Recovered Cancer Patients Fall Between Cracks

After chemotherapy ends, cancer patients in Israel often face bewildering bureaucratic limbo that fails to address their needs.

Dan Even
Dan Even
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Dan Even
Dan Even

The number of people recovering from cancer has risen dramatically, thanks to new medicines and advanced instruments. But the health system has not set appropriate treatment after chemotherapy sessions end, leaving patients without a clear solution for their problems.

More than 200,000 people have been healed from cancer in Israel, and the number is expected to hit 500,000 by 2020.

The increase in the number of cured people requires the health system to provide them with a treatment course. But health officials have not been able to tell patients when to part with their oncologist and return to their family doctor.

To make matters worse, communication between the oncologists and family doctors is sometimes non-existent. Most oncologists don’t provide the family doctors with detailed documents about the patient’s condition, which harm the patient, doctors say.

“Some oncologists fear that passing the responsibility for the patient to the family doctor will lessen their profits,” says a senior doctor.

The hospitals’ oncological institutes receive large sums of money from the health maintenance organizations for checking up on patients cured from cancer. An oncological or hematological examination is priced by the Health Ministry at NIS 230 a visit.

“Some oncologists are afraid that once the patient is treated by the family doctor, the number of visits to oncology institutes will go down, which in turn will lead hospitals to reduce the institutes’ staff,” he says.

Some oncologists, especially senior ones, offer patients private services, charging as much as NIS 2,000 or more for oncological consultation.

“There’s no communication between oncologists and family doctors, and both sides are to blame,” says Dr. Tzachi Gur, director of the Ezer Mizion clinic for patients healing from cancer.

“When a patient is diagnosed with cancer, he passes to the oncologist’s care and for 12 to 18 months the family doctor becomes a clerk who issues referrals for blood tests and to specialists, usually without having a clue about the patient’s condition,” he says.

“Mostly the oncologist doesn’t give the family doctor a summary letter and even when he does, usually after the family doctor asks for it, it lists the tests without any explanation. This is because the oncologist thinks the family doctor doesn’t understand anything about cancer,” he says.

Oncologists say family doctors cannot always give appropriate treatment, especially due to a shortage of time. A family doctor gives each patient only 12 minutes.

One woman’s story

In February, after six months of hospital treatments, Aida Laufer was told she was cured of lymphoma. Laufer, 43, of Kfar Sava, was told she could resume her life with one limitation − her condition must be monitored.

This marked the beginning of a new struggle, this time with the health system.

A patient is considered cured if he has been in remission for five years after the end of his treatment. When medical problems arise, including the reappearance of the tumor in another part of the body, the patients are at a loss for whether to go to an oncologist or their family doctor.

“After the oncologist performed a CT and told me I was healthy, he invited me for a check-up. When I have questions between check-ups about problems, I go to my family doctor,” says Laufer.

“I have an oncologist at Meir Medical Center who belongs to Clalit health maintenance organization, whom I can see in a private clinic, and a family doctor in Maccabi HMO. I don’t want to go to his private clinic, so I coordinate between them. The oncologist sends me a form referring me to specialists and then I go to the family doctor for a referral,” she says.

A committee appointed by the National Council for Oncology, which advises the Health Ministry, started working this month on determining the treatment for people who have recovered from cancer.

“Doctors worldwide have been trying to figure out in recent years how to treat people who have healed from cancer and we already have some models,” says committee head Prof. Eliezer Robinson, who is also chairman of the Oncology Council and the Israel Cancer Association.

In the United States and a few European states, clinics offer patients who have been cured of cancer a day of treatments and diagnoses. At the end of the day the patient is given a detailed document for his family doctor, outlining his treatment.

A number of similar clinics operate in Petah Tikva and in Hadassah Ein Kerem Medical Center. The HMOs finance the clinics’ treatments, but each clinic can only treat a small number of patients a day, says Robinson.

“Also, these clinics require resources, additional staff and funds for equipment. This means they can only treat a few of the patients,” he says. So far only 3.5 percent of the patients have been treated at these clinics.

“Some patients say ‘when I was sick I could call the oncology ward and get tests done immediately. Now I’m left alone with the fears. If my leg hurts or there’s a swelling − is it associated with the disease?’” says Orit Shapira, director of the rehabilitation department in the Cancer Association.

“These people need answers, because they’re dealing with side effects on their own and should receive services,” she says.

Illustration photo by Alon Ron.

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