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As the country observes Childhood Cancer Awareness Month this September, it is important to consider the current challenges and opportunities in enhancing the treatment of Filipino children living with cancer. Over 4,700 children (aged zero to 19 years) are expected to be diagnosed with cancer each year in the Philippines, with leukemia accounting for approximately 49% of childhood cancers, according to the World Health Organization (WHO). Nearly two-thirds (67%) are diagnosed with advanced cancer.
In the Philippines, childhood cancers are associated with a 25%-50% fi ve-year overall survival rate, compared to 80% in many high-income countries, WHO data show. Each year, an estimated 1,700 Filipino children die due to cancer. A recent scienti fi c paper by Columbres, et.
al. revealed that up to 80% of families of Filipino children with cancer may abandon treatment due to the heavy economic burden associated with pediatric cancer care. Published in June 2024 in The Lancet Regional Health Western Pacif i c , the paper entitled “Pediatric cancers and family financial toxicity in the Philippines: insights for Southeast Asia and similarly resourced settings” describes how fi nancial toxicity affects families of pediatric patients with cancer in the country.
As de fi ned, “ fi nancial toxicity” refers to the problems faced by patients and their families in paying for medical care. Columbres, et. al.
identified “myriad barriers” to childhood cancer care in the country, including limited access to oncologists, few pediatric oncology referral centers, variable health literacy and cancer awareness, geographical factors, limited funding, and poor fi nancial security at the baseline for many families. Noting that PhilHealth covers early-stage cancer treatments with limited coverage for more advanced diseases, the authors stressed that the majority of cancer care costs are paid by families of cancer patients; moreover, families of pediatric cancer patients often face higher out-of-pocket expenses compared with adults with cancer. Columbres, et.
al. identified three elements of fi nancial toxicity associated with pediatric cancer care in the country. Direct costs include the cost of treatment and surgery, among others.
Indirect costs include the cost of transportation to treatment centers, lodging during treatment, and parents’ ability to hold a down a job during their child’s treatment. Psychosocial distress may push parents and caregivers to resort to negative coping mechanisms such as self-blame and borrowing money or pawning assets, which may lead to compromised caregiver health and wellbeing. The authors presented several recommendations to mitigate the fi nancial toxicity faced by pediatric cancer patients and their families.
First, equip local clinicians to screen patients and their families for fi nancial toxicity early on in the pediatric cancer treatment course, and guide clinicians regarding available fi nancial toxicity screening resources that have been developed and have shown promise in other low- and middle-income countries (LMICs). These resources include the Comprehensive Score for Financial Toxicity (COST) and Patient-reported Outcome for Fighting Financial Toxicity (PROFFIT). Second, connect families of pediatric cancer patients to free or low-cost fi nancial assistance services such as the Philippine Charity Sweepstakes Office (PCSO) Individual Medical Assistance Program (IMAP), and the Department of Health (DoH) Acute Lymphoblastic Leukemia Medicines Access Program (ALLMAP), among others.
Third, improve concrete financial support by reevaluating the PhilHealth Z-bene fi t package in terms of current usage and areas for improvement, and doubling e ff orts to turn the provisions of the National Integrated Cancer Control Act (NICCA) into material support for childhood cancer patients and their families. Fourth, improve access to pediatric oncology clinical trial participation by expanding recruitment efforts, providing regular updates on the Philippine Health Research Registry, and increasing funding and strengthening pediatric oncology clinical trials to improve access and guide practice guidelines. Lastly, enhance the role of community health workers in care and health education to correct oncology- and treatment-related misconceptions through programs such as the Abot Kamay Ako at ang PSMO (AKAP) Barangay Health Worker (BHW) Training and Workshop online educational course.
Additionally, reduce the burden of the referral pathway from primary to tertiary centers. The passage in 2019 of the NICCA and the Universal Health Coverage (UHC) Act represents a major step in enhancing cancer care in the country. As Columbres, et.
al. rightly pointed out, all that is needed is the full implementation of the two landmark pieces of health legislation in order to provide concrete support and comprehensive benefits to cancer patients and their families. The research-based pharmaceutical industry is dedicated to improving cancer management based on more effective partnerships and collaborative approaches to providing access to healthcare.
We work constantly to adapt R&D and models to improve access to innovative treatments. We believe that the capacity to strengthen health literacy and healthcare workforce must be increased. To address existing health inequities and gaps in cancer care management, palliative care also needs to become more ef fi cient.
Our industry stands with the government and other key stakeholders in ongoing efforts to provide quality cancer care, reduce the burden of cancer, and strengthen the country’s health system by building capacity in policy and research. Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines which represents the biopharmaceutical medicines and vaccines industry in the country.
Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos..
