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Following is a question by the Dr Hon Leung Ka-lau and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (December 1):
Question:
Recently, it has been reported that colon cancer has become the number two killer-cancer with a substantial increase of 16% in the number of new cases within a short period of five years from 2002 to 2007. The medical profession has also anticipated that colon cancer will replace lung cancer as the number one killer-cancer. At present, infusional chemotherapy for treatment of colon cancer requires patients to be hospitalised at regular intervals: those using 5-fluorouracil (5-FU), a commonly used infusional drug for colon cancer treatment, have to be hospitalised for 30 hours every six months on average to receive intravenous infusion, while those using a combination of 5-FU and other drugs even have to be hospitalised for 576 hours; these figures indicate that using such treatments has posed a burden on the medical system. On the other hand, orally-administered drugs with the same efficacy, such as capecitabine, allow patients to take the drugs at home, thereby improving the quality of life of both the patients and their carers as well as reducing the pressure of demand for hospital beds. In this connection, will the Government inform this Council whether it knows:
(a) the respective numbers of colon cancer patients of the Hospital Authority (HA) receiving infusional 5-FU chemotherapy (including single agent and combined drugs) and orally-administered 5-FU chemotherapy (including single agent and combined drugs) in each of the past three years; and the total number of such treatments;
(b) calculated on the service costs of HA, the respective average total costs and average costs by item (including costs of medical and nursing staff, hospital beds, drug administration, drugs, etc.) for each treatment cycle of a colon cancer patient using infusional 5-FU (including single agent and combined drugs) and orally-administered 5-FU (including single agent and combined drugs) in each of the past three years; and
(c) at present, the average time spent by a colon cancer patient in the hospital for each visit for receiving infusional chemotherapy (including single agent and combined drugs) from registration upon arrival to completion of intravenous infusion?
Reply:
President,
At present, the treatment options for colorectal cancer offered by the Hospital Authority (HA) include tumour excision, adjuvant chemotherapy, radiotherapy and palliative chemotherapy. As an infusional drug used in adjuvant chemotherapy, 5-fluorouracil (5-FU) is listed in the Drug Formulary as a standard drug and can be used for monotherapy or in combination with other drugs (usually with Oxaliplatin) for treatment of various types of cancer, including colorectal cancer, breast cancer, oesophageal cancer, stomach cancer, pancreatic gland cancer, liver cancer, anal cancer, ovarian cancer, cervical cancer, urinary bladder cancer, prostate cancer as well as head and neck cancer, etc.
Since the clinical conditions of individual patients vary and there are different treatment and medication options for different types of cancer, doctors will assess carefully the clinical needs of individual patients and provide them with appropriate treatment required in accordance with clinical treatment protocols.
The reply to various parts of the question is as follows:
(a) There is currently no 5-FU in oral formulation for common use in the global market, and HA does not provide orally-administered 5-FU chemotherapy (including both monotherapy and combination therapy) for colorectal cancer patients.
As infusional 5-FU can be used for treatment of many types of cancer, and different patients have different treatment and medication needs, HA has not kept separate statistics on the number of colorectal cancer patients using this drug for treatment and the total number of such treatments. In 2007-08, 2008-09 and 2009-10, there were respectively 3,213, 3,058 and 3,139 patients receiving infusional 5-FU (including both monotherapy and combination therapy) for treatment of different types of cancer in public hospitals with colorectal cancer patients taking a greater portion.
(b) Since infusional 5-FU can be used for treatment of many types of cancer, and individual patients have different treatment and medication needs and require different length of stay in hospital; coupled with the fact that doctors will, having regard to different patients' clinical conditions, prescribe the drug for monotherapy or combination therapy with other drugs for treatment and arrange different supplementary procedures and examinations for the patients, HA is not able to calculate the total costs and a breakdown of the costs for treatment of colorectal cancer patients with infusional 5-FU.
(c) As the dosage required for infusional chemotherapy varies with the type of cancer and the clinical needs of patients, and different patients will undergo different examinations or supplementary procedures before or after receiving infusional chemotherapy, HA has not specifically kept statistics on the time spent by patients who receive infusional chemotherapy from admission registration to the completion of intravenous infusion on each occasion. Generally speaking, according to established clinical treatment protocols, it takes about 48 hours for colorectal cancer patients to receive 5-FU infusional chemotherapy.
Ends/Wednesday, December 1, 2010
Issued at HKT 16:04
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