San José, Costa Rica, since 1956

Thyroid Cancer Patients Face Yearlong Waits for Treatments

IF doctors had to choose their own cancer, manywould undoubtedly opt for thyroid cancer, a highly curable,rarely deadly form of the disease, according toHenry Naranjo, a nuclear medicine technician at CIMAHospital in the western San José suburb of Escazú.However, thyroid cancer patients forced to wait upto twelve months to receive radioactive iodine treatmentat the country’s public hospitals, operated by theSocial Security System (Caja), might disagree. A lackof thyroid treatment facilities at public hospitals makestimely treatment a costly luxury.“People without funds cannot go through this,” saidTeresa Saprissa, a former thyroid cancer patient andpresident of the Costa Rican Thyroid CancerAssociation.THYROID cancer affects the thyroid gland, a hormone-producing gland at the base of the neck that capturesiodine and regulates bodily functions such asmetabolism, according to Mario Ponchner, head of the endocrinology department at HospitalMéxico, a Caja hospital west of the capital.This type of cancer usually manifestsitself as a nodule on the front of the neck.In the 5% of cases where the tumor ismalignant, surgeons must extract the entirethyroid gland, Ponchner said. However,because the thyroid gland is often attachedto other delicate structures in the neck,such as arteries, surgery cannot alwayscompletely remove it.Thyroid cancer produces general metabolicdifficulties such as imbalances that mayresult in excessive sleepiness, extreme bodytemperatures and water retention. Peoplewho have had their thyroid gland removedmust take a hormone-substitute medicationfor the rest of their lives to artificially recreatethe gland’s work, Saprissa said.AFTER removal of the gland, patientsmust receive a radioactive iodine treatment,administered in capsule form or dissolvedin water, Ponchner explained.“Thyroid cancer is not usually lethaland offers good prospects when detectedon time,” Ponchner said of this form ofcancer, which affects more women thanmen, according to doctor Adolfo Ortiz,from the Health Ministry’s National TumorRegistry.In Costa Rica, of the 209 cases of thyroidcancer reported in 2004, only 22 caseswere lethal, Ortiz said.However, Caja hospitals force thyroidcancer patients to suffer extended waits toreceive the radioactive iodine treatmentthey often need after a thyroidectomy(extraction of the thyroid gland).According to Naranjo, from CIMA, theCaja’s troubles stem primarily from thedifficulty of administering the radioactiveiodine treatment.BECAUSE Costa Rica has no medicalnuclear production plants, hospitals heremust import radioactive iodine from theUnited States, a costly process thatrequires special handling and can result indelays.In addition, the shortage of adequatethyroid treatment facilities creates longwaiting lists for Caja thyroid cancerpatients.“Manipulation of a radioactive substancerequires special hospital infrastructure,”Naranjo said, referring to specialleaded isolation rooms where thyroid cancerpatients must remain for two to fourdays after receiving 30 milicuries or moreof radioactive iodine, an amount that couldresult in dangerous radioactive emissionsfrom the patients to anyone exposed tothem.“The Caja service is saturated, withone (isolation) room in each hospital.They can only treat one patient per week.The earliest (radioactive treatment)appointments San Juan de Dios (a Cajahospital in downtown San José), is nowoffering are for March 2007,” Naranjotold The Tico Times.San Juan de Dios director ManriqueSoto said his hospital contains two isolationrooms, one for full-time use andanother for weekends only. HospitalMéxico and Hospital Calderón Guardia, indowntown San José, each contain one isolationroom.WHILE San Juan de Dios AssistantDirector Mario Arias said he could notcomment on the average wait for radioactiveiodine treatment at the hospital, hesaid, “The only comment we will make isthat we use only one (isolation) room inthis hospital, and radioactive iodine mustbe imported for each treatment. We are tryingto reduce our waiting list as much aspossible.”According to Arias, by the end of thisyear or the beginning of 2006, the hospitalmay offer “ambulatory treatment” – theapplication of radioactive iodine treatmentat home.“Patients would ingest fewer milicuries(of radioactive iodine). This way, it can begiven to them at home,” said Arias, addingthat this form of treatment complies withinternational standards established atnuclear medicine summits.IN contrast to the waits at Caja hospitals,CIMA, the only private hospital inCosta Rica with a nuclear medicine department,can offer immediate treatment tothose who can afford a thyroid cancertreatment starting at $1,050 for two nightsin the hospital’s single isolation room and20 milicuries of radioactive iodine, accordingto Naranjo.CIMA treats an average of threepatients per month in the hospital’s singleisolation room, he said.Although it had been anticipated thatthe inauguration of an additional hospitalbuilding – expected to include two newisolation rooms – in October at San Juan deDios would alleviate the appointmentshortage, plans have changed, and the newbuilding will no longer include the thyroidtreatment facilities, according to doctorCarlos Agustín Páez, construction coordinatorfor the new building.Páez, a hematologist, said the originaldesign for the new building, to be inauguratedthis year to commemorate the hospital’s160th anniversary, did not establishconstruction of any additional isolationrooms.“After we came up with the idea ofincluding two new (isolation) rooms, wecarried out a financial viability study.Based on our budget, the rooms are notsustainable. They would only result infinancial losses,” he said, explaining thatconstruction of the rooms is very costly.However, the doctor said he envisionsa remodeling of the existing isolationrooms.“I would like to make them prettier, tooffer higher quality for our patients,” hesaid, explaining this is his vision but nosolid plan exists for their alteration.IN the meantime, patients continue tosuffer extended waits for their treatments.Doctors diagnosed 35-year-old housewifeZulay Acuña with thyroid cancer inMay 2004 and performed a thyroidectomytwo months later.One year later, Acuña finally receivedher first radioactive iodine treatment atSan Juan de Dios Tuesday and had toremain at the hospital’s isolation roomuntil today.“Maybe I needed my iodine treatmenta couple of weeks after my operation lastyear, but I don’t really know. They toldme there was no space until this year andI have faith. I trust in God,” Acuña toldThe Tico Times during a phone interviewfrom the hospital.In Julieta Abarca’s case, doctors performeda thyroidectomy in 1996 to removea benign nodule in her thyroid gland.The 47-year-old housewife only hadto wait three months for the operation.However, her surgeon accidentallyremoved her parathyroid gland, a glandthat regulates calcium levels in the body,along with her thyroid, leaving her a slaveto calcium supplements for the rest of herdays.“I tried to take legal action but mylawyer didn’t really help much. The Cajasaid they would cover the damage by supplyingme with medication,” she said.“Calcium is my life now. I have to takenine calcium pills every day, plus vitaminsand pills to protect my kidneys.”WITH the objective of supportingthyroid cancer patients through their illness,12 concerned Costa Rican residentsformed the Costa Rican Thyroid CancerAssociation this year.According to association presidentSaprissa, the group awaits only the publicationof its license (cédula juridica) inthe government daily La Gaceta thismonth to become an official association.Saprissa dreamed of forming thisassociation in November 2004, a visionthat became a reality with the group’s firstmeeting last January.“We expect to recruit more membersand to benefit other patients by helping toinform the public about this disease, helpingthem get their medication and tryingto raise funds for critical cases,” she said.For more info on the association, contactTeresa Saprissa at 385-0755.

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