Why Package Cost for Oral Cancer Treatment Cannot be Predetermined?

Diagnosis of Oral cancer is hard enough without considering the direct and indirect costs associated with Oral cancer treatment. Beating your cancer is your first priority, but financial worries are often not far behind. Most Oral cancer patients fail to understand, why package cost for Oral Cancer treatment cannot be predetermined.

The answer is simple; cost of treating oral cancer can vary from Rs. 2 Lacs to 10 Lacs. The cost variation will depend on which part of the oral cavity is involved i.e. Tongue, Gum, Cheek, Jaw (Upper/Lower), Palate, Base of the Tongue, Uvella and Stage of the Disease (Early / locally advanced / metastatic) and modality of treatment required as per National / International treatment guidelines to achieve best treatment outcomes.

Before calculating the cost of treating oral cancer the following scenarios have to be considered:-

Does the patient require surgery? If yes, what type of surgery will be done? In other words, Will it be simple removal of the tumour with clear margins; Is there need for removal of mandible (lower Jaw or maxilla (upper jaw) followed by reconstruction; Does patient require resection of the neck.

Reconstruction of the Jaw (after its removal) — Another small surgery is done. Fibula (Non weight bearing bone of the lower leg) is removed and shaped like the original jaw. It is fixed with a stainless steel plate with screws.

Additional cost of removing original teeth, Stainless steel plates to hold the fibular graft to reconstruct the Jaw and parenteral nutrition have to be taken into account for patient requiring jaw removal. Some patients require gastrectomy for feeding the patient, till such time, one can start taking oral feeds.

Chemotherapy — Postoperatively patient may / may not require chemotherapy. The cost will also vary depending on what kind of chemo drugs are recommended based on the histology of the tumour. First line of drugs may / may not produce desired results. Second / third line chemo drugs and targeted therapies are more expensive. Some chemo drugs have to be imported and are very expensive. Cost can also go up if patient needs hospitalization for chemotherapy instead of Day care Chemotherapy.

Radiotherapy — Most patients postoperatively require radiotherapy. The cost of radiotherapy also varies from patient to patients depending on what application of radiotherapy is involved. If the patient is immobile due to any reason and cannot come daily for OPD Radiotherapy, the cost of hospitalization will add up to the radiotherapy bill. Depending on the category of bed chosen by the patients, cost will be different for different categories of rooms.

Supportive Care — Patients with stage IV disease do not require surgery. They are given radiation, chemotherapy and other supportive treatment i.e. Blood / Blood Component Therapy, Parenteral Nutrition etc. The maximum cost is incurred when patient has stage IV disease.

In view of the above, patient must undergo a complete diagnostic workup with numerous investigations to confirm the cancer; this is following by staging work up to find out the stage of the disease. After knowing the stage of the disease and modalities of treatment required, one can give the estimated cost of surgery, Radiation, Chemotherapy, Supportive care, rehabilitation etc.

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