IMPROVING AND EXPANDING IMPROVING AND EXPANDING ACCESS TO CARE FOR ACCESS TO CARE FOR CHILDHOOD CANCERCHILDHOOD CANCERIN THE PHILIPPINESIN THE PHILIPPINES

Julius A. Lecciones, MDExecutive Director

Philippine Children’s Medical CenterQuezon Avenue, Quezon City 1100, Philippines

www.pcmc.gov.ph

11th CES Annual ConferenceZamboanga City, 14-16 November 2012

As a pediatric oncology private practitioner…As a pediatric oncology private practitioner…

Saving a child with Saving a child with cancer one patient cancer one patient

at a timeat a time

As PCMC Executive Director…As PCMC Executive Director…

Saving as many children with cancer Saving as many children with cancer in the communityin the community

The story of the The story of the struggles of struggles of

these brave kids these brave kids and their and their

ultimate triumph ultimate triumph against all against all

odds…odds…

……and the story of all those who fought and the story of all those who fought hard for their survival.hard for their survival.

Worldwide, cancer kills Worldwide, cancer kills more than malaria, TB and more than malaria, TB and

HIV combined. HIV combined. In the In the Philippines, cancer ranks Philippines, cancer ranks

33rdrd among the leading among the leading causes of morbidity & causes of morbidity &

mortality mortality

CHILDHOOD CANCER PROBLEM IN THE PHILIPPINES:

3,5003,500 – estimated number of children diagnosed with cancer every year

Leukemia, Lymphoma & Retinoblastoma Leukemia, Lymphoma & Retinoblastoma (cancer of the eye) – most common cancers

Accounts for 60%60% of all childhood cancers among Filipino children

At least 80% At least 80% could be potentially curedcured ….. ….. Only 16-20% Only 16-20% actually attain long-term survivallong-term survival More than 2/3 More than 2/3 late stages at diagnosis

……and therefore receive medical and therefore receive medical attention in the late stages of the attention in the late stages of the

disease… disease…

……when cure is when cure is usually no usually no

longer longer possible.possible.

……or is possible only with intensive and or is possible only with intensive and expensive treatment most could not expensive treatment most could not afford, and usually are not available afford, and usually are not available outside the major centers in Manila.outside the major centers in Manila.

Why are we getting them

at the late stages ???

Barriers to early detection and diagnosisBarriers to early detection and diagnosis

Issues of ignorance Issues of ignorance and/or indifference of and/or indifference of the general publicthe general public

Barriers to early detection and diagnosisBarriers to early detection and diagnosis

Inefficient referral Inefficient referral systemsystem

Barriers to early detection and diagnosisBarriers to early detection and diagnosis

Lack of access to informationLack of access to information

Barriers to early detection and diagnosisBarriers to early detection and diagnosis

Ignorance of Ignorance of available resources available resources for carefor care

Barriers to early detection and diagnosisBarriers to early detection and diagnosis

Low index of Low index of suspicion among suspicion among frontline frontline healthcare healthcare workersworkers

For the 1/3 in early stages, as much as For the 1/3 in early stages, as much as 80% will not continue treatment and 80% will not continue treatment and will be lost to follow up.will be lost to follow up.

Why is there such a high

rate of treatment

abandonment???

Barriers to optimal managementBarriers to optimal management

High cost of treatment High cost of treatment and medical supportand medical support

Barriers to optimal managementBarriers to optimal management

Majority of well-established Majority of well-established cancer centers and specialists are cancer centers and specialists are in Metro Manila, Cebu and Davaoin Metro Manila, Cebu and Davao

Geographical inequity, where rural and isolated communities receive less and lower quality health services, and socioeconomic inequity, when the poor do not receive health services due to inaccessibility and non-affordability issues

Only 1000 children out of 3500 will be diagnosed and cared for: Concentration of resources in Metro Manila Less developed in the provinces, particularly in

public hospitals

ACCESS PROBLEM:

No Pediatric Oncology referral unit - children are seen in many hospitals (public/ private); all benefit from the same highly qualified specialists as consultants.

The gap between private and public is huge: paying patients will benefit from up-to-date and high quality facilities and treatment while the poor will have difficulties to afford care and treatment. The civil society try to fill-in this gap but this support is not sufficient. Cost remains the main barrier

ACCESS PROBLEM:

Almost all will not Almost all will not survive their first survive their first

year with the year with the disease.disease.

The poor will not The poor will not opt for treatment opt for treatment

anymore.anymore.

Staggering amount of pain and suffering Staggering amount of pain and suffering of children, and despair and of children, and despair and

hopelessness of parentshopelessness of parents

No one can bear doing nothing of the No one can bear doing nothing of the situation.situation.

Anak ko, Buhay ko, Pananagutan koMy Child, My Life, My Responsibility

MY CHILD MATTERS PHILIPPINES

We will go out of PCMC and find these patients even before they come to the

hospital

Synthesis of potential leversSynthesis of potential levers

1st symptoms Diagnosis Treatment Follow-up1st consultation

• At least 2 cases out of 3 are not diagnosed

• If diagnosed, only at a stage where curative treatment is more difficult

• Gold standards available but not standardized

• Strongly modified for charity patients

• Quality of life can still be improved

• Lack of baseline data

• Low survival rates for charity patients

ISSUES

Training frontliners

Building a referral network

Setting-up practice guidelines

Providing funding solutionsProviding reliable epidemiological data

Providing information and support for families

Setting-up reference protocols

Fostering palliative care

LEVERS

Reducing the cost of treatment

Expanding Access To Treatment And Improving Care To Filipino Children with Cancer

1 GENERAL OBJECTIVE

IMPROVEMENT OF THE SURVIVAL RATE OF CHILDHOOD CANCER IN THE PHILIPPINES

Improving Quality Of Care Nationwide

Developing A Strong Referral

Network

Establishing Epidemiological

Research to Guide Future Planning

3 AXES FOR ACTIONS

My Child Matters Philippines Program

MY CHILD MATTERS PROGRAM:

National public awareness campaign that childhood cancer is curable if detected early and treated effectively

Community mobilization and advocacy to bring the issue in the forefront of public agenda

Organize the different sectors to collaborate so that concrete actions can be taken

Focus on solutions to barriers to effective childhood cancer control and management program

PUBLIC AWARENESS: MEDIA CAMPAIGNS

PUBLIC AWARENESS: PRINT MEDIA

COMMUNITY MOBILIZATION

BUILDING PARTNERS

Involved 20 Involved 20 pediatric pediatric

oncologists in 13 oncologists in 13 participating participating

hospitalshospitals

Dr. Marieleise AfableDr. Miriam Quimpo

Dr. Alvin BalatbatDr. Jane Stewart

Dr. Cynthia Melicor

Dr. Lydia Ramirez

Dr. Marita Mimay

Dr. Mae Conception Dolendo

Dr. Maria Victoria Dela Cruz

Dr. Bernadela Sancover

Dr. Vincent AlbaDr. Genaro BermudezDr. Aliw Paulino

Dr. Enriquetta Salvador

Dr. Tess Fajardo

Dr. Kathy Pascual

Dr. Enriquetta Salvador

Dr. Lita Fe Paclibar

Dr. Crispin DalisayDr. Jo Ann Gomez

GraduatesFellow

NATIONAL REFERRAL NETWORK

My Child Matters PhilippinesMy Child Matters PhilippinesImprove survival of Filipino children with Improve survival of Filipino children with

cancercancer

Chemotherapy Provider CoursesChemotherapy Provider Courses

Trained 208 nurses and medical residents from 24 hospitals

My Child Matters PhilippinesMy Child Matters PhilippinesImprove survival of Filipino children with Improve survival of Filipino children with

cancercancer

Unified Leukemia ProtocolUnified Leukemia Protocol

Requires at least PhP 185,690 per child

A Locally-Developed Uniform Protocol for the Treatment of Acute Lymphocytic Leukemia in Filipino Children

PEDIATRIC CANCER AND HEMATOLOGY CENTER AT THE PHILIPPINE CHILDREN’S

MEDICAL CENTER

DOH-NCPAM ALLMAP

CHEAP TO FREE CHEMOTHERAPY

DRUGS TO SERVICE PATIENTS

Pediatric Oncology Network Organized by My Child Matters Philippines with PCMC-Trained Pediatric

Oncologists as the Back Bone of the System

Ma. Victoria Dela Cruz, MDCagayan Valley Sanitarium and

Hospital

Ma. Victoria Abesamis, MDJoseph Vincent Alba, MD

Maria Cecilia Leongson-Cruz, MC

Reynaldo De Castro, MDRosemarie Fajardo. MD

Beatriz Gepte, MDJulius Lecciones, MDEustacia Rigor, MD

Michelle Rodriguez, MDPhilippine Children’s Medical

CenterKathyrine Pascual,

MDClinica Pascual,

TarlacMaileen Roa, MD

Aliw Paulino, MDCecilia Fernandez,

MD

Jo Ann Gomez, MDPediacare Clinic, General Santos

City

Shiela Marie Flores, MDSilliman Medical Center, Dumaguete

City

Chang Melicor, MD

Ma. Lita Fe Paclibar, MDWestern Visayas

Regional Medical Center

Ma. Enriqueta Salvador, MDMary Mediatrix Medical

CenterBatangas

Genaro Bermudez, MDAmy Goleta-Dy, MDPacita Lopez, MD

St. Luke’s Medical Center

Marieleise Afable, MDWorld Citi Medical

Center

Ma. Teresa S. Fajardo, MD

Cabanatuan

Crispin Dalisay, MD

Expansion to

35 pediatric oncologists

in 24

participating hospitals where free

chemo drugs are available

PHILHEALTH Z-PACKAGE FOR LEUKEMIA

Catastrophic disease insurance package

Increased reimbursements of up to PhP 210k for three years of treatment

Patients need to commit to finish treatment

RESULTS OFTHE LAST SIX YEARS

Late diagnosis reduced to 30% from 70%

Treatment abandonment rate decreased to only 10% from 80%

2-year survival rate increased to 68% from 16%

The children can now expect to have not The children can now expect to have not just one Christmas or two, but as many just one Christmas or two, but as many

as everybody else.as everybody else.

A CESO as a public servant A CESO as a public servant makes a difference in people’s makes a difference in people’s

lives.lives.