Topic: Sakit Pangmayaman – The Burdens of Costs

of Having Cancer Treatment and Diagnosis in the

Philippines

I. Objectives

The lecture aimed to:

1. Provide basic information about cancer.
2. Identify and emphasize the roles of pharmacists in improving the health of cancer patients.
3. Identify the burdens of costs of cancer treatment and diagnosis in the Philippines.
4. Enumerate government programs for cancer awareness, diagnosis, and treatment.

II. Basic Information About Cancer

A. Definition
According to the WHO (World Health Organization), cancer is the is the uncontrolled growth and
spread of cells. It can affect almost any part of the body. The growths often invade surrounding
tissue and can metastasize to distant sites. Many cancers can be prevented by avoiding
exposure to common risk factors, such as tobacco smoke. In addition, a significant proportion of
cancers can be cured, by surgery, radiotherapy or chemotherapy, especially if they are detected
early.

B. Cancer Statistics
a. Worldwide
 8.8 million deaths in 2015
 2nd Leading Cause of Death – in the United States.
 3rd most expensive to treat
 High Case Fatality
 1 out of 6 deaths worldwide is due to cancer.
 50-60% of deaths are from low- to middle-income countries.
b. Philippines
 7 adults every hour and 8 children every day dies of cancer.
 Lung cancer – leading type for males.
 Breast Cancer – leading cause for females.
 Metro Manila has the highest incidence rate.
 98,200 new cases per year.
 59,000 Filipinos die each year.
 Figure 1. WHO List of Breast Cancer Incidence and Mortality in 11 countries/Regions in 2012.

Figure 2. Number of New Cases for 10 Most Common Cancers in 2015, both Sexes, and
Corresponding Number of New Deaths (GLOBOCAN 2012)
III. Burdens of Having Cancer
A. Financial
The Cost of Cancer treatment and diagnosis is very high due to it’s high cost of research and
development and additional cost on management of side effects. The total estimated economic
cost of cancer in 2010 is about 1.16 trillion US dollars. Direct Medical and Non-medical Costs
are incurred In this type of burden.

B. Geographical
Primary Health Care facilities such as Municipal Health Centers are the most accessible health
establishments to patients. However, they don’t often offer cancer diagnosis and treatment
services. Patients are often referred to secondary or tertiary care institutions which are located
mostly in cities, commonly in Metro Manila. The Philippines being an archipelago, this will incur
a lot of direct non-medical costs to patients and their families.

C. Emotional
With cancer, there comes fear, anxiety and even depression that can affect both patients and
their families. Fear of finances, fear of recurrence, and fear of losing a loved one. Those
affected can incur productivity loss and when viewed in a larger scale can affect the economy
of the country.

IV. The Burden of Cancer Costs in the Philippines

Cancer is referred to by many as “Sakit Pangmayaman”.

“Sakit Pangmayaman” or “Disease of Affluence” often refers to diseases that are more common
in Western and/or industrialized countries. Same is true in the Philippines, the more industrialized
Metro Manila has the highest rate of cancer incidence and mortality as compared to any other
provinces.

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 A B

Figure 3. Map Showing the Age Standardized Incidence rates of Lung (A) and Breast (B) Cancer
in Males (A) and Females (B), from 2003 to 2007.

Our country has a relatively poor health care coverage due poor implementation of Insurance
Programs, Corruption, and Poverty. According to the 2005-2007 preliminary estimates of the
Philippine National Health Accounts (PNHA) released by the National Statistical Coordination
Board (NSCB) more than 80% of Philippine families cannot afford out-of-pocket expenses needed
for basic medical care. What more for the expensive cancer treatment?

Private out-of-pocket expenditure in 2007 was 54.3% of total health expenditure, with government
contributing 13.0% and local government units (LGUs) contributing 13.3%. The share of Social
Insurance was 8.5%, down from 9.8% in 2005.

The Philippines is also poverty-stricken. In 2015 (National Statistics Office):

The average monthly family income of Filipino families is 22 thousand pesos
AVERAGE annual family income of Filipino families = 267 thousand pesos
AVERAGE annual family expenditure = 215 thousand pesos
AVERAGE annual family savings = 52 thousand pesos

Comparing these data to the current costs of cancer treatment and diagnosis – it is very
worrisome. Within these families there might be a dilemma between allocating the
money to treat the disease or use it to feed the family.

Table 1.

Current Costs if Common Cancer Treatment Regimen and Diagnostic Procedures in the
Philippines

DIAGNOSIS
PROCEDURE Common Philippine PRICES (Php)
BIOPSY 200-700
X-RAY 150 and up

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 MRI 7,000 and up
CT SCAN 2,500 and up
TREAMENT
PROCEDURE Average PRICE in Pesos
1. Taxol (Paclitaxel) – P42,000 per session
2. Granulokine (Filgrastim) – P7,000 per 300mg vial
4. Other expenses (room, professional fee, etc.) – P36,000 per
CHEMOTHERAPY
session
3. Oral Chemotherapy – 90,000 to 120,000
4. Herceptin – 41,600 per 150 mg vial
1. radiotherapy (P3,000.00/session)
2. chemoradiation with cobalt and brachytherapy (low dose) for
cervical cancer stage IA1, IA2 – IIA1 (P120,000.00/case)
3. chemoradiation with linear accelerator and brachytherapy
(high dose) for cervical cancer (P175,000.00/case)
RADIOTHERAPY
4. radiotherapy using linear accelerator for rectal cancer stage
II-III (P400,000/case)
5. radiation therapy for breast cancer stage 0 to III-A
(P100,000.00/case)
6. low to intermediate risk prostate cancer (P100,000.00/case)
VARIES

NATURAL/ALTERNATIVE Involves:
MEDICINE Dietary Changes  Vegetarian; sometimes ketogenic
Food supplements  “No approved Therapeutic Claims” ;
Sometimes almost the same price as chemotherapy.
100,000 pesos
Surgery
Depending on Type and Stages of Cancer

V. The Roles of Pharmacists

A. Patient Guidance
1. Give them hope:
a. EARLY DIAGNOSIS
b. Chemo is not Poison
2. Refer them to Financial Assistance Programs
a. Government Programs
i. Department of Health

Philippines Cancer Control Program through the Administrative

Order No. 89-A s. 1990

National Cancer Prevention and Control Action Plan 2015-2020

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 ii. Philippines Charity Sweepstakes Office (PCSO)
Individual Medical Assistance Program (IMAP)
Covers:
1. Confinement
2. Laboratory Diagnostic Procedures
3. Chemotherapy Drugs
4. Others (stated in Implementing Rules and Regulations)

Go to affiliated hospitals or PCSO offices

Prepare the following requirements:
1. Treatment Protocol
2. Prescription
3. Clinical Abstract
4. Biopsy Result
5. Letter of request addressed to the director of PCSO

iii. Philippines Health Insurance Corporation (PhilHEALTH)

Philhealth Circular No. 35 s. 2013 – states the

Implementing Guidelines on Medical and Procedure
Case Rates

Requirements:
1. Valid PhilHealth Membership ID (monthly contributions are monitored)
2. Accomplished Claim Forms
3. Valid IDs

iv. Senate of the Philippines

The following list of senators offers assistance to any patients from ANY
GOVERNMENT HOSPITAL under the Department of Health. Patients must
prepare the following documents:
1. Prescription
2. Laboratory Results
3. Social Case Study
4. Clinical Abstract
5. Treatment Protocol
6. Certificate of Indigency
7. Endorsement letter from the hospital
8. Billing from the hospital
9. Identification card of the patient and requester
10. Personal letter addressed to the Senator.

v. House of Representatives

The House of Representatives offers assistance to patients from NATIONAL

KIDNEY AND TRANSPLANT INSTITUTE, EAST AVENUE MEDICAL CENTER,
and PHILIPPINE HEART CENTER. Patients must prepare the following
documents:
1. Medical Certificate
2. Prescription

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 3. Social Case Study
4. Clinical Abstract
5. Treatment Protocol
6. Certificate of Indigency

You may pass these documents at Constitutional Hills, Quezon City every
MONDAY (8am-5pm). For further inquiries you may call the following numbers:

House of Representatives: 931-5001

National Kidney and Transplant Institute: (63) (2) 981-0300, 981-0400
East Avenue Medical Center: (632) 928-0611
Philippine Heart Center: (632) 925-2401

b. Private Institutions
i. Philippine Cancer Society, Inc. (PCSI)

ii. GMA KAPUSO FOUNDATION

GMA Kapuso Foundation offers assistance to patient age 0-18 years old from
ANY GOVERNMENT HOSPITALS. Patient must prepare the following
documents:
1. Medical Certificate/Clinical Abstract
2. Social Case Study
3. Treatment Protocol
For more details, you may call their landline 928-4299 or you can go to 2/F
Kapuso Center Samar St. Cor. Jamboree St. Diliman, Quezon City.

iii. ABS-CBN TULONG CENTER

ABS-CBN Tulong Center offers assistance to patients from any government
hospitals. Patients must prepare the following documents:
1. Medical Abstract (Updated)
2. Prescription/Laboratory Request
3. Laboratory Results
4. Social Case Study
5. Referral from the hospital
You can pass these requirements at ABS-CBN Center Road, Mo. Ignacia St. in
Quezon City or you may also call their landline 414-1296/414—5431

iv. ST. JOHN THE BAPTIST PARISH/QUIAPO CHURCH

St. John the Baptist Parish only offers MEDICAL ASSISTANCE. Patients must
submit the following requirements:
1. Clinical Abstract
2. Prescription
3. Social Indigency
4. Barangay Certificate
5. Identification card of the patient and the immediate family accompanying them
You can pass the following requirements every TUESDAY-FRIDAY (9AM).

B. Treatment Management
Our drug expertise is very important in improving clinical outcomes in cancer patients. Patient
counseling is essential for patients especially if they have other pre-existing conditions and
exposure to risk factors. Proper treatment management and reporting of Adverse Drug Events can
also help improve the quality of treatment and can possibly prolong patients lives even more.

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 C. Research and Development
Despite years of research and development, it is undeniable that we still don’t know that much
about cancer. We still don’t have the perfect pill to cure cancer. Continuous research and
development is much needed as cancer continuously claim more and more lives.

Possible aspects on Research and Development:

i. Drug discovery – discovery or synthesis of new compounds
ii. Improvement of Dosage forms – for a more target-specific or localized action of
chemotherapy drugs that can reduce their side effects. e.g Nanoparticle (Aurimune)
iii. Understanding the Pathophysiology of the disease – e.g. finding target sites

D. Cancer Awareness Promotion

Advocacies:
Early Diagnosis and Treatment
Visual Inspection in Acetic Acid or VIA for Cervical Cancer Screening
Human Papilloma Virus (HPV) Vaccination
Self-Breast Examination (women 30 years and older)

Figure 4. Cancer Awareness Ribbons

If you are interested to volunteer, visit the Philippine Cancer Society, Inc. Website.
E. Advocating Mental Health Care
Listen and empathize with them.

F. Pushing for Better Treatment Options

1. Universal Health Care

The main national health insurance provider, PhilHealth, in cooperation with local government units,
has been steadily increasing the enrolment of indigent families, and aiming to insure a large portion
of indigent families and the self-employed, particularly starting but slow during the immediate past
year or so with the advent of the Universal Health Law and Sin Tax Law.

The Universal Health Care Bill is a bill that seeks to ensure that every Filipino citizen is entitled to
healthy living, working, schooling conditions and access to a comprehensive set of health services
without financial hardships. Some of its features include simplifying PhilHealth membership,
redirecting its operation towards enhancing national and regional health insurance system and
improve population coverage.

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 Pharmacists can help in advocating, formulating, and implementing these policies. Simplifying
finances for health coverage into one institution will reduce the amount of red tape needed and can
reduce the burden to patients.

In the meantime, as compared to our neighboring Asian countries such as India and Indonesia we
are not that far behind in terms of healthcare coverage. The percentage of out-of-pocket
expenditure over the total expenditure on health in the Philippines is around 53.7%, in Indonesia is
46.9%, and India is 62.4%. United States of America and Canada is leading when it comes to
healthcare coverage with only 11.1% and 14.6% out-of-pocket expenditure respectively.

2. Health Technology Assessment and Pharmacoeconomic Evaluations

Due to continuous research and development, and the generation of more and more generic
counterparts of drugs. Screening and evaluation of the cost and benefits of these drugs are
needed.

Cost-Utility Analysis
Example:
Paclitaxel/Cisplatin (US) – ICUR: $US 18,200 or ₱950,000 per Quality Adjusted Life Years
Trastuzumab (UK) – ICUR: £18,000 or ₱1,315,728.18 per additional QALY

VI. Question and Answer Portion

A. What can pharmacists do to help improve health care coverage in the country?
Refer to section on Universal Health Care.
B. There is a really high amount of red tape required in order to avail health care coverage, is budget
really the problem?
In out Public Health class, Mr. Roderick L. Salenga, has presented the following graphs from the
WHO OECD Health Statistics:

Figure 5. Pharmaceutical Expenditure as a Share of Total Expenditure on Health per Capita,

2014

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 Figure 6. Government Share of Pharmaceutical Expenditure, 2010-2014

Figure 5 shows that Philippines allocates a greater fraction of the health budget to drugs as
compared to other countries Asian and Pacific. It ranks no.5 according to the graph, however in
Figure no. 6 our country is 2nd last in the list when in comes to government coverage of
pharmaceutical expenditure. As emphasized by Sir Salenga, in the Philippines budget is not the
root cause of the problem it is poor implementation and corruption.

When UHC bill is passed it is expected that the amount of red tape for health insurance will reduce
and PhilHealth will cover even non-contributory member such as indigents. When the red tape is
reduced – Filipinos will not need to prove that they are “poor” in order to avail the cancer care.

VII. References

Cytimmune. (n.d.) Aurimune: A Nanomedicine Platform. Retrieved April 20, 2018, from
[http://www.cytimmune.com]
Department of Health. (n.d.). Universal Health Care. Retrieved April 20, 2018, from
[http://www.doh.gov.ph/universal-health-care]
Department of Health. (n.d.). Universal Health Care Bill. Retrieved April 20, 2018, from
[http://www.doh.gov.ph/node/10646]
Department of Health. (2017). The Philippine Drug Price Reference Index (5th ed.). DOH.
Philippines.
Department of Health. (n.d.). Philippine Cancer Control Program. Retrieved April 20, 2018, from
[http://www.doh.gov.ph/philippine-cancer-control-program]
Fukuda, T. Ph.D. (2008). Pharmacoeconomics of Trastuzumab (Herceptin ®). Retrieved April 20,
2018, from [https://www.chugai-pharm.co.jp/html/meeting/pdf/080303eFukuda.pdf]
International Agency for Research on Cancer. (2012). GLOBOCAN 2012: Estimated Cancer
Incidence, Mortality, and Prevalence Worldwide. France.
Laudico, A. V., et.al. (2015) 2015 Philippine Cancer Facts and Estimates.
Philippine Cancer Society. Manila.

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 Philippine Cancer Society. (2014). Find Medical Assistance. Retrieved April 20,
2018 from [http://www.philcancer.org.ph/find -medical-assistance-2/].
Philippine Cancer Society. (2014). Cancer Prevention Guidelines. Retrieved April
20, 2018 from [http://www.philcancer.org.ph/learn -about-cancer/cancer-
prevention-guidelines/].
World Health Organization. (2015). 2015 Global Survey on Health Technology Assessment by
National Authorities . Retrieved April 20, 2018 from [http://www.who.int/health-technology-
assessment/country-profile/htaph.pdf]
WHO and Organisation for Economic Co-operation and Development. (2018). OECD Health
Statistics 2017. Retrieved April 20, 2018, from
[http://stats.oecd.org/Index.aspx?DataSetCode=SHA]
Young, M. and Plosker, G.L. (2001). Paclitaxel: a pharmacoeconomic review of its use in the
treatment of ovarian cancer. Retrieved April 20, 2018, from
[https://www.ncbi.nlm.nih.gov/pubmed/11772158]