Cancer burden in the Philippines needs to be addressed

IN 2015, in Bali, Indonesia new research from Sydney was presented recommending urgent action against cancer in Southeast Asia. Studies have shown that the disease has become an overwhelming burden on society and healthcare systems in Southeast Asian regions.

The study, dubbed the ASEAN Costs in Oncology (ACTION) study, was conducted by the George Institute for Global Health and examined 9,513 new cancer patients from Cambodia, Indonesia, Laos, Malaysia, Myanmar, Thailand, Vietnam, and the Philippines aged 18 years old and above and monitored them from diagnosis onwards.

The results of the study showed that a cancer diagnosis in Southeast Asia is disastrous within only 12 months for 75 percent of new patients. Just a year after diagnosis 29 percent of the participants of the study died while 48 percent experienced financial catastrophe. Additionally, almost half, or 44 percent, of those who survived experienced economic hardship as a consequence of the cancer; with the majority using their life savings for cancer care. Socioeconomically disadvantaged patients with advanced cancer stages were common and particularly vulnerable to adverse economic outcomes and poor survival.

The numbers are steadily increasing. In 2012, there were more than 770,000 new cancer cases and 527,000 cancer deaths in the region. The study predicted that this number is expected to rise by roughly 70 percent or 1.3 million by the year 2030 due to smoking, unhealthy diet, and sedentary lifestyle among other attributes. Aging population and rising cancer burden are leading the risk of cancer becoming an epidemic that will eventually overwhelm the region.

Cancer study in the Philippines

The ACTION study presented a bigger picture view of cancer burden throughout the Southeast Asian region. To put cancer burden into perspective in the Philippines, a subanalysis of the ACTION study was conducted just in the Philippines entitled the Philippine Costs in Oncology Study or the PESO Study.

The study looked at a controlled group of 909 cancer patients in the Philippines with a mean age of 52 years. Of the group 58.5 percent were females and 74.81 percent were married. 45.5 percent were household heads, 32.3 percent were spouses of the household head, 13 percent were offspring, and 3.5 percent were parents. Many of the subjects of the study were in the lower income bracket earning less than P51,500 to P103,000 annually, 40 percent had access to higher education, and 40 percent had no private health insurance.

In the study, breast cancer was the most common cancer site at 33 percent or one-third of the study group. The following was gastrointestinal tract with 23 percent, head and neck with 11 percent, respiratory with 9 percent, hematologic with 6 percent, and other cancer sites making up the remaining 18 percent.

Cancer and financial catastrophe

The study followed cancer patients from diagnosis to treatment to document the effects the disease had on their lives, from quality of life to financial catastrophe. Financial catastrophe is described as more than 30 percent of the household income being spent on out-of-pocket medical expenses. In the Philippines, out-of-pocket health expenditure is almost always higher than annual family income. These expenses include hospital stay, medicine, and other costs such as medical supplies, food, and transportation.

As most of the patients in the study belonged to the lower income group, financial catastrophe was felt by the bulk of the participants. Only 40 percent of the study group had access to health insurance, but even then, this did not have a significant impact on survival or prevention of financial catastrophe. Only the study participants in the very small upper income bracket had a lower risk of financial catastrophe. Those in the lower income group felt the pinch after only one planned treatment cycle (once cycle of chemotherapy or one week of radiation therapy).

Additionally out-of-pocket expenses increased by as much as 71 percent three months after diagnosis. Ultimately these expenses took up 60 percent of total health expenditures while insurance covered only up to 20 percent and government insurance (PhilHealth) covered only 11 percent of the total health expenditures.

The study showed that 36 percent of patients died within a year of diagnosis with respiratory cancer having the highest incidence of death. All patients had planned treatments, but due to financial difficulties, many of them did not receive these treatments, attend medical appointments, or buy medications. A very low percentage was given biopharmaceutical drugs. Breast cancer patients in the country had the highest incidence of complete remission. However, they also had the highest percentage of financial catastrophe.