Over radiation at Brian Lara Cancer Treatment Centre

 

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Category: Health Care 31 July 11
 

“The purpose in seeking you out is to speak on behalf of those whose voices are barely heard in this outrageous debacle, because I, too, am a cancer survivor, six years and counting. We, the cancer patients, seem to have no locus standi in this situation, save as numbers (223 patients) who may have received increased external beam radiation doses from a linear accelerator machine that was miscalibrated anywhere ranging from 3 to 19 per cent—depending on whose story you believe. “It is burning me up inside. Not just the possible over radiation of frail human bodies already being ravaged by an implacable enemy, cancer, but the entire way in which this fiasco has been allowed to develop and continues to be played out on the front pages of the newspapers, reports on allegations swirling around the owners, medical authorities of various disciplines, state representatives but not the effects such an overdose could engender on the men, women and children of our nation.”
A reader responding to last week’s column

Letter from Dr Anesa Ahamad 

In last week’s column, I interviewed one of the 223 patients who were exposed to higher than recommended doses of radiation at the Brian Lara Cancer Treatment Centre (BLCTC) between January 17, 2009 and June 7, 2010. A year later, she still has not been told how much she has been over radiated. “Did I get more or less than the touted 14 per cent? Am I going to drop dead of cardiac arrest three years hence? I don’t know and no one can tell me. We, the patients are broke and worn out. All 223 of us (or less as some of us have died) have this cloud hanging over us for the next five years, in addition to dealing with a cancer diagnosis.”

This patient’s testimonial also brought a response from the doctor central to the imbroglio surrounding the BLCTC, Dr Anesa Ahamad. As a columnist, I’ve refrained from entering the debate of “who done it;” whether or not the centre was “sabotaged” under the care of Dr Ahamad, the former chief operating officer, clinical director and clinical oncologist of the BLCTC (who left the facility on acrimonious terms with the BLCTC board), or whether as counterclaimed by Dr Ahamad, there was noncompliance and negligence by the board of BLCTC who failed to heed her plea to ensure mandatory checks on the linear accelerator machine were done.

Without taking sides and in the spirit of ensuring that the patient remains central to this story, I am reproducing a letter from Dr Ahamad to me, which addresses the concerns of over radiated patients:

“Dear Ira, I wanted to give you information about the radiotherapy techniques I use in general and the effect an overdose may have on patients in particular. Radiotherapy is a localised treatment given in short daily bursts over a period of weeks, in most cases. Doses are only delivered to the exact area to be treated and radiation is kept away from critical surrounding structures such as  nerves and organs as much as possible.

“If a patient received a dose in excess of that prescribed then it will only affect the targeted area, as there were no errors in the targeting of the radiotherapy. The treatment and possible side effects will be different according to the body part that received the treatment, the total dose given, the technique of treatment, and the dose given per daily treatment. This will vary from patient to patient, although I can make general statements regarding radiotherapy that will apply to most patients who suffer from a particular type of cancer.

“The common cancers in Trinidad and Tobago that require radiotherapy are cancer of the prostate, breast, rectum, uterus, cervix, head and neck (throat, mouth, voice-box, and sinuses). There are also less common cases of cancer of the brain, bladder, lymphoma, oesophagus, pancreas and soft tissue sarcomas.

“Certain cancers require a high dose of radiation to be treated properly: prostate cancer (76.6 Gy) and head and neck (70 Gy.) Gy is an abbreviation of Gray, a unit of radiation. The technique which was used for these two types fortunately delivers the least dose to normal tissues compared to other radiotherapy techniques. However, the high doses required to treat these tumours make these patients vulnerable to severe late effects if they were overdosed.

“Late effects are side effects that present months or years after treatment. These are contrasted with acute effects, which present relatively quickly after radiotherapy and typically go away after a period of time, and are usually easy to treat such as reddening of the skin around the area treated, which usually heals after the completion of treatment. For the prostate, a gland situated below the bladder and in front of the rectum, a specific limited amount of dose is allowed to go to the rectum and bladder; these doses give less than a three per cent risk of severe late side effects. If such a patient’s rectum received a dose that was higher than the prescribed dose, the chance of severe late effects increases.

“We are unable to predict among those patients who were overdosed which ones will develop late effects. They may only get low grade effects such as increased frequency of bowel or bladder movement, discomfort in the rectum or on passing urine, or may get bleeding from the bladder and rectum, pain, having to force to pass urine or stool. In the most severe cases, patients may have obstruction of the rectum, bleeding to the extent of requiring blood transfusion, or stiffening and shrinkage of the bladder so severe that it cannot function to hold the urine.

“In these cases surgery or special procedures such as laser coagulation is needed by specially trained surgeons, vascular surgeons, urologists and gastroenterologist. Patients who were treated for head and neck cancer (throat, mouth, voice-box, and sinuses) also get a high dose of radiotherapy. Again, patients who were overdosed may not have any late effects. If effects develop, it may be low grade such as more dry mouth than expected, thinning of the gums with exposure of the underlying bone, chronic ulcers in the mouth and throat, stiffening of the jaw muscles making it difficult to chew.

“In some cases more severe effects can occur such as softening of the voice box requiring a tracheotomy, stiffening of the swallowing muscles with the patient needing to be fed by a tube inserted into the stomach, breakdown of the jawbone needing surgery to repair, or opening of a connection between the throat and the skin of the neck (called a fistula). If irradiated tumours were near the eyes or ears patients may have disturbed vision or hearing.

“Patients who have tumours in the abdominal area such as rectal cancer, pancreatic cancer, uterine cancer, and cervical cancer are normally treated to an intermediate dose of 45 – 60 Gy. The organs in this area, such as the small bowel, kidneys, and liver are very sensitive to radiation, and normally we plan treatments to keep as much radiation away from these organs as possible. If these organs received more than they can tolerate the chance of late damage increases. In the small bowel, patients may have discomfort, nausea, difficulty absorbing nutrients from food, and become malnourished and blockage of the bowel requiring surgery.

“Patients need to report any new symptoms to their doctors promptly and keep a copy of their medical records which stated their treatment and any reported overdose. This is important for any doctor who has to diagnose and manage their side effects. It cannot be assumed that any new symptom is related to an overdose since there are other treatable conditions that give these same symptoms.”

Yours sincerely,
Dr Anesa Ahamad –radiation oncologist
 

The findings of the independent investigation proposed by the Ministry of Health will point the way forward. Ultimately, the real questions are what will this mean for patients who may not know up to five years from now what effect the over radiation (if any) had on them and what is the Government doing to ensure this will never happen again? The Ministry of Health, while it has the authority to licence (and suspend licence) in medical institutions, does not have in place a framework to regulate, monitor and oversee radiotherapy in this country. If it did, this might have never happened.

 

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All Articles Copyright Ira Mathur