Curbing the catastrophic costs of cancer treatment

Isay Reyes, ABS-CBN News

Posted at May 01 2019 01:47 PM

Different cancer institutions join hands during a press conference at the Cancer Congress for Patients and Survivors.

MANILA – Erika Mandanas, daughter of an ovarian cancer patient, recalled how financially challenging it was for them to go through her mother's cancer treatment. 

Her mother, Erly Mandanas, battled ovarian cancer for 6 years before she passed away last July 26, 2016. 

Before her death, the family spent 100,000 pesos per cycle of chemotherapy every three weeks; 20,000 pesos for oral medications per month; and more or less 100,000 pesos for a series of diagnostic tests to monitor the progress of her medications. 

Total cost of chemotherapy treatments for the entire duration: 5 million pesos.

"Mahirap talaga financially pag may cancer ang kapamilya. Napaka hirap ng financials kahit may kaya pa," Mandanas said.

Mandanas’ story is just one example of how much families spend in the Philippines when a family member is diagnosed with cancer.

The Philippines is among the highest in terms of out of pocket cost for cancer treatment, the Philippine Cancer Society said. Health authorities said a cancer patient should only spend less than 25% for cancer treatment expenses while the rest should be shouldered by government. 

To address the growing number of cancer patients in the Philippines and the need to provide for them, President Rodrigo Duterte signed Republic Act 11215 or the National Integrated Cancer Control Act on February 19, 2019.

Mandanas said she hopes the new law would help more Filipinos survive the catastrophic costs of cancer.

"Big help talaga 'yan para sa lahat kasi hindi na iisipin kung saan kukuha ng pambayad sa mga gamot at chemotherapy," she said.

CANCER CASES 

According to the World Health Organization, the number of cancer cases in the Philippines in 2018 was at 141,021 with total deaths at 86, 337.

Breast cancer has the highest incidence rate at 24,798 affecting all female patients. Meanwhile for males, lung cancer has the highest incidence at 12,086.

Total of cancer incidents for both sexes are as follows: 

Breast Cancer - 24,798 
Lung Cancer - 17, 255
Prostate Cancer - 7, 290
Liver Cancer - 9,628 
Other Cancers - 66,370 

Number of new cases in 2018 for males

Lung Cancer - 12,086
Colorectum Cancer - 8, 791
Prostate Cancer - 7,290 
Liver Cancer - 6,848
Leukaemia - 3,088

Other cancers - 23,899 

Number of new cases in 2018 for females 

Breast Cancer - 24,798
Cervix uteri Cancer - 7,190
Colorectum Cancer - 6,889
Lung Cancer - 5,169
Ovarian Cancer - 5,069
Other cancers - 29,904

Under RA 11215, cancer patients and survivors will be classified as PWD or Persons with Disabilities. The new law also mandates the construction of Philippine Cancer Center and the creation of a Cancer Council.

People who are cancer patients and survivors will be receiving the same benefits intended for persons with disabilities. They will all receive the same 20% discount and exemption from the value added tax on the sale of certain goods and services. 

The Philippine Cancer Center will be a government owned and controlled corporation similar to National Kidney Institute, Lung Center of the Philippines, and the Philippine Heart Center.

The cancer council, meanwhile, will be aggressive in campaigning for awareness and prevention of cancer. 

Under the new law, funds will be allocated for a medical assistance program. "Kapag sinabi yung medical assistance program, kasama 'yung diagnostics and therapeutics ng pasyente. So talagang walang out of pocket ang pasyente. And then medicines access, purely systemic treatment," the health department's Clarito Cairo said. 

Cairo added cancer funding will be included in the yearly budget appropriations including some from sin tax revenues.

PHILIPPINE CANCER CENTER 

Similar to the Philippine Lung Center, National Kidney Institute, and The Philippine Heart Center, the (soon to be) Philippine Cancer Center will be the APEX hospital for cancer treatments. 

Regional cancer centers and comprehensive cancer centers will also be built and equipped to give greater access to patients.

The National Integrated Cancer Control Act will also equip patient navigators that provide personal guidance to patients as they go through the stages of their battle with cancer from diagnostics to finding the proper facility and medications. These are people who may have professional medical, legal, financial, or administrative experience in the field of cancer.

Patient navigation aims to remove the back-and-forth of patients from one clinic to another that often make treatment harder and more costly for them.

The law will also include adding specialized courses on oncology to school curriculum in medicine schools. 

CANCER JOURNEY

The new law aims to address the whole journey of cancer patients - from awareness up to survivorship, prioritizing middle and lower class patients during the first phase of implementation. Upper class patients will have cost sharing with Philhealth, according to the Department of Health. 

"Kailangan umabot sa poorest of the poor," Paul Perez, President of Cancer Coalition Philippines, said.

Vaccinations for vaccine preventable types of cancer will be strengthened. Teaching and encouraging people to have vaccines will be prioritized and funded, Dr. Claire Soliman of the Philippine Society of Medical Oncologists added.

"I think the LGUs will help us in this aspect. With the cancer bill and the universal health care, together, they can encourage the LGUs to promote vaccinations," Soliman said.

The DOH said there will also be a systematic framework - a balance between the burden and the government's capacity to address the burden.

For instance in the Philippines, the highest number of cancer cases are breast cancer. 

"Ipapa-plot natin 'yan. Mataas ang burden ng breast cancer. May magagawa naman tayo, from sin tax revenues. May screening naman available. May gamot, may services tayo or mga specialists," Cairo said.