Help the medicine go down
Needing urgent treatment for recurrent advanced breast cancer, and with her savings running dry, Ms Ng was in a quandary. Her doctor had suggested chemotherapy and targeted therapy, a treatment combination that would cost HK$100,000 over six months.
Ng (whose real name has been withheld for patient confidentiality reasons) tried applying for treatment subsidies, but being in the middle-income bracket, or sandwich class, and living with her husband in their own flat, she failed to qualify. Ng, who is in her early 60s, feared her medical costs would become a huge burden on her two married daughters once her savings ran out.
Last week, help arrived in the form of the Cancer Drug Relief Fund, a collaboration between the Hong Kong Cancer Fund (HKCF) and drug maker GlaxoSmithKline (GSK). Instead of paying HK$126.25 for each tablet of the targeted therapy drug Lapatinib, she now has to shoulder only 20 per cent - or HK$25.25 - of the cost. With a daily dose of five or six tablets, that's a saving of more than HK$15,000 each month.
Over the next three years, the HKCF aims to support 600 low-income and sandwich-class cancer patients like Ng - a quota of 200 cases per year - with free or subsidised drugs through the HK$42 million fund.
'Families in these groups are financially stretched at the best of times, so when they are faced with cancer and the additional costs of treatment, their financial situations often become dire,' says Sally Lo, HKCF founder and chief executive.
'The Cancer Drug Relief Fund came about due to a much needed gap in our cancer support services. With more and more families coming to us for help, it is my hope that this fund will help us lessen the financial burden of cancer.'
The pilot project includes only two drugs - Lapatinib for breast cancer and Topotecan for cervical, ovarian and small-cell lung cancer - but Lo hopes the list will expand to include more drugs and reach more people in the future. 'We're open to co-operation with other drug companies,' says HKCF head of service Tammy Leung.
GSK's contribution to this pilot project is valued at HK$25 million, according to GSK Hong Kong general manager Jose Alberto Pena. HKCF will raise the fund's remaining HK$17 million in the same way it raises money for all its other operations: through public donations. The organisation, founded in 1987, receives no money from the government or Community Chest.
'We are asking the public to support us to build this special fund,' says Lo. 'This is the last resort [for these patients].'
Lapatinib and Topotecan are self-financed drugs on the Hospital Authority's Drug Formulary, and both are used primarily as second-line treatment in advanced cancer patients when first-line treatment has failed. They were selected by HKCF's panel of doctors from a list of five or six GSK drugs, says Lo. '[The panel of doctors] chose the ones they thought would be most appropriate for patients to prolong life and to give them quality of life.'
Professor Anthony Chan Tak-cheung, head of the clinical oncology department at Chinese University, says: 'Clinically, these two drugs are more efficient in controlling tumour growth, delaying disease progression, relieving symptoms and reducing complications in patients who have failed to respond well to traditional chemotherapy... There are potential side effects, but on the whole, these are well-tolerated drugs.'
Lapatinib is used to treat a certain type of advanced breast cancer in patients who have already been treated with other chemotherapy medications. The drug works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop or slow the spread of cancer cells, therefore prolonging the progression-free survival in patients. Pena says Lapatinib was introduced in 2008 to Hong Kong, where about 200 to 300 people have been treated with the drug since then.
The fund will subsidise 80 per cent of the cost of Lapatinib for 300 breast cancer patients over the project's three years - and only for sandwich class patients. This is because the drug is also supported by the Community Care Fund Medical Assistance Programme administered by the Hospital Authority for low-income patients.
Topotecan, on the other hand, will be free under the fund for the low-income group and 80 per cent subsidised for the sandwich class. Three hundred patients over three years will benefit - 90 with ovarian cancer, 90 with cervical cancer and 120 with small-cell lung cancer.
The chemotherapy drug, given via infusion or an oral capsule, was launched here in 2000 and has been given to a 'few hundred' people, according to Pena. Chan says it's taken for a few days in a row every three to four weeks, for an average of three to four months. Depending on various patient factors, this works out to between HK$4,000 and HK$10,000 per cycle.
Asked how many patients in Hong Kong would potentially need Topotecan, Chan says: 'Unfortunately, for small-cell lung cancer, most of them at some point will reach this stage [of advanced cancer that has failed first-line treatment] because it's a devastating disease. For cervical cancer, only about 20 to 30 per cent would get to this stage. For ovarian cancer, it's probably a little less, about 20 per cent.'
Dr Daniel Chua Tsin-tien, clinical oncologist and associate director of the Comprehensive Oncology Centre at the Hong Kong Sanatorium and Hospital, says the fund is a 'good step' because the middle class usually 'have difficulty getting support from the government and other channels'.
But he adds: 'Topotecan is actually a very old drug. Its use is more limited as we're seeing fewer and fewer small-cell lung cancer and cervical cancer cases. Lapatinib is more promising as it can reach out to a lot of breast cancer patients.'
Statistics from the Cancer Registry show that lung cancer is the most common cancer and biggest cancer killer in Hong Kong - although only 10 to 15 per cent are cases of small-cell lung cancer. Breast cancer is the third most common, while ovarian and cervical cancers are not in the top 10 (though ranked sixth and seventh respectively in incidence among women).
For more information on the Cancer Drug Relief Fund visit the HKCF website www.cancer-fund.org