If doctors had to choose their own cancer, many would undoubtedly opt for thyroid cancer — a highly curable, rarely deadly form of the disease — according to Henry Naranjo, a nuclear medicine technician at CIMA Hospital in the western San José suburb of Escazú. However, thyroid cancer patients forced to wait up to twelve months to receive radioactive iodine treatment at the country’s public hospitals, operated by the Social Security System (Caja), might disagree. A lack of thyroid treatment facilities at public hospitals makes timely treatment a costly luxury.
“People without funds cannot go through this,” said Teresa Saprissa, a former thyroid cancer patient and president of the Costa Rican Thyroid Cancer Association.
Thyroid cancer affects the thyroid gland, a hormone-producing gland at the base of the neck that captures iodine and regulates bodily functions such as metabolism, according to Mario Ponchner, head of the endocrinology department at Hospital México, a Caja hospital west of the capital. This type of cancer usually manifests as a nodule on the front of the neck. In the 5% of cases where the tumor is malignant, surgeons must extract the entire thyroid gland, Ponchner said. Because the thyroid gland is often attached to other delicate structures in the neck, such as arteries, surgery cannot always completely remove it.
Thyroid cancer can cause metabolic imbalances that result in excessive sleepiness, extreme body temperature fluctuations, and water retention. People who have had their thyroid gland removed must take a hormone-substitute medication for the rest of their lives to artificially recreate the gland’s work, Saprissa said.
After removal of the gland, patients must receive a radioactive iodine treatment, administered in capsule form or dissolved in water, Ponchner explained. “Thyroid cancer is not usually lethal and offers good prospects when detected on time,” Ponchner said of this form of cancer, which affects more women than men, according to doctor Adolfo Ortiz from the Health Ministry’s National Tumor Registry. In Costa Rica, of the 209 cases of thyroid cancer reported in 2004, only 22 cases were lethal, Ortiz said.
However, Caja hospitals force thyroid cancer patients to suffer extended waits to receive the radioactive iodine treatment they often need after a thyroidectomy. According to Naranjo, the Caja’s troubles stem primarily from the difficulty of administering the radioactive iodine treatment.
Because Costa Rica has no medical nuclear production plants, hospitals must import radioactive iodine from the United States, a costly process that requires special handling and can result in delays. In addition, the shortage of adequate thyroid treatment facilities creates long waiting lists for Caja thyroid cancer patients.
“Manipulation of a radioactive substance requires special hospital infrastructure,” Naranjo said, referring to lead-lined isolation rooms where thyroid cancer patients must remain for two to four days after receiving 30 millicuries or more of radioactive iodine — an amount that could expose others to dangerous radiation.
“The Caja service is saturated, with one isolation room in each hospital. They can only treat one patient per week. The earliest radioactive treatment appointments San Juan de Dios (a Caja hospital in downtown San José) is now offering are for March 2007,” Naranjo told The Tico Times.
San Juan de Dios director Manrique Soto said his hospital contains two isolation rooms, one for full-time use and another for weekends only. Hospital México and Hospital Calderón Guardia, in downtown San José, each contain one isolation room.
While San Juan de Dios Assistant Director Mario Arias said he could not comment on the average wait for radioactive iodine treatment, he noted, “We use only one isolation room in this hospital, and radioactive iodine must be imported for each treatment. We are trying to reduce our waiting list as much as possible.” Arias said that by the end of this year or early 2006, the hospital may offer “ambulatory treatment” — administering radioactive iodine treatment at home with smaller doses that comply with international nuclear medicine standards.
In contrast to the waits at Caja hospitals, CIMA — the only private hospital in Costa Rica with a nuclear medicine department — can offer immediate treatment to those who can afford it. Thyroid cancer treatment there starts at $1,050 for two nights in the hospital’s single isolation room and 20 millicuries of radioactive iodine, Naranjo said. CIMA treats an average of three patients per month in its isolation room.
Although it had been anticipated that the inauguration of an additional hospital building — expected to include two new isolation rooms — at San Juan de Dios in October would alleviate the shortage, plans have changed. The new building will no longer include thyroid treatment facilities, said doctor Carlos Agustín Páez, construction coordinator for the project. Páez explained that financial studies showed the new rooms would not be sustainable.
However, he said he envisions remodeling the existing isolation rooms. “I would like to make them prettier, to offer higher quality for our patients,” Páez said, adding that this remains just a vision with no solid plan.
Meanwhile, patients continue to endure long waits. Doctors diagnosed 35-year-old housewife Zulay Acuña with thyroid cancer in May 2004 and performed a thyroidectomy two months later. One year later, Acuña finally received her first radioactive iodine treatment at San Juan de Dios and had to remain in the isolation room until today.
“Maybe I needed my iodine treatment a couple of weeks after my operation last year, but I don’t really know. They told me there was no space until this year and I have faith. I trust in God,” Acuña told The Tico Times during a phone interview from the hospital.
In Julieta Abarca’s case, doctors performed a thyroidectomy in 1996 to remove a benign nodule. The 47-year-old housewife waited only three months for the operation, but her surgeon accidentally removed her parathyroid gland — the gland that regulates calcium levels in the body — leaving her dependent on calcium supplements for life.
“I tried to take legal action but my lawyer didn’t really help much. The Caja said they would cover the damage by supplying me with medication,” she said. “Calcium is my life now. I have to take nine calcium pills every day, plus vitamins and pills to protect my kidneys.”
To support thyroid cancer patients, 12 concerned Costa Ricans formed the Costa Rican Thyroid Cancer Association earlier this year. According to Saprissa, the group is waiting for the publication of its legal status in La Gaceta to become an official association.
“We expect to recruit more members and to benefit other patients by helping to inform the public about this disease, helping them get their medication and trying to raise funds for critical cases,” she said.
