Written by MSD in the Philippines
Often, when Filipinos hear the term "cancer," it evokes thoughts surrounding health and financial concerns. Many people worry about how the disease will affect their lives and the people around them. Perhaps, one of the most pressing issues Filipino patients encounter is their source of funds to suffice for their cancer care regimen. Along the journey, emotional and psychological burdens may also arise not only for the patient but also for their family and peers.
Understanding these adverse effects of cancer contributes significantly to improving the patients' quality of life. It pushes the creation and acceleration of more programs and awareness campaigns beneficial for cancer patients.
Cancer in the Philippines
According to The Global Cancer Observatory’s 2020 report, the number of prevalent cancer cases in the Philippines within a five-year period has reached 354,3981. In the same year, 153,751 new cancer cases were recorded in the country1. The report also shows that Filipinos have a 16.5% risk of developing cancer before reaching the age of 751.
Supplementing this data, a recent survey commissioned by MSD in the Philippines and carried out by IQVIA, a health technology, and research firm, reported that cancer remains among the top 3 diseases in the country responsible for the morbidity and demise of many patients2. It affects 189 in every 100,000 Filipinos, with about 96 cancer patients dying every day2. That means about four Filipinos die of the disease every hour2.
Breast cancer is the most common cancer in the Philippines, while lung cancer has the highest mortality rate1. Other commonly diagnosed cancers in the country are colorectal cancer, leukemia (cancer of the blood), prostate cancer, liver cancer, and cervical cancer1.
Moreover, about 2 out of 5 Filipino respondents in the IQVIA survey have personal experience with cancer2. Either they themselves were diagnosed, or a family member was diagnosed with the disease2.
Financial Implications of Cancer Among Filipinos
According to the PhilippinE CostS in Oncology (PESO) analysis, which included 909 respondents in the country, the mean combined out-of-pocket expenditures recorded from the 3rd month and 12th month of the study amounted to PhP181,789.003. Expenses for medication stood at PhP51,138.42, while the mean expenditure of hospitalization among hospitalized patients within the Month 3 and Month 12 interval was PhP47,569.963.
This figure shows that the malignancy can cause a tremendous economic burden, especially for families belonging in the lower-income groups (those earning PhP103,000 or less annually), potentially leading to a decrease in household income and even impoverishment in some cases3. Conversely, being in the upper-income groups had a statistical significance in lowering the risks of financial catastrophe3.
Because of limited finances, some reported not going to their medical appointments and not buying medication3. On the other hand, some obtained loans or sought medical assistance in the Philippines to cover their bills3. There were also patients who resorted to selling assets to get more funds3.
While many of the respondents had some sort of insurance scheme, it still was not enough to cover the bulk of the expenses3. Government insurance, in particular, experienced difficulty in fulfilling its main objective of providing financial protection at the conduct of the study3.
During the onset of the COVID-19 pandemic, patients experienced more financial hardships4. A retrospective cohort study conducted at a private tertiary healthcare institution in Metro Manila composed of two facilities compared clinical characteristics and data treatment of 111 cancer patients amid the global health crisis4.
The results show that decrease in salaries due to reduced work hours and unemployment were among the factors that contributed to financial losses among Filipinos amidst the pandemic4. For 8.5% of the patients included in the study, the pandemic has exacerbated financial barriers to cancer-related medical services, further delaying the delivery of proper cancer care4.
With factors like income decline and unemployment, cancer patients may not be able to adequately support their health care expenditure given the previously mentioned figures of out-of-pocket, medication, and hospitalization costs.
The Emotional and Psychological Impact of the Malignancy
From the time of diagnosis to its treatment and beyond, cancer creates changes in a patient's daily activities, work, and even relationships5. Many often feel as if they have lost autonomy or control over their life5. As a result, cancer patients may experience depression, cognitive dysfunction, and self-image issues, which are equally debilitating as the physical effects of the illness5.
Dealing with the disease in the pre-pandemic period is already burdensome on the physical and mental health. With the limitations and health risks in the midst of the COVID-19 pandemic4, many may feel an extra weight of frustration, especially upon experiencing impediments in their cancer care regimen that may result in the progression of the disease.
These adverse emotional and intellectual effects emphasize the importance of the involvement of family members and friends regarding how to support cancer patients5. Likewise, seeking professional help and reaching out to other cancer survivors may also be beneficial in improving a patient's psychological well- being5. All these may also be considered as necessary steps after cancer diagnosis and throughout the cancer patient journey.
Movements Toward Better Local Cancer Care
The PESO analysis continues that the national insurance program has undergone many changes since the study, expanding its benefit packages for Filipino cancer patients3. Still, there remains a need to constantly improve such programs to ensure better protection against catastrophic health costs3, especially when unforeseen circumstances arise like the COVID-19 pandemic.
Supplementary to the aforementioned data, the IQVIA survey lists several recommendations to improve the landscape of cancer healthcare in the Philippines2. Efforts to raise public awareness on cancer prevention, available treatments (including innovative ones), and funding sources for these medicaments should be increased, maximizing the use of digital media in the process2. In addition, there should be fortified government support in the implementation of the Cancer Control Act2.
Through continuous efforts and cooperation among stakeholders for better and more accessible cancer care, Filipino cancer patients may enjoy a longer life and improved chances of survivorship.
1 International Agency for Research on Cancer (2020). The Global Cancer Observatory Philippines Fact Sheets. Retrieved from Globocan: https://gco.iarc.fr/today/data/factsheets/populations/608-philippines- fact-sheets.pdf. Last Accessed December 9, 2021.
2 IQVIA. (2021). Measuring Philippine Population’s Attitude and Belief Towards Cancer Full Report. Last
Accessed October 18, 2021.
3 Balete, S., Kimman, M., Lam, H., Ngelangel, C., Real, I., Rivera, A. (2018). Philippine Costs in Oncology (PESO): Describing the Economic Impact of Cancer on Filipino Cancer Patients Using the ASEAN Costs in Oncology Study Dataset. Acta Medica Philippina, 52(2). https://doi.org/10.47895/amp.v52i2.418. Last Accessed October 19, 2021.
4 Pandy, J.G., Maaño, O., Balolong-Garcia, J., Datukan, J. (2021). Risk factors and clinical outcomes of systemic cancer treatment delays in Filipino patients with solid tumor malignancy during the COVID-19 pandemic: A single tertiary center study. Wiley Cancer Reports, 2021;e1426. https://doi.org/10.1002/cnr2.1426. Last Accessed October 19, 2021.
5 Cancer Treatment Centers of America (2019). Tips for managing the emotional and intellectual side effects of cancer. Retrieved from Cancercenter.com: https://www.cancercenter.com/community/blog/2019/05/tips-for-managing-the-emotional-and- intellectual-side-effects-of-cancer. Last Accessed October 20, 2021.
Published by Cecille Tamsyn