Too bad for SA's breast cancer patients
Drug only costs R1 a day, but it's been out of stock for two weeks at Baragwanath. This in Breast Cancer Awareness Month
The most common and cheapest breast cancer drugs have been out of stock or running very low at Chris Hani Baragwanath clinic – in Breast Cancer Awareness Month.
The clinic, which serves about 1,700 breast cancer patients and survivors, is believed to be out of tamoxifen, a drug taken by 75% of women who get breast cancer, a doctor confirmed.
It costs only R1 a day.
Stock-outs of antiretrovirals (ARVs), contraceptive injections and a TB vaccine are worse than normal, said a number of doctors working in government hospitals and clinics, but the reasons are varied.
Tamoxifen is often taken to prevent a recurrence of breast cancer for 10 years. It reduces oestrogen, a hormone that encourages the growth of many types of breast cancers.
It has been out of stock for the past two weeks, although the Chris Hani Baragwanath pharmacy has just managed to get a little more.
“It’s a disgrace,” said a doctor, who asked not to be named because he is not authorised to speak to the media.
He said it is the cheapest and simplest treatment for breast cancer.
“Tamoxifen is even available in poor countries like Ethiopia.”
It has very few side-effects and sometimes can be used instead of expensive chemotherapy.
A similar drug given to breast cancer survivors for five years, Arimidex, is also out of stock because the supplying company allegedly cannot fulfil the demand. Multiple phone calls to their offices in Sandton on Tuesday went unanswered.
The doctors at Chris Hani Baragwanath Hospital said running out of simple medicines was not good for breast cancer patients or survivors.
They said patients don’t return for drugs because they don’t always have money for taxi fare to keep returning to the hospital, and many come from far.
“Running out of tamoxifen is like running out of bread and water,” said Lauren Pretorius, co-founder of NGO Campaigning for Cancer.
The lack of basic drugs comes after President Cyril Ramaphosa used his first address to the nation in February to promise a focus on cancer care and improved treatment for the disease.
Health Minister Aaron Motsoaledi launched the government Breast Cancer Policy in August, a 10-year plan drawn up by doctors, NGOs and state officials to improve screening, detection and treatment of the disease.
Motsoaledi said the plan would ensure people were treated sooner and better.
He also boasted that the government had recently secured the lowest price in the world to supply a high-cost drug used by very few women with a specific form of breast cancer to prevent it returning. The drug, Herceptin, costs the government at least R250,000 for a year’s course.
But tamoxifen, which has been running out at the country’s largest hospital, costs about R360 for a year’s treatment.
Acting CEO of Baragwanath Hospital Richard Lebethe denied the stock-out was as bad as doctors said.
“Tamoxifen is available at the facility. However, I can confirm that the hospital pharmacy ran low on Wednesday.
“Out of the 35 patients seen by the breast clinic about seven patients did not get tamoxifen.”
The facility took the names and contact details of patients who did not get their medication, and they were called on Friday to collect it, he said.
“To this end, I can put it on record all patients are continuing to receive their medication without any hindrance.”
But doctors maintain the drug was out of stock for two weeks and that the hospital had since only secured limited supplies. It was believed to still be out of Arimidex.
Cancer patients are not the only ones at risk of not getting medication on time.
The Stop Stockouts Programme, which gathers anonymous reports from health workers across the country, said there was a countrywide shortage of contraceptive injections and certain second-line antiretrovirals (ARVs), which are given to people who have become resistant to the common ARV.
The project said no one could get answers to why provinces were turning people away without medicine.
“Communication from the national department of health has been limited and without a clear action plan to immediately resolve this crisis.
“We are at a loss as to how to proceed, and frankly a little stunned at how poorly these stockouts and any clinical guidance have been communicated to healthcare workers on the ground. It’s a ticking time bomb,” said Lauren Jankelowitz, spokesperson for the Southern African HIV Clinicians Society.
Motsoaledi said earlier there was a global shortage of the antiretroviral lamivudine because the Chinese government had shut down the factories producing it.
Local suppliers cannot make the ARVs because they do not have all the ingredients.
The NGO Global Fund (sponsored by Bill and Melinda Gates) is negotiating with the Chinese government to reopen the factories, he said. The health department had just ordered lamivudine from other countries that had not yet run out of stock.
Also out of stock, said Motsoaledi, was the two-monthly contraception injection NeT-EN, because there is also a worldwide shortage of the active ingredient, norethisterone enanthate.
Patients are now offered the Depo-Provera injection, which is administered every three months.
Motsoaledi said SA did not manufacture any of its own active pharmaceutical ingredients in drugs, making it vulnerable to global drug shortages.