Cancers of the head and neck topped the list of referral cases to India

Health: The steady increase in cancer cases in the country is fast emerging as a major burden on the health ministry’s coffer.

Records show that the health ministry spent Nu 7.5 million (M) in 2007, which increased to 36.5M in 2013. Treatment costs have increased steadily until 2013, after which it dropped following a drop in referral cases with 148 cases in 2014. The ministry spent Nu 12.1M for 148 patients in 2014.

From 44 cases referred in 2007, it increased to 289 in 2013. The initial phase of treatment takes about three to six months for which the ministry spends Nu 300,000 to one million on an average.


According to the Bhutan Cancer Report 2015, referral cases to India entails a huge financial burden on the government coffers. The government sends cancer patients to India mainly for radiation therapy in absence of medical facilities in the country to provide comprehensive treatment for cancer patients.

Health officials said a substantial amount of the health budget is spent on referral cases abroad. On an average, the government spends about Nu 160M annually on referrals.

Public health director Dr Pandup Tshering said that most cancers are caused by behavioral factors and can be prevented by adopting healthy lifestyles like refraining from consumption of alcohol and tobacco. “It can also be reduced by avoiding exposures to chemicals from the food that we eat and from environments that we work or live in,” he said.

Dr Pandup Tshering emphasised that it is important for people working in industries to use protective attires to reduce exposures to different chemicals.

He added that infection with Hepatitis B virus causes liver cancer, which can be prevented by adopting healthy sexual practices like avoiding multiple sexual partners and use of condoms, among others.

As for cervical cancer, Dr Pandup Tshering said regular PAP smear examinations for women between 25 to 65 years could help in early diagnosis and treatment. “To protect women from cervical cancer, Human Paplloma Virus vaccine is given to school girls in class VI and at 12 years of age for those out of school,” he said.

Meanwhile, cancers of the head and neck followed by hematological and cervical cancers topped the list of referral cases to India. The report states that in the past solid tumors involving gastrointestinal, hepato-biliary and the respiratory system would also comprise a substantial number. Now with the availability of specialists including oncologists in the country, cases have reduced significantly.

The average expenditure for treating one patient with a particular cancer is highest for brain cancer at Nu 190,000 followed by lung cancer at Nu 170,000. The average cost of treating stomach cancer was Nu 320,000 a patient in 2011 while it was less than Nu 100,000 for all the other years.

Although cervical and hematological cancers constitute the highest number of cases, the average cost of treatment is less when compared to other cancers.

Cancer is an important cause of morbidity and mortality in Bhutan. From 211 (all types of cancer) cases in 2008, it increased to 639 in 2014 across the country with a higher incidence among the male population. Of the 639 cases in 2014, about 61 percent were male followed by females.

The various causes of cancer in Bhutan are linked to lifestyle, consumption of doma (betel nut), alcohol and tobacco, and diet and obesity besides infections, among others.

Stomach, cervix, colo-rectum, esophagus and head and neck cancer topped the list of the types of cancer in Bhutan followed by the rest. Except for stomach cancer, which shows a decreasing trend, all the other types of cancer were increasing, according to the cancer report.

The report also states that economic development has a marked influence on lifestyle such as diet, physical activities and environmental exposure. With increasing socio-economic development, cancer caused by infections such as stomach, liver and cervix are expected to decrease while cancer caused by unhealthy lifestyles such as colo-rectum, breast and prostate are likely to increase.

According to health officials, about one third of the cancer cases are preventable. Modifying lifestyle, avoiding known carcinogens, exercising regularly and vaccinations are some of the measures to prevent cancers.

Besides mortality issues, cancer also consumes huge expenses from the limited health budget, the report states. “Addressing cancer has health, social and financial benefits,” the report states. Cancer control programme is combined with other non-communicable diseases and managed by the lifestyle related disease programme.

Kinga Dema


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