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A Regular Day at "K Hospital" in Hanoi

Cancer - Viet Nam

Patients at Viet Nam's National Cancer Hospital, awaiting the results of their medical tests, collecting medication or registering for treatment. (Photo: P. Pavlicek/IAEA)

It could be mistaken for Hanoi's central railway station at rush hour. Hundreds of people, many with bags and camp beds, wait in long queues.

But they are not buying tickets or boarding trains. They are awaiting the results of medical tests, collecting medication or registering for treatment.

This is a typical morning at Viet Nam's National Cancer Hospital, commonly known as "K Hospital".

Located in a run-down French colonial-style building, it is the busiest cancer hospital in the country, dealing with up to 5 000 patients every day at three campuses.

As some people try to understand their medical results, others pay for services their health insurance does not cover. Some patients, too weak to walk alone, are supported by family members, while others sleep after their long journeys to the capital.

As in many other developing countries, cancer is on the increase in Viet Nam. According to the latest statistics from the World Health Organization (WHO), there are around 125 000 new cancer cases and 94 000 deaths each year. These figures are expected to double by 2035.

"Cancer is currently one of the major health issues in Viet Nam. Over the past ten years we've seen a large increase in incidence and mortality, with a fifty percent increase in cancer cases," said Dr. Pham Thi Quynh Nga from the Hanoi office of the WHO.

"Risk factors for cancer are very high. Almost fifty percent of men are smokers and over half of the population, including children, is being exposed to second-hand smoke. More than one third of men are using alcohol at harmful levels. We also have problems with environmental pollution, food safety, and lack of physical activity, which are adding to the current burden of cancer."

Since many cancers occur in people over the age of 65, the fact that people are now living longer in Viet Nam is also contributing to the rising cancer figures and due to improved diagnostic methods, more cancers are being detected.

Professor Tran Van Thuan, Vice-Director of K Hospital, said the country is seeing increases in almost every type of cancer, with the most common types of cancer being lung and liver cancer in men, and breast, cervical and liver cancer in women.

The Professor, who is also the Director of the country's National Institute for Cancer Control, added: "Our statistics show that tobacco causes over 30 percent of cancer cases in Viet Nam. Other causes include infection and viruses such as hepatitis, inappropriate nutrition and genetic factors."

An estimated one third of cancers are curable if detected early and treated properly, but in Viet Nam mortality statistics from the WHO indicate that the cancer survival rate is very low.

"The mortality rate is high mainly because people with cancer often go to hospital too late. This is because there is a lack of awareness about cancer prevention and treatment," said Professor Thuan. "Over 70 percent of people are diagnosed with cancer at stage three or four. By this stage, it's too late to cure it."

"We need to focus on raising awareness on cancer prevention and control through the mass media so that people can have basic knowledge and can recognize cancer at an earlier stage," said the Professor.

Viet Nam has a growing population of around 90 million and cancer patients from all over the country are referred to K Hospital for treatment.

Nguyen Xuan Bien is a 60-year-old farmer from Tuyen Quang Province, who is suffering from lung cancer.

"A tumour was detected in my left lung last October. At first I went to a district, then to a provincial hospital. But I requested to be moved to a better hospital and I was sent here to the National Cancer Hospital," he said.

"At first, I felt desperately sad, but now I strongly believe that I can be cured. At this hospital, I've been treated with radiotherapy and the doctors and nurses are very dedicated."

Mr. Bien has so far received seven courses of radiotherapy. He believes the treatment is working and feels that his "pain has been soothed."

The father of three is already making plans for his life after treatment: "After recovering, I will go back to my home, enjoy life with my family and my grandchildren," he says. "Now I'm old, working on the field is for my children. I can just help them sometimes."

Fellow patient, 39-year-old Ngo Thanh Nga from Ha Nam Province, is not so positive. She is one of many breast cancer patients waiting patiently for radiotherapy.

They say they have become "friends through cancer." They share jokes and remove each other's hats or head scarves to reveal their hairless heads.

Like her husband, Ngo is a farmer. They have two children. As she has no health insurance, she has to pay for the treatment and needs to rent a temporary room in Hanoi.

"I was first diagnosed with fibrocystic breast disease in 2003," Ngo explained. "A tumour was found in my breast. But after I took medicine, it disappeared. Last July, I had a medical check-up and was diagnosed with breast cancer. I had surgery and chemotherapy."

Now she is midway through a course of 25 radiotherapy treatments.

"The doctors here are very kind, but the machines are not very good. They are old and can break down suddenly, even during treatment. They need to be repaired quite often. Sometimes patients have to wait for up to two days for treatment," said Ngo.

"I wish that there was more support so that the hospital could buy more modern machines to help cure these poor patients. There are too many of them here. With more machines they could diagnose cancer sooner and treat it more efficiently."

The increasing number of patients is leading to long waiting times for treatment and severe overcrowding in K Hospital, with in- and out-patients and their families having to share beds.

Doctors say they are doing their best to improve the situation.

"One short-term solution is to encourage doctors and nurses to work over-time and utilize the machines more," said Professor Thuan.

The hospital's two radiotherapy machines now operate for 18 hours a day, both delivering 180 courses of treatment. The sole mammogram machine, which is used to diagnose and manage breast cancer, serves 160 patients a day.

"We're also introducing a new campus in Tan Trieu in the south of the city with 1 000 beds. In the long term, we're trying to improve the cancer control network so that provincial hospitals can treat cancer and thereby decrease the pressure on national hospitals," Professor Thuan added.

For over three decades, the IAEA has played a key role in providing cancer-related assistance to countries throughout the world, primarily in the areas of diagnosis and treatment.

"We receive a lot of support from the IAEA in terms of training and equipment. It has helped us set up our national campaign on cancer control. This was approved by our Government in 2008 and is working well," said Professor Thuan.

"We also receive some equipment. For example, a radiotherapy machine, which is located in a hospital in Can Tho province, and annual scholarships for training in radiation medicine in places like the USA, Australia, Singapore and the Republic of Korea."

The IAEA is supporting Viet Nam through its Technical Cooperation programme. "Cancer is a significant burden for Viet Nam," said Gashaw Wolde, Programme Management Officer at the IAEA Department of Technical Cooperation.

"We're working with the Ministry of Health and a number of hospitals to strengthen cancer and nuclear medicine services. We also helped establish a PET-Cyclotron facility in Tran Hung Dao hospital in Hanoi to produce radiopharmaceuticals that are used in several hospitals to diagnose and manage cancer."

Through its Programme of Action for Cancer Therapy (PACT), the IAEA is introducing a two-year project to improve screening for breast and cervical cancers. The project is due to start this year and the National Cancer Hospital is expected to play a key role in its implementation.

Breast and cervical cancer are the two leading causes of cancer deaths and illness in Vietnamese women, accounting for approximately one third of all new cancer cases every year. But currently the country has very limited screening opportunities.

The IAEA project, which is being funded by the OPEC Fund for International Development, aims to increase public and doctors' awareness about breast and cervical cancers. The project should result in cancers being detected at an earlier stage, improving cancer survival rates for women in the project population.

The project may be too late to help women like Ngo, but she hopes that fewer women will end up in her situation: "When I first came to K Hospital, I was surprised to meet so many people like me with breast cancer. It would be good if there were not so many people sick like this. If people could live, work and enjoy their lives. Everything would be better."


-- by Louise Potterton, IAEA Office of Public Information and Communication


(Note to Media: We encourage you to republish these stories and kindly request attribution to the IAEA)