Radiotherapy progress

It' been 1 and half week since the Radiotherapy(RT) started. Out of 28 sittings, 8 have finished. 4 more weeks to go as it happens only on the week days. The 2 days gap every week is given to give the healthy cells some time to recuperate.

Until now no side effects except some redishness in the exposed area. No other problems.

There is some pain in the breast occasionally which is unrelated to the therapy and is more likely associated with the surgery.
For that Mom has been prescribed a pain killer, Tryptomer (10 mg) daily before going to bed.

One word for the Manipal hospital RT staff . They are exceptionally polite, helping and professional led by a very caring Dr. Sanjiv Sharma. It's been worth travelling 30 kms (15 one way) daily for the treatment.

Cost of treatment until now

Over the past month I've realized the fact that cancer treatment is a costly affair and made me think how difficult it would be for poor people to get through it. It has also re-emphasised the importance of proper and adequate insurance coverage.

The following are the details of the treatment cost in Mom's case:

- Diagnostic tests - Rs. 15000/-
- Surgery - Rs 65000/-
- Radiotherapy - Rs 102000/-
- Hormone therapy 5 yrs (1 Arimidex tablet daily) - 5 * 365 * Rs. 233/- = Rs. 425225/-

My corporate insurance with United India Insurance has covered the first 3. But there is no approval on Hormone therapy as yet and I'm very skeptical that it would come.

Another patient whom we had met during Mom's surgery in Rangadore hospital suggested us to get the cancer medicines from the Kidwai Memorial hospital drug store. It's a government hospital and they sell the medicines there on discounted price and not on MRP. I checked there and got the Arimidex tablet at a discounted price of Rs. 173/-. So the total cost for this medicine would be:

5 * 365 * Rs. 173/-  = Rs. 315725/-

I'm amazed how much money the drug companies make on these drugs. Read somewhere that Astra Zeneca, the Arimidex manufacturer has sales of around $2-3 billion from just this drug annually.

Besides it made me realize that how much margins the pharma retailers make on medicine sales and state governments in India are doing their bit at providing these at lower costs.

Radiotherapy

For Radiotherapy we were reffered to the radiation oncologist Dr. Sanjiv Sharma of Manipal hospital. Since he was on leave for a week we thought of meeting couple of other radiation oncologist to get some information and clear our doubts about this therapy. Besides I wanted to explore the option of getting the therapy done in Apollo hospital which is very close by.

I got the following info on Radiation therapy after the meetings:
1) It is done to kill any cancer cells in and around the tumour area remaining even after the surgery.
2) It is must after breast conservation surgeries(lumpectomy) but not essential post mastectomy.
3) It has minimal side effects. These are mainly skin darkening and peel off in the treatment area besides some itchy feeling. These normalise after the treatment.
4) The risk of radiations impacting heart and lungs is very less owing to advance technology.
5) Mainly external radiotherapy is done. Internal is not that common and anyways it is relevant more for very small tumours < 2 cm.
6) Two techniques of external radiotherapy are available: 3D CRT and the newer IMRT. These use X-Ray beams using medical linear accelerators. Differences in the techniques:  http://www.pamf.org/radonc/tech/imrt.html.
7) 25 to 36 sittings are required. This happens daily 5 days a week. First sitting takes few hours as the radiation exposure area is marked and other planning is done along with CT scan. Subsequently 10 mins. is sufficient.
8) The radiation oncologist himself doesn't do the therapy. His role is more in consulting and planning. There are other specialist in his team who operate the equipment.

As far as Im aware the following hospitals in Bangalore have the ccapability:
1) Manipal hospital, Old airport road
2) Bangalore Institute of Oncology
3) Apollo hospital
4) Kidwai Memorial hospital

We met Dr. Sharma eventually on 29th November. He gave us the details of the therapy, cleared all the doubts we had and reiterated the fact that the risk involved was negligible specially at Mom's age. I found him far more confident and convincing than the couple of others I had met.

He did a clinical examination of the operated breast and subsequently mentioned the following treatment for Mom:
- 28 sittings of radiation for 5 1/2 weeks
- Forward IMRT (This is latest)
- 5 days a week.
- The Hormone therapy tablet Armidex have to be stopped during this 5 1/2 week period.

We have to first get a CT scan done. Post that his team would require couple of days of planning and then the therapy would start. For the scan no fasting is required unlike as mentioned by previous doctors.

The team at Manipal is very trained and experienced and the equipment is latest. I found the treatment cost also fairly less than the other private hospitals.

I decided to go ahead with the treatment in Manipal hospital under Dr. Sharma.

We got the scan done the same day. The RT team also tattooed few markings(spots) on Mom's chest area for accurate radiation exposure regularly.

The therapy started 2 days later on 1st Dec 2011.