MoU signed between AEB, KDU, and medical suppliers
[caption id="attachment_114364" align="alignright" width="710"]
State Minister Duminda Dissanayake (third from right) and attendees at the launch of the Aluth Husmak programme[/caption]
Renuka Ekanayake, a cancer patient currently residing in the Gampaha District, has been on a waiting list that could potentially save her life. For the past five months, she has been in the queue for a positron emission tomography (PET) scan, which most doctors around the world deem essential when fighting cancer.
Speaking to The Sunday Morning, Ekanayake stated that she has been on the waiting list for the scan since May 2020, at which time she was scheduled to do it in three to four months. However, with the ongoing Covid-19 pandemic, and the scarcity of the compound Fluorodeoxyglucose (FDG), the scan has been pushed back indefinitely.
Ekanayake is one of 25,000 registered Sri Lankans diagnosed with cancer every year, out of which around 14,000 die annually, according to research done by the National Cancer Control Programme.
Experts around the world have labelled PET scans a necessity for these patients when it comes to their diagnosis, staging of the tumour, planning treatment and response detection, and detection of any recurrences over the years.
Despite the importance of PET scans, Sri Lanka is still unable to cater to the demand of local cancer patients. This is due to the country having to depend on imports of the FDG dye, which is the main component when it comes to the scans.
Understanding this need, the Atomic Energy Board (AEB) of Sri Lanka entered a tripartite agreement with the General Sir John Kotelawala Defence University (KDU) and Medical Supplies Division to locally manufacture FDG.
The event, which took place on Wednesday (13), saw the signing of two MoUs between the three bodies to ensure the construction of a cyclotron plant in the KDU hospital in Werahera.
Matching demand via local manufacturing
[caption id="attachment_114369" align="alignright" width="704"]
State Minister Duminda Dissanayake addressing the gathering[/caption]
According to AEB Chairman Prof. S.R.D Rosa, while KDU will be providing the facility, the AEB will be responsible for setting up the plant, and the medical supply division will be ready to buy the dye once produced.
He explained that Sri Lanka is currently only able to conduct around 1,500-1,600 PET scans a year, with only three hospitals capable of these scans, and needs to increase the number of scans to cater to local demand.
These hospitals include the privately-owned Asiri Hospital, which established their PET scan in 2011 and carries out around 700 scans per year. The next is the Apeksha Hospital in Maharagama, which gained the ability to do the scan in 2018, when it came in the form of a donation from the Fight Cancer Team Sri Lanka. However, the hospital only has the ability to conduct one session per week for just 10 patients. The third hospital, the National Hospital, which only established PET scans in 2019, only has the ability to do around three sessions a month.
“Even with both the private and public sector hospitals combined, we are only able to do 1,500 scans a year, and this is due to the non-availability of the FDG dye. However, with this dye, we can even perform the scans daily,” said Prof. Rosa.
Speaking to us, KDU Senior Consultant Oncologist and Senior Lecturer Dr. Jayantha Balawardana stated that unlike X-rays, Ultrasounds or MRI scans, which only pick up anatomical abnormalities, the PET scan also detects if the abnormality is metabolically active/cancerous or not. These scans also help doctors precisely highlight the active area, and only give treatment to that area, sparing the normal tissue around it.
He went on to explain that the scans also help doctors identify if the patient is responding to the treatment, and whether the tumorous tissue has completely disappeared from the patient’s body. Moreover, PET scans every year or two also helps doctors detect any re-emergence of the cancer in the body.
“During the course of the cancer illness, a patient should have a minimum of three scans. However, in Sri Lanka, we can only do one scan per patient in the government sector. Therefore, access to these scans has become a luxury and not a necessity, so we want it to become a necessity, which is why we decided to move forward with this project,” said Dr. Balawardana.
Costly, yet short-lived
[caption id="attachment_114367" align="alignright" width="727"]
The Mou being signed between the Atomic Energy Board, General Sir John Kotelawala Defence University, and Medical Supplies Division [/caption]
Currently, the Government imports FDG from India; however, as with any radioactive substance, the dye has a very short half-life of 110 minutes, which is required of radioactive substances being injected to the body, to avoid long-term exposure. This less-than-two-hour half-life makes the quality of the radioactive dye decay when in transit.
“We order in millicuries (mCi), which is a unit of measurement of radioactivity. So, if we order about 3,000 mCi, by the time it comes here, it will be 100 mCi. Then the PET scan takes around 10-15 minutes to conduct, which will also result in further decay. Importing the FDG is a waste of our time, money, and resources.”
According to Dr. Balawardana, the Government is currently spending Rs. 100 million a year in foreign exchange to bring down this dye, but is only able to scan a little over 1,500 patients a year. Moreover, the scan is not readily available to the patients, with the waiting list for the two government hospitals being as long as three to four months, and the private sector scan being very costly.
He explained that if Sri Lanka were to manufacture our own FDG dye, the three hospitals can carry out daily scans and conduct 30,000 scans a year; which caters to the demand of the annually-diagnosed cancer patients.
The total project has a budget of Rs. 1.2 billion; however, Dr. Balawardana estimated that by saving the Rs. 100 million spent on importing the dye, Sri Lana will be able to recover the budget within a 10-year period.
“PET scans cost the Government Rs. 54,000 per scan only for the FDG dye, but once we start manufacturing FDG here, it will come down to Rs. 14,000 per scan.”
Furthermore, the doctor pointed out that the PET scans are also essential in diagnosing other diseases, such as Alzheimer’s, where the scan helps detect who is vulnerable to the disease, and epilepsy, where the scan helps pinpoint the origin of the fits. It also highlights the damage done to a heart muscle post-heart attack.
The FDG manufacturing plant is set to produce its first batch of the dye in January 2022, since the construction of the plant is a complicated process, having to incorporate special construction elements to handle the radioactive material within the plant.