By Eulalee Thompson, Staff Reporter 
Survival rates for acute childhood leukaemia, a potentially curable cancer, is very disappointing in Jamaica because many patients cannot afford the long, expensive treatment.
THE SURVIVAL rates, in Jamaica, for acute childhood leukaemia, cancer of the white blood cells, is very disappointing.
Statistics are not generally available but, fewer than 50 per cent of the 10 to 20 children diagnosed with acute lymphocytic leukaemia (ALL) at the University Hospital of the West Indies'
(UHWI's) Haematology Department will survive long after diagnosis comparing unfavourably with a more than 80 per cent cure rate in countries such as the United States.
The disparity in survival and cure rates is not necessarily a function of substandard treatment protocol but Dr. Joye Taylor, UHWI's haematologist, indicated that too many patients cannot afford the long, complicated and expensive treatment.
"Cost is a major problem because... most of our patients are financially-challenged, and even if initially they can keep up with the cost, after the first few months they begin to fall off and then that maintenance phase (of the treatment protocol), which is probably the most important aspect of the treatment, suffers," Dr. Taylor said. "We find that the patients, because they can't afford the medications, they are 'stretching' them and they are not taking them properly. So we think that that is one factor influencing our cure rate."
The entire treatment for ALL lasts between three and three-and-a-half years and health personnel speak of a cure upon five-year survival of the patient after diagnosis.
The treatment strategy is divided into four phases induction, consolidation, central nervous system (CNS) prophylaxis and maintenance. In the first phase the induction a combination of tablets, chemotherapy and spinal injections are given to the patient for four weeks and at the end of this period the cancer goes into remission. This phase runs up a bill of about $100,000 and in many cases, the treatment ends here for many patients not only because they have run out of money but because they don't understand the disease.
"Although we try to explain, a lot of patients don't understand the nature of the disease...Usually after the first four weeks, the patients are well (and) when patients are ill, the priority is to get the medication to make them better but once they are better, medication becomes low on the list of priority. So I think education is very important," Dr. Taylor said.
The treatment at the end of four weeks enters the consolidation phase where the haematologist said a further combination of chemotherapy is used to destroy any cancerous cells which might have survived the previous stage. The next phase is the CNS prophylaxis -- treatment of any possible cancer cells hiding out in the brain.
The longest treatment phase is the maintenance, lasting two to two-and-half years for girls and a bit longer for boys, because Dr. Taylor indicated that cancer cells can actually hide out in the testes.
Another drawback in treating childhood leukaemia here, is the inability to clearly identify the risk factor. For example, haematologist here can diagnose the type of leukaemia ALL or AML (acute myelogenous leukaemia) but they cannot do the chromosomal and other testings that will identify whether the patient is in the high risk or standard risk group.
"Usually, in most of the protocols we vary the treatment based on whether it is high risk or standard risk but we just give one standard treatment regime (for high risk) that would perhaps be an overkill for the standard risk patients," Dr. Taylor indicated.
The doctors in the UHWI's Haematology Department are however, trying to address some of the pitfalls in leukaemia management here, such as the high cost of drugs, the need for further research and more precise diagnosis by setting up a Leukaemia CARE group. The group has so far been trying to raise funds to assist the most needy patients.
