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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

REGIONAL INITIATIVES

CANCER CONTROL 2015 139

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