By Teodoro B. Padilla
Almost half (48%) of households in ASEAN countries with a member newly diagnosed with cancer faced financial catastrophe within the first year of seeking care, according to the Association of Southeast Asian Nations Costs in Oncology. The ASEAN region consists primarily of low- and middle-income countries, including the Philippines. It found that significant contributors to the risk of financial catastrophe for patients were belonging to the low-income bracket and lack of health insurance.
In 2012, the Philippine Health Insurance Corp. (PhilHealth) launched its Z Benefits Package to help Filipinos avert financial catastrophe by reducing household out-of-pocket healthcare costs, especially for catastrophic illnesses such as heart attack, stroke and cancer. Included in the package are payment for hospital services such as hospital room and board fees, drugs and laboratory exams, operating room and professional fees for the entire course of treatment, including mandatory and other services required per illness.
PhilHealth also established the Z Benefits Package for patients with colorectal cancer to finance standard of care treatment of Filipino patients with early-stage or locally invasive colon or rectal cancer (stages I to III), particularly those who cannot afford to pay for their care. Patients enrolled in this package receive care through a multidisciplinary specialist team composed of medical oncologists, colorectal surgeons, radiation oncologists and diagnostic radiologists. The team holds weekly conferences to plan for patient care and assess outcomes of ongoing therapy.
Most colorectal cancers start as polyps, according to the Healthy Pilipinas website, the flagship digital asset of the Department of Health for medically verified health information. These polyps can change into cancer over time. It says not all polyps become cancer. Once they become cancerous, they can then travel to nearby lymph nodes or to distant parts of the body. The US Centers for Disease Prevention and Control (CDC) adds that screening tests can find polyps so they can be removed before turning into cancer. Screening also helps find colorectal cancer at an early stage, when treatment works best.
The Philippine General Hospital (PGH) has been the pilot site to implement the Z Benefits Package for colorectal cancer since 2016 under which patients receive fully subsidized treatment. Authors Frederic Ivan L. Ting and Danielle Benedict L. Sacdalan from the PGH Colorectal Polyp and Cancer Study Group reviewed data to determine the treatment outcomes of 251 patients enrolled in the Z Package program for colorectal cancer from 2016 to 2018.
The average age of the patients was 57 years old and majority (66%) were male, had rectal cancer (78%), and were diagnosed with stage III disease (82%). Most (75%) were compliant with their treatment plans and clinic follow-up. Ninety percent underwent the prescribed surgery, 77% had chemotherapy and 96% received radiation treatment. Recurrence, morbidity and mortality rates were relatively low at 17%, 22%, and 19%, respectively. Patients had a two- and three-year survival probability of 74% and 70%, respectively, which are comparable with data from more developed nations.
“Our study shows that when the highest standards of patient care are provided through a multidisciplinary team, patients’ overall survival is also maximized,” the researchers said. “It also shows that a national insurance program that [helps patients access] the highest standards of care is essential.”
With early detection and optimal treatment and follow-up, colorectal cancer is highly treatable and often curable. “Appropriate follow-up improves [treatment] outcomes as patients who have been lost to follow-up after initial work-up and treatment return [to the clinic] later with more advanced disease, if they come back to their physician at all,” wrote Sacdalan and others in their 2020 study that aimed to identify patient-specified factors that contribute to continued follow-up at the PGH Colorectal Multidisciplinary Clinic.
The researchers asked 128 patients at the clinic to answer a questionnaire designed to identify factors that the patients felt contributed to their continued follow-up at the clinic. The respondents identified trust in their attending physician, adequacy of family support during treatment and affordability of treatment at the clinic as the top three factors that influenced continued follow-up.
As the country observes National Colorectal Cancer Awareness Month, the full implementation and funding of the National Integrated Cancer Control Act can deliver on the landmark law’s promise to give cancer patients access to optimal healthcare services and provide their families with emotional, physical and financial risk protection, among others.
Teodoro B. Padilla is the executive director of the Pharmaceutical and Healthcare Association of the Philippines, which represents the biopharmaceutical medicine and vaccine industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.