Is Chavez sacrificing cancer care for privacy?
(AP) SAO PAULO — As Venezuelan President Hugo Chavez flies to Cuba
Friday for surgery to remove a possibly cancerous growth, top doctors
say he could be taking a risk by skipping more respected cancer centers
in Brazil or the U.S. if his illness proves more complicated.
What muddies that assessment is the miserly amount of detail the
firebrand leftist president has revealed about his condition. Since
first disclosing his cancer in June, he has only said doctors removed a
baseball-sized tumor in his pelvic region last year, and that the new
growth discovered this week was two centimeters (one inch) in size and
found in the same area.
He had earlier said his cancer was in remission after completing weeks
of chemotherapy.
But late Thursday Chavez, 57, said he's "preparing to face the worst."
Referring to the new growth, he said: "The possibility that it's
malignant is greater than it not being (malignant)."
Medical experts said that if Chavez has a "standard" cancer, or one that
hasn't spread or isn't a rarer and deadlier type of tumor, seeking
treatment in Cuba is likely as good as anywhere else.
But if his cancer is more complex, many said he's at risk in not opting
for treatment in the U.S., Europe or Brazil — which has Latin America's
most advanced cancer centers with specialized radiation equipment.
"If you have a 'common' cancer, that of the breast, colon or lung ...
then it's going to be easy to find standards of care that are the same
in the U.S., Brazil or Cuba," said Dr. Julian Molina, an oncologist at
the Mayo Clinic in Rochester, Minnesota. "The problem comes when you
have a tumor that's not one of the common ones, and that's what most of
us suspect Chavez has."
Latin America's top cancer doctor Paulo Hoff, who heads the cancer
center at Sao Paulo's Sirio-Libanes hospital, considered the region's
best, would not talk specifically about Chavez's case. But he did say
that a cancerous tumor in the pelvic region would be mainly limited to
four types: prostate, rectal, bladder and sarcoma, the latter being a
rare and deadly form of tumor.
Mayo clinic cancer specialist Molina said the consensus among doctors in
Latin America and the U.S. he's spoken with is that Chavez has a sarcoma
tumor because those tend to come back in the same site where a previous
tumor was removed, which appears to be the case with Chavez.
The leader made a live television appearance from a hall in the
Miraflores government palace Thursday night. Shouting "I will live! I
will live!" he pounded a table and said he would undergo surgery early
next week. It's not clear if Chavez would then have radiation therapy
after surgery; if so, it normally begins between three and six weeks
after the procedure.
Brazil's President Dilma Rousseff, who successfully underwent cancer
treatment at Hoff's center in 2009, invited Chavez to seek treatment at
the Sirio-Libanes hospital Sao Paulo last year when he was first diagnosed.
Hoff said the matter never went further than that and that he's not
involved in Chavez's treatment. Given Chavez's position, Hoff said, "I'm
sure they did due diligence on deciding where he would be treated" and
decided Cuba was a safe bet.
Cuba's health system has long been one of the pillars of the 1959
revolution. Health care is free for all Cubans and generally considered
good compared to what's available to most people in Latin America and
the Caribbean.
There has been some decline in the level of care over the years,
however, as economic difficulties make it difficult to purchase medicine
and supplies. The U.S. embargo also complicates replacing outdated
equipment, despite the fact that the sanctions in theory exempt medicine
and most supplies.
If Chavez's cancer has spread to his liver, brain or lymphatic system,
the most likely locales for a cancer coming from the pelvic region, he
may need more advanced machines that can pinpoint intense bursts of
radiation at tumors and not damage nearby tissue.
Dr. Demetrios Braddock, an associate professor of pathology at Yale
University's School of Medicine in New Haven, Connecticut, whose
research focuses in part on cancers that spread, said a two-centimeter
(one-inch) lesion "isn't a small recurrence, that's a significant tumor."
"Even if it were sarcoma, the way it's typically treated it to go back
in and taken it out. That's how it would probably be treated up here in
the U.S.," Braddock said, underscoring that's the procedure taken if the
cancer hasn't spread.
Molina, however, questioned even that surgery, noting that the pelvic
region "is really fully packed with organs, nerves, blood vessels ...
there is not much room to work."
He added that Chavez's previous surgery in the same area would have
produced scar tissue, further complicating the procedure.
Molina said he didn't know about the specific capability of surgeons in
Cuba to deal with such a tumor. But both he and several doctors
interviewed in Brazil acknowledged that surgeons in the U.S. have the
advantage of routinely encountering more complex cancer cases and also
having a much larger pool of colleagues to consult.
"When you go to a place like Cuba or Brazil, even with all the
development in Brazil, you find less people with enough knowledge to
make good advice about what to do," Molina said. "That is where the
concern about Chavez comes in — the concern that the knowledge is not at
the same level."
Dr. Peter Bourne, chairman of the Medical Education Cooperation with
Cuba, a nonprofit organization working to enhance ties between the Cuban
and U.S. medical communities, said he routinely visits the island and
knows its doctors are up to the challenge of treating all but the most
"exotic" cancers.
"They have a very excellent cancer institute in Havana, which is the
facility where he's being treated," said Bourne, a former drug czar in
the Carter administration who works closely with Cuban doctors and
routinely visits the island. Chavez has not publicly specified where
he's being treated in Cuba.
Bourne, trained in psychiatry, acknowledged he has no inside information
on the illness Chavez is facing. But based on the information that is
public, it "seems certain he has cancer of the colon and that the
treatment for it would be similar wherever he might seek it."
Bourne, for one, said he thought Cuban doctors would be up to the task
of tackling a dangerous recurrence of sarcoma.
"They're very sophisticated in Cuba," he said, "and would be able to
treat that as well as he would be treated anywhere."
___
Associated Press writer Peter Orsi contributed to this story from Havana.
http://www.cbsnews.com/8301-501714_162-57384285/is-chavez-sacrificing-cancer-care-for-privacy/
No comments:
Post a Comment