The crisis is intensifying, as is the outbreak of the disease, as neither time is the ally of cancer patients, nor is money within the reach of many of them. The drug crisis oscillates between “temporary solutions” and the greed of drug importers and agents controlling the neck of patients in Lebanon. Subsidized and unsubsidized medicines are very expensive, cancer treatments of all kinds are very expensive or unavailable, and cancer grows more in the bodies of breast cancer patients.
Instead of writing about the results of research and experiences in developing modern and advanced treatments for breast cancer, we are writing about the cries of hundreds of cancer patients to demand their drugs and their right to obtain their treatments, which now require selling what is “above and below them” to receive, or simply abandoning treatment sessions indefinitely.
The journey of agony begins from the first moment the patient decides to have a mammogram to detect cancer early or prevent the risk of infection. Two years ago, due to the Corona pandemic and then the economic crisis, the Ministry of Health stopped launching awareness-encouraging campaigns to reduce the cost of mammograms and encourage women to detect breast cancer early.
The head of the Barbara Nassar Association for Cancer Patients Support Hani Nassar confirms that the cost of a mammogram ranges from 60 to 120 dollars, depending on the center or hospital, after its cost did not exceed 40,000 Lebanese pounds. Today we are talking about an amount ranging between 2 million and 4 million Syrian pounds, which a large part of women may not be able to bear, which leads to the spread and growth of the tumor more as a result of the inability to detect it early.
From the picture to the confirmation of infection, a woman with breast cancer begins her long treatment journey, the beginning of which is a partial or complete surgery to remove the tumor and the breast. The cost of a mastectomy without restoration is about 3000 to 3500 dollars, “according to Nassar, and this surgery is necessary and inevitable for women with first, second and even third degree breast cancer. As for the reconstruction of the breast after its removal, the cost reaches 6000 dollars, which was paid Many women are encouraged to abandon this idea, especially since the Lebanese state, with its guarantor institutions, does not recognize the restoration process as a cosmetic procedure.
Accordingly, the patients were forced not to perform reconstructive surgery because they were unable to bear the high cost in light of the lack of health coverage for this type of medical intervention, knowing that removing the breast without repairing it greatly affects the psychological health of women.
As for the biggest catastrophe, it lies in the chemical treatments to confront this malignant, and only those who found themselves in this therapeutic journey will imagine the size of the numbers.
Nassar accompanies patients on their journey, knows what is going on and the suffering that accompanies them on the journey to find medicine or to secure the cost of a single session.
Nassar points out that the cost of radiotherapy ranges between 1500 and 4000 dollars, depending on the side of the affected breast. If the right breast is approved, the cost is 1500 dollar While the cost doubles to reach 4000 dollar If the tumor is in the left breast and the mass is close to the heart, because it requires the use of a more accurate technique that does not cause burns in the treated area. The guarantors are still covering the cost at 1500 pounds to the dollar, or 3900 pounds, and the patient has to pay the difference.
The biggest pain is chemotherapy, and as Nassar says, “there’s the crying and gnashing of teeth.” When the Ministry of Health lifted the subsidy on some types of medicines and kept the subsidies on other types, this was to rationalize the subsidy and maintain two types of subsidized medicines for each type. However, the problem was that the drug agents did not import the types of subsidized medicines and the import of unsubsidized medicines.
After cooperating with the Ministry and issuing a list of medicines and finding a solution for each category, the best solution was the merchandise of the Indian “Cipla” company registered in Lebanon, which was to arrive in Lebanon at the end of August. We were waiting for all the drugs for subsidized chemotherapy to arrive, but the Ministry informed us that the expected goods would not reach Lebanon. Therefore, today we lack any vision or alternative for any subsidized chemotherapy drug available on the market.
What is the difference between a supported and unsupported session?
Nassar explains that the hospital average per session is about 200 . dollar Anything more than this amount is included in the cost of unsubsidized medicines. For example, a patient takes a drug called Gemzar, whose formula is subsidized gemcitabine, and Gemtabine produced by the Lebanese company Benta, and all other medicines are not subsidized.
In the Lebanese market, there are only unsubsidized medicines, which cost about 6 million pounds or more, depending on their type. The cost of the Taxotere drug is about 15 million pounds, as well as the Taxol drug, which costs about 7 million pounds. Thus, the cost of treatment will be between 9 million Lebanese pounds and 20 million Lebanese pounds for each session. Note that there are patients who undergo three sessions per month and not one session every three weeks.
As a result, a huge number of cancer patients gave up their treatments due to the high cost. Today, it can be said that the Ministry has lifted the subsidy on the chemical cancer drugs that are given in the hospital because the subsidized drugs do not exist. In this regard, Nassar says, “Benta is supposed to deliver one brand, the subsidized Gemcitabine, to the market, which is one of the 10 drugs for chemotherapy we need, and its quantity is limited and sufficient for the market need.
And in the end, as women with breast cancer, chemotherapy in the hospital is not supported, and the result? The lack of treatment for the affected woman leads to the development of the disease in her body and the transition to the fourth stage. The difference between the first, second and third stages of cancer is that the patient is able to recover and complete her life normally, while the fourth stage is doomed to death, but thanks to the treatments that are given today, the patient’s life can be extended to five years or more.
These treatments, such as Ibrance pills, Verzenio or Kisqali, are all cut-off, and if they are available, they will be available for a month and in very small quantities (it meets the needs of half of the patients) before it resumes for two months. As for morphine to relieve pain, it is also cut in its 10, 60 and 100 gauges, and patients must wait two months or more for another shipment of it to arrive.
But what about hormonal treatments?
Nassar confirms that these treatments are given to the patient who has finished her treatment and she has to take this treatment for years (ranging between 3 and 10 years according to each patient because the cancer does not return). There are 4 types of medications for hormonal therapy, namely:
1- Tamoxifen is cut off in Lebanon and its price was about 13 thousand pounds, today it has become about 200 one thousand.
2- Exemestane has been removed the support For one type of it (it cost two million and 200 thousand pounds), while the subsidy was kept on the other type, and the two do not exist.
3- The drug Femara, from which the subsidy has been lifted, and its price is about one million 860 thousand pounds. As for the subsidized Femazol, which is produced by the benta company, its price is about 450 thousand pounds. While those concerned are waiting for the “Hikma” company to deliver a shipment of subsidized medicine, the price of which does not exceed 40,000, and the limited quantity will be delivered to the Ministry of Health.
4- Arimidex has a price of about one million and 800 thousand pounds. As for Victeve, which is supposed to be subsidized, and its price does not exceed 45 thousand pounds, the manufacturer has stopped producing it and the agent refuses to import it due to problems with the Banque du Liban.
After this detailed refutation of the treatment journey for breast cancer patients, what do we say to the patients today in Lebanon? Either sell everything you have for treatment or wait until subsidized drugs are available on the market. According to the Ministry of Health figures for the year 2016, personality In Lebanon 2500 new cases annually in breast cancerIn addition to cases that are still undergoing treatment.