PAEDIATRIC CANCERS
‰ multidisciplinary rounds; diagnoses to 30–40% from baseline of 70%2. The current
‰ blood transfusion committee meetings. referral and treatment network of 39 paediatric oncologists
made subspecialty care nationally available particularly to
Thus, the training programme became the nidus in which the poorer patients outside of Metro Manila, reaching an annual
basic structures were organized for treating patients average of 2,553 patient beneficiaries to date from a
comprehensively and holistically, i.e. 1) the provision for baseline of only about 10001,2. The treatment abandonment
inpatient wards and outpatient clinics; 2) pathology and rate was brought down to 10% from a baseline of 80%, and
laboratory services; 3) imaging procedures and radiotherapy the currently available two-year survival rate for childhood
services; 4) paediatric surgery; 5) pain and palliative care; 6) leukaemia based on hospital-based data from participating
multidisciplinary teams that included paediatric oncology hospitals improved to 68% from a baseline of only 16%2. To
nurses, social workers, oncology pharmacists and clinical further expand services to as many places of the country
nutritionists, and; 7) infection control and management. without paediatric oncologists, PCMC has now increased
The implementation of a demonstration project at PCMC in the number of clinical fellows entering the first year in the
2006, as part of the Sanofi-Aventis and UICC My Child training programme to four from an initial two, which
Matters (MCM) programme in partnership with the together with one from the UP–PGH are expected to
International Network for Cancer Treatment and Research provide in the next ten years for an adequate number
(INCTR), was another milestone for further development. The necessary for the manpower needs of the country for
goal was to create public awareness about the curability of paediatric oncologists who will practice in underserved
childhood cancer, particularly childhood leukaemia, and areas outside the NCR.
implement community mobilization campaigns. It focused A more recent developmental milestone is the active
public attention to address delays in diagnosis and high involvement of government. In 2008, the Department of
treatment abandonment rates that were mainly responsible Health (DOH) designated PCMC as the national end-referral
for poor survival rates of childhood cancer in the Philippines cancer centre for children, later providing funds for the
postulated to be at 10%1. The ultimate objective was to construction of a cancer centre facility, which started early in
improve survival rates of leukaemia, the most common type of 2012. In 2011, the DOH’s National Center for Pharmaceutical
childhood cancer in the Philippines accounting for at least 60% Access and Management (NCPAM) partnered with PCMC and
2
of cases , to at least 50% in five years. The strategy was to: MCM in the implementation of its Acute Lymphocytic
‰ train frontline physicians in early cancer detection; Leukemia Medicines Assistance Program (ALLMAP), which
‰ develop capabilities for satellite treatment units outside provided free chemotherapy drugs to indigent patients, funds
of the National Capital Region (NCR); for the establishment of a data registry, and for the training of
‰ address the affordability issues of chemotherapy mainly health care professionals directly involved in childhood cancer
responsible for high treatment abandonment rates. management. In June 2012, the participating hospitals in the
MCM referral network expanded to 24 government and
The graduates of the training programmes of both UP–PGH privately-owned hospitals from the original 13, which are all
and PCMC, particularly those who returned to the provinces, recipients of the NCPAM’s ALLMAP and selected on the basis
were crucial in the organization of a national referral network of the presence of paediatric haematologists-oncologists in
of initially 13 participating hospitals spread out in five regional those hospitals.
catchment areas. Based on two regional population-based Likewise in July 2012, Philhealth, the national social
studies conducted by the Department of Health and the insurance system, launched the Z-package intended for
Philippine Cancer Society, respectively, with a current catastrophic illnesses, which included childhood acute
estimated annual incidence of paediatric cancer (age <15 lymphocytic leukaemia (ALL). PCMC assisted Philhealth in the
years) of 115 cases per million1,3 in a country with 31 million crafting of the benefit package and the implementing
children (age <15 years) spread out to 7,107 islands, the guidelines. Requirements for insurance reimbursements are:
network resulted in improved access to care; geographic ‰ use of any of PSPO-determined standard treatment
considerations being a major obstacle for prompt diagnosis protocols;
and treatment where specialists and facilities are mainly ‰ presence of basic structures in collaborating hospitals for
concentrated in Metro Manila. accurate diagnosis, and safe administration of
Within five years of the MCM programme, national public chemotherapy;
awareness campaigns brought down the number of late ‰ effective management of treatment side effects.
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