actually attains long-term survival (11). In our experience for
many years, two-thirds of patients are in advanced stages of
their cancer at the time of diagnosis. This is because
childhood cancer in the Philippines is not detected early
enough for a cure to be possible.
Obstacles to early diagnosis and effective
treatment
Obstacles to early detection and effective management of
childhood cancer in the Philippines are the following: 1)
subtle signs are not recognized promptly by frontline
physicians at the primary levels of care; 2) patients and/or
parents delay medical consultations, or when diagnosed will
not opt for treatment, and; 3) for those who seek medical
attention, there is no appropriate cancer treatment facility
in the locality, or the parents do not know where to go to
seek treatment. Due to financial reasons, those who are
positively diagnosed to have cancer are not treated
adequately with only one in five patients receiving gold
standard treatment, mostly as paying patients (11).
Thus, for the majority of paediatric patients with cancer in
the Philippines, no treatment is given, or patients are initially
treated but end up abandoning the treatment due to: 1)
geographic inequity with cancer treatment facilities heavily
concentrated in major cities, far and inaccessible to many
patients, and 2) economic inequity when the majority cannot
afford the costly treatment. There is a huge gap between the
rich and the poorer patients. The cost of chemotherapy
drugs and other supportive medicines remains the main
barrier for the poorer service patients.
Three main reasons can account for these dismal
observations. First, two-thirds of patients come to medical
attention when the disease has reached an advanced stage
such that a cure is no longer possible, or require very
aggressive and expensive treatments that are available only
in hospitals in cities. Second, more often than not, families
will opt not to undergo further treatment, or to receive
palliative or supportive care for their patients due to
financial constraints. And third, out of the 20% to 30% of
children diagnosed at an early stage, a significant percentage
(80%) are unable to continue follow-up visits or
hospitalization (11).
The paediatric oncologists, numbering only about 39 all
over the country, as well as a greater number of
haematologists, are fully aware of these conditions facing
Filipino cancer victims under their care. Hopelessness
usually prevails in many affected families. Additionally,
stakeholders are not effectively mobilized to ensure that
strategies to control childhood cancer are targeted at those
who are most in need, and major stakeholder groups were
not considered in the development of effective cancer
control strategies. This includes encouraging and pushing
government to implement measures addressing issues of
inequities of and poor access to cancer care.
The Philippine National Cancer Control Program
The Philippine Cancer Control Program (PCCP), which
started in 1988, is an integrated approach utilizing primary,
secondary and tertiary prevention in different regions of the
country at both hospital and community levels. The goal is to
establish and maintain a system that integrates scientific
progress and its practical applications into a comprehensive
programme that will reduce cancer morbidity and mortality
in the Philippines. The six pillars of the PCCP are: 1)
epidemiology and research; 2) public information and health
education; 3) prevention and early detection; 4) treatment;
5) training; and 6) pain relief (4).
Unfortunately, there is hardly any strategy directed
specifically for childhood cancer. The PCCP is primarily
focused on the top adult cancer sites whose major causes are
known (where action can therefore be taken for primary
prevention), such as cancers of the lung/larynx (antismoking
campaigns), liver (vaccination against hepatitis B
virus), cervix (safe sex), and colon/rectum/stomach (healthy
diet) (4). No strategy for early detection of childhood cancer
had been included in the national programme, nor are there
plans on how effective treatment in children could be
implemented.
This is probably because of the unfortunate notion that
childhood cancer is a small proportion of the total data and
therefore considered unimportant - a notion that is no
longer tenable when viewed within the broader global
context, and in how the disease affects the whole family in
terms of major psychosocial disruptions, the broader
economic issues of the disease, the prevailing human rights
which should be accorded to children with this tragic malady,
and the potentially high cure rates of cancer in children than
in adults.
In 1996, the Asian Development Bank (ADB) working with
the Department of Health (DoH) undertook the Philippine
Adult Health Project, which assessed prevention and control
efforts for cancer in the Philippines (12). The audit confirmed
that mortality from cancer had increased substantially over
time and was likely to continue increasing. Significant
shortcomings in six areas were identified: 1) existing data
and data gaps; 2) programmatic efforts, gaps and problems;
3) medical education; 4) policy issues; 5) treatment
guidelines and problems; and 6) quality control of testing
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CANCER CONTROL 2015 139