 Hello and welcome to Issues and Answers, a production of the Government Information Service. I am Jolene Beset-Joseph. The Cantor Centre of Eastern Caribbean, located Antigua, was launched in July of 2015, offering high-quality oncology services. In 2017, a branch of the centre was opened right here in St Lucia at the Tapio Hospital, offering consultations and systemic therapy. Getting treatment is provided at the Cantor Centre in Antigua. Now, whilst a lot of us might have heard about the branch opening here in St Lucia, many may still not be aware of how they can go about accessing radiation therapy at the centre. So today, I am joined by a couple of individuals who are going to give us some insight into how anybody who needs treatment can actually go about getting treatment from the centre. So let me introduce Mr Henry Hazel, who is the Chief Operating Officer at the centre, and Dr Glenn Jones, who is a Radiation Oncologist. Hello. Good morning. Thank you for joining me. Good morning. Yes, good to be here. Great. Now firstly, can you give us a little background behind the centre, first of all? Well, way back in 2009, the heads of our OECS countries, they got together and they thought it fitting that we ought to properly have a cancer treatment facility within our OECS region. And so several years afterwards, via a public-private partnership, the establishment of the centre came through to fruition July 1, 2015. The main facility, located in Antigua, and as you mentioned earlier on, we opened our branch here in St Lucia in April of 2017. So it is a treatment facility that serves the entire OECS, all nine countries of the OECS, and because of the level of investment for our radiation centre itself, we can only have one at this particular point in time. And so strategically, and by consensus, it was agreed that it would be established in Antigua. But we have chemotherapy capability here in St Lucia via our facility as well. Of course, the consultations get done here as well. And throughout the rest of the OECS countries, we do what we call oncology clinics where our doctors actually go there, mainly in the government facilities to see cancer patients on a consultation basis. And then they would advise on the treatment plans thereafter, and they would be directed to where they ought to go, whether it is in Antigua or here in St Lucia, if it's just a case of chemotherapy. Okay, excellent. Now, as I was saying, a lot of people, because there was a lot of awareness put about when the branch first opened here in St Lucia, so a lot of people know about the centre, but not a lot of people know about how they can go about accessing treatment. So can you start off by telling us a little bit about the referral process? Right. So I probably could allow Dr. Jones to deal with that, but I might just preface it by saying it all starts with a referral from your general physician, your family physician. And after that diagnosis is made, then that physician refers patients to us, the treatment centre, to take it from there. Dr. Jones? Yeah, it's very important when a referral is made that we have a lot of the background information. So for instance, there may be imaging studies like CAT scans or mammograms, and we need those reports, but we often need to also see the images or the pictures. We need the pathology report, so for most patients who get cancer, there is a piece of the tissue, the cancer tissue, which is looked at in a lab. And there's a report on what type of cancer it might be. So we need that report as well. Sometimes we need it reviewed or further discussed. So at that point, then, there may be discussions between ourselves and the referring physicians and other physicians about the situation so that we can all share the same information, make sure that information is complete. If there's additional tests to be done, we can help direct that. And at some point along this process, a decision can be made that it's now an opportune time to see the patient with their family if need be or friends, and then make a decision about what the best treatment should be. So sometimes that's immediate, especially if it's an urgent situation, or it may take several days. Right now, our typical time from referral to being seen is approximately six days, calendar days. Okay, so that's all. And that's, I understand, that's followed by the consultation process, right? Yeah, the consultation process then happens in one of the clinics, whether it be here or in Antigua, for example. Okay, now, during that part, I know there's a lot of, I mean, I guess many people have been touched by cancer, whereas they have people in their family with that cancer. And there's that part where the patient is first diagnosed, where they go through there themselves, go through a lot of emotional turmoil. People go through any kind of stages with people from the center in that regard and being maybe guided and reassured somewhat in the steps they can be taken next, because I know it becomes a very traumatic time for people. Yes, right, so our clinical staff included our physicians and our therapists, they are very well equipped to provide that level of care as part of the overall care. So even at the consultation stage, there's a certain amount of counseling that gets done. What we would wish to happen, and we are planning for that in the future, is to actually either onboard as part of our staffing compliment, specialize skilled counselors, or we strike strategic partnership with same persons to provide that level of care. So we will actually be referring to a specialist consultant in the area of counseling. So we actually know of a couple right here in St. Lucia. There are a few in Antigua as well too, and the plan is to actually get everybody on board in this collaborative. I think in this we'll call it shared management or something like that as it relates to medical care, being administered to a particular patient. Yeah, distress is obviously common in just about every patient who has a diagnosis of cancer, and often in their families, significant others. So we realize that only about 10 or 20% of the patients, meaning out of every 10, one or two, will actually have significant distress that continues and is ongoing. One of the significant things that reduces distress, influences the emotions and helps move towards decision making, is to get critical information about what the cancer is, what's recommended, and what the treatment will be. So most studies demonstrate that once patients get that information, their distress level goes down considerably. And in fact, I think the primary goal of counseling and so on, if possible, is to both deal with the distress, but also move towards a kind of a problem-solving strategy, where you're sharing information, you're trying to, through the information, achieve consent for whatever the next step is, and then to proceed forward in a fairly organized way. So we want a wise decision for the treatment, not the most expedient decision. We don't want the fastest, we want the wisest. So it does take a few days, sometimes extra tests are needed, and patients need to be aware of that, that sometimes at the consultation, a plan is not fully developed. And in fact, it often takes further discussion with other doctors and maybe a team approach to actually come up with a plan. Once the plan is there, then it's important to move swiftly to treatment and then to continue the treatment and adhere to the program as much as possible to get the best benefit. Okay, excellent. Now, I also understand that after that there's actually a funding process as well, yeah? That's correct. What exactly takes part during that process? Right, so almost immediately, we discuss with the patient how are they proposing to pay for their care. It has to be paid for, right? So ideally we have three basic categories of patients, insured patients, where patients have major medical insurance and the insurance company would ideally take care of that. Oftentimes on a cost-sharing basis, 80-20. Insurance pays 80% of the cost and the patient pays their co-pay of 20%. So in such an instance with an insured patient, we would immediately make contact with the insurance provider and obtain what you call a pre-certification. This is an approval from an insurance company, yes. This is our insured client. We will take care of their cause. Please go ahead and treat the patient. So that's essentially what they would say to us. So immediately we'll proceed to onboard that patient, discuss with them how they are going to pay for their co-pay. If they are in a position to pay it, then it is required that they do so upfront. If they're not in a position to pay that upfront, then we also have a payment plan for them to deal with that particular co-pay, right? So then there are those who do not have insurance and they are in a position to pay for their cause. So they can simply write us a check, pull out their credit card, round up some cash among themselves and family members, et cetera. So they come to us and they pay for their care. Again, if they're not able to pay all of it upfront, we have a payment plan as well that we can put such patients on, right? Self-paying patients, as we call them, normally would get a 20% reduced rate relative to what we would build an insurance company, right? So you don't have insurance and you are not in a position to pay for your care yourself amongst yourself and your family. Then you would then have the option of looking to government for some semblance of financial aid, right? There is a process to that as well in terms of touching base with the appropriate persons at the Ministry of Health and then there's an approval process there, right? Once that gets approval, we get communication via the permanent secretary in the Ministry of Health indicating that they will be sponsoring this particular patient. On receipt of that, then we move almost immediately to onboard that particular patient. If the treatment costs that we will ascribe to government sponsored patient, and I can come back to that later on, is not totally covered by the government, then we will also get into discussing with the patient how are they going to cover the shortfall on that. Now I don't want to cut you short, but we just have to take a break. But just a little while and we're going to come back and hear a bit more about the payment process. Yes. Okay, all right then. So stay with us, we'll be back after this break. Pamela, I noticed that you built your retaining wall on my property. You will have to give me my land back or compensate me for that. My contractor isn't dumb. I trust that he will not build anything on your property. Where is your proof? Let's go to court. This situation does not require you to go to court. Looks like we have to go through mediation here. Mediation is a way people resolve conflicts like this. Someone, a third party, comes to speak to both parties. This person is called the mediator. The mediator is impartial. He or she makes sure that communication between both parties is effective and efficient. So, the mediator is a judge? No, the mediator is not a judge. Mediators, unlike judges, do not decide cases or impose settlements. Let me get a mediator to handle this retaining wall and that kitchen. Kitchen? Yes, your kitchen also falls on my land. Let me call the mediator. Welcome back to Issues and Answers. Today, we are joined by the Cancer Center Eastern Caribbean. We are actually joined by Mr. Henry Hazel and Dr. Glenn Jones. And they're telling us all about the accessing radiation treat therapy at the center. So, we were talking about the payment process before we went to break, Mr. Hazel. So, if you could carry on just telling us a little bit about that. Right. So, I was actually into discussing the process as it relates to accessing financial assistance from the government. So, once we receive approval from the Ministry of Health via the Permanent Secretary, then we will proceed to treat the patient. Our aim really is to start treatment as soon as possible because time is of the essence, right? So, our administrative process really has to be top-notch in terms of the leasing that we have to do with the relevant persons. Now, to talk a little bit about the payment plan that we offer. And this could apply to an insured patient who has a challenge paying for his copay. It could apply to a self-paying patient who is contemplating paying for the overall treatment course. And it could apply to a government-sponsored patient as well where the government does not fully cover the amount agreed for the particular treatment. Let me start with the government-funded patients first. When we established, we indicated earlier, it was on a mandate from the governments of the OECS countries. And so, inside of that agreement, we would assist the government in making oncology care available to citizens at reduced rates, particularly radiation therapy, at reduced rates. And in that arrangement, we have agreed a flat fee of $10,000 US dollars for a course of radiation therapy. Now, to put that into perspective, our fees for radiation therapy could go up to $40,000 US dollars, depending on the nature of the disease and the techniques that are used to devise the plan, right? So, on the lower end of the scale we have for a brisket, for example, at $22,500. And we get into the brain tumors that need to be met, planning and so on, up to 40, yeah, $40,000 US dollars. Inside of that, irrespective of the disease we're treating, the complexity of the plan, a government-sponsored patient would be for $10,000 US dollars. The government of St. Lucia, presently, they are aiming to cover the full $10,000 US dollars in our latest discussions with them. They are not yet there. What they provide presently is $10,000 US dollars, right? And so the patient now have to deal with trying to come up with the remainder of the $17,000 US dollars, right? So they have lots of workarounds for that. Other agencies, common board, like National Community Foundation, et cetera, and the LEND assistants in this regard, right? So we work with the patients. For a self-pain and an insured patient who are trying to meet either overall cost or the part of the co-pay, we would offer a payment plan that would require them to make at least 50% down payment with us and then we start treatment immediately. The remainder of that, ideally we would want to be repaid over the course of treatment. It is not always possible for all patients and so sometimes on a case-by-case basis, we extend beyond the termination date of the treatment, right? So if the treatment is gonna finish, gonna be completed within two months, there are times when we actually give patients up to maybe three, four, five months to pay off the remainder of their balance with us. Okay, all right, brilliant. Now, can you tell me about the treatment process itself? Where in regards to traveling to Antigua and accommodation and such like, tell me a little bit about that process. Right on that. So again, as Dr. Jones mentioned earlier on, only if you need radiation or radiation combined with an auto-particle like chemo, radiation or surgery and things, you would need to travel to Antigua for that. Traveling to Antigua, we have already made arrangements with property owners, guest house apartments, that would give us concessionary rates for accommodation. Radiation in Antigua could ideally span from say three weeks to up to eight weeks and so you would have to be present there in Antigua during that period of time because the treatment is daily. Okay. You come into the center for about a half an hour every day, right, on a daily basis for that period of up to eight weeks. So of course you would need accommodation and so that accommodation, we have agreements in terms of concessionary rates. We make all of the arrangements patient comes through, of course, they would have to provide the funding for that. The patient would also have to ensure that they are financially equipped to take care of the other incidentals like food and small other incidentals. Okay. Transportation on the ground, we offer that free of charge for all incoming patients. Okay. We even pick them up from the airport. Okay. We have had experiences though for several solutions who would come to Antigua. They would have already had family connections or friend connections there. So they would have totally eliminated the pickup from the airport. Okay. To the transportation and the accommodations as well. Okay, okay, I get you. All right. Now I understand that there's also CT scan simulation, right, and treatment planning. Tell us a little bit about that. No, this is Dr. Jones. Okay. Great. So almost all the patients require a CAT scan. This CAT scan is usually done with no injection. And if you have to swallow anything, it might just be a bottle of water because we want the bladder and pelvic patients that we're gonna be treating to be filled up in some cases. So there is a little bit of patient preparation. So that information is given to the patient so they can help prepare. Typically though, the preparation can be done in the clinic. There's an appointment for about an hour for a CT scan. So it's very straightforward. And there's a discussion with the person about what's going to happen. And then the scan is done. The scan takes only a few seconds and it gives 300 roughly pictures through the body of the area that we're going to treat. So if we're doing breast cancer, for example, we scan from the jaw down to probably just below the ribs. So we have the entire volume within which the breast and the lymph nodes are present. And then since each person differs from person to person, their shape and body composition is different. We have a unique information about each patient. So this then, there's some permanent little tattoo dots that may be placed on the skin with a little bit of a poke with a needle, with a bit of ink in order to assist in setup for all the treatments. At this point then the information from the scan goes to the physicians and the planners. And then what we do is we draw the target areas that we want to treat. We draw the areas that we want to avoid, like the lungs, the heart and other places like that. And then we use this information to develop a unique plan for that patient. So although it's very similar from patient to patient, there's small little differences and nuances. These are all taken into account. So this is why it takes sometimes three to 10 calendar days, sometimes even two weeks to actually develop the specific plan for that individual. We also do a lot of quality assurance. So that means that at each step of the process, and there may be five or 10 steps through this whole period of time, there's quality assurance done by a second person or even more in order to guarantee that at each step things have been done properly. So at the end then we have a good plan which we believe we can deliver in a reliable way on a daily basis throughout the entire course of treatment from Monday to Friday. So that's the upfront. That's why the scan is needed. Now, if you have a very superficial spot on your skin and we're going to treat it by just looking at it and marking it up on the skin, then we may not need the CAT scan, say for instance of the hand. But some of the treatment that we do on the surface only, you can use the scan to get more information. So even in that situation may well do a scan. Okay, all right, brilliant. Now I should just add that the price of that scan is included in the overall cost. We do not, all of the planning, the scan, all of the education around that is all covered within the envelope of the treatment. Okay, brilliant. Now, funnily enough, we've actually run out of time. But before we go, I just want to just very quickly just touch on starting and continuing daily treatments. So if you could just very quickly, just tell me a little bit about that. Okay, on the first day there's some quality assurance done as well. So the first session takes a bit longer. It could take half an hour or 45 minutes. After that, most of the treatment sessions are 10 or 15 minutes in the actual area where the machine is. So we recommend that people come about 15 minutes before and then they can leave promptly after the treatment because they don't feel unwell from that treatment. If they're seeing the nurse or seeing the doctor for an assessment, which happens at least once a week, then on one of those days that they're there during the week, they'll be there twice as long or three times as long in order to allow that assessment to happen. So otherwise, it's very routine. Okay, all right, brilliant. Now, sorry again, we have run out of time. There's so much information. Yes. If anybody wants to just really find out, is there a way that they can get in touch if they want some more information? Absolutely. So our offices here in St. Lucia, we are located at Datapio Hospital and our contact number 459-2201. Excellent. Well, thank you very much for joining us today. This information is vital and it's wonderful that you're here with us to make sure that everybody in St. Lucia knows about the treatment that's available out there. And thank you everybody for watching issues and answers. Please stay tuned to the National Television Network. Until next time, bye-bye.