Dr Ekaphop
Sirachainan, president of the Thai Society of Clinical Oncology, explains the need to increase patient access to oncology treatment in Thailand, and the crucial need for collaboration with the public sector in terms of prevention and to spread information to all healthcare professionals. Sirachainan also underlines the importance of collaboration with the private sector to bring more innovative products to Thailand at the most affordable prices.
Could you introduce yourself and the Thai Society of Clinical Oncology (TSCO) to our global audience?
I studied at Ramathibodi Hospital, part of Mahidol University in Bangkok, which is actually in the top 3 best hospitals in Thailand, along with Chulalongkorn Hospital, and Siriraj Hospital. After my internal medicine program, I started to train in another program, the oncology field. When I started, there were only a few medical oncologists in the country. The unmet need was presented in the cancer care field. The Thai Society of Clinical Oncology (TSCO) was founded in 1996; with the primary goals of educating medical oncologists through major cancer centres in the university hospitals and improving cancer care along with other professional societies involved in the treatment and prevention of cancer.
In addition to advancing medical oncology education, TSCO is committed to providing education in other disciplines to advance the quality of cancer care in Thailand. We are trying to increase the number of oncologists in the country by improving the training program, a fast track training program. The number of oncologists is still low, but it is increasing every year. We just had the final board examination and we have 22 new medical oncologists this year. If we looked back ten years ago, we had only five to ten new oncologists per year. Today we have almost 300 doctors specialized in the medical oncology fields.
Cancer is one of the major health issues around the world, not only in Thailand. At the moment the mortality rate for cancer is higher than from cardiovascular disease or other diseases. The incidence of cancer is rising every year and, unfortunately, as our population is growing and also ageing, the number of cancers will not decrease, and the need for more oncologists, including medical oncologists, radiation oncologists and surgeons will still remain a crucial need.
Is enough being done in regard to cancer prevention in Thailand?
Regarding prevention, we have seen various campaigns put in place. One of the most successful is ‘Smoking Thailand’. Professor Prakit Vathesatogkit, a pulmonologist, in Ramathibodi Hospital, was behind this campaign. He managed to set up a law prohibiting smoking in public areas. This kind of new measure also helps for lung cancer for example. But obviously, there is not enough being done in terms of prevention in Thailand. We need to have more collaboration between the stakeholders in order to be more efficient in prevention. For example, regarding breast cancer and colorectal cancer screening, at the moment we do not have enough physicians and instruments to carry out the screening process. With more professionals, we will be able to organize more prevention screening for breast cancers and to do exactly the same as the Western countries.
Could you tell us more about the multi-stakeholder collaboration in oncology?
The TSCO collaborates a lot with the public sector and the private sector. We are collaborating with the Ministry of Public Health on cancer treatment. As in other countries, the cost of cancer treatment is very high, and the patients often cannot afford it. We collaborate with the Comptroller General’s Department (CDG), which is in charge of the reimbursement of the cost of the drug and treatment. They set up a program called OCPA (onco pre-authorization). When the doctors have to prescribe an expensive drug in order to treat the patient, they have to ask for permission and pre-authorization to the CDG. The CDG is able to approve for the entire reimbursement of the drug. Basically, the government will pay for the patient treatment, but they have to fit in all the criteria and condition.
We have also encouraged and facilitated different hospitals to conduct a clinical trial in Phase II and Phase III studies. It is a huge advantage for the patient because when they are part of the clinical studies, they have access to the new and expensive drugs without any expense. Regarding the private sector, we collaborate with pharmaceutical companies. When European FDA, or US FDA approved their drugs, they can be imported for compassionate use or clinical trials in University and large hospitals prior to Thai FDA approval.
Finally, we collaborate with other oncology societies. We have a long-standing collaboration with the American Society of Clinical Oncology (ASCO), which allows us to organize a Best of ASCO meeting every year. This year we are bringing the meeting in Thailand, to allow our Thai oncologists to update their knowledge from new clinical trials and the latest studies in the oncology field. Most of our doctors cannot attend the annual meeting in the United States, so we decided to bring the meeting to them. It is in the best interests of the patient that our oncologists receive the best and most up to date information on what is going on in our field today. In Asia, we have set up an inter-Asian countries’ oncologists’ group, called Asia Oncology Summit (AOS) in order to develop our strength in research and communicate more.
How do you rate the level of access to innovative cancer treatment and products in Thai healthcare?
Of course, cancer treatment in Thailand is an unmet need, like other countries. But unlike western countries, the problem is lack of patient access to effective treatments. In Thailand, there are a lot of liver and lung cancers, and we do not have enough research and innovative treatments in those fields. Sometimes we have to create our own clinical trials or research to develop the treatment for some diseases. And it is not easy to conduct clinical trials by ourselves, it is costly, and we need more support from government and the pharmaceutical companies. If the pharmaceutical companies bring more innovative products and clinical trials to Thailand, we will be able to use them, and the patient will have better access to treatment.
You have a well-established background in the oncology field, what would you like to be your greatest achievement in the field?
I know that it is ambitious, but I wish one day we could conquer cancer in Thailand. Right now, it is one of the biggest health issues in the country, so we would like to improve cancer care across the nation. Outside of the big cities and Bangkok, there is a big unmet need and it is our duty to collaborate with other specialists in cancer care and work as a team. Every country has the same problem with cancer, it is a global problem. We need to group together in order to find the best way to improve cancer care. Thailand is not a rich country and considered as an upper-middle-income country, and most cancer patients here cannot afford effective treatment – a major problem. If most patients could have access to the most innovative treatments, at an affordable price, we would be able to reduce the number of cancer deaths. But in order to be successful in this mission, we need to have more collaboration and put our forces together.
