for patients with inoperable liver tumours; is this a game-changer?
Surgery is the first prize when you are hoping for a cure, and the fact that SIR-Spheres have been shown to shrink tumours mean that previously inoperable tumours may well become eligible for surgery in some cases. That does change the picture for some patients. When surgery isn’t an option, this treatment can offer sustained symptom relief and prolonged survival.
Presumably, like all cancers, liver cancer differs from patient to patient. Does this mean the treatment might not help certain patients with inoperable liver tumours?
That is true, sadly – every patient is unique. A lot of cancers that spread end up going to the liver, but suitability for treatment all depends on the patient’s particular disease profile. Close collaboration with the oncologist is crucial for deciding the best treatment option.
Why do you think medical aids have refused to pay for this treatment until now?
New treatments are being developed for many medical conditions all the time, and it takes time for clinical studies to be published and assessed. Modern oncology treatments such as radioembolisation can be expensive, therefore the medical aid industry has to follow regulatory guidelines.
What is your view of Discovery’s agreement to reimburse patients?
I welcome it fully. Having the buy-in of a big health insurer is significant, as it may pave the way for others to follow suit. At the end of the day, it means that more patients with liver cancer can benefit from this powerful targeted treatment.
It’s early days, but has this decision by Discovery made a difference in any of your patients’ lives?
The Discovery agreement happened mid-April and I can say that, since then ,we’ve experienced fewer issues with getting approval for patients, so it is looking positive.
– Melinda Shaw
