IMPROVING AND EXPANDING ACCESS TO CARE FOR CHILDHOOD CANCER IN THE PHILIPPINES

1. IMPROVING AND EXPANDING ACCESS TO CARE FOR CHILDHOOD CANCERIN THE PHILIPPINES Julius A. Lecciones, MD Executive Director Philippine Children’s Medical Center Quezon Avenue, Quezon City 1100, Philippines www.pcmc.gov.ph 11th CES Annual Conference Zamboanga City, 14-16 November 2012

2. As a pediatric oncology private practitioner… Saving a child with cancer one patient at a time

3. As PCMC Executive Director… Saving as many children with cancer in the community

4. The story of the struggles of these brave kids and their ultimate triumph against all odds…

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

6. Worldwide, cancer kills more than malaria, TB and HIV combined. In the Philippines, cancer ranks 3rd among the leading causes of morbidity & mortality

7. CHILDHOOD CANCER PROBLEM IN THE PHILIPPINES: • 3,500– estimated number of children diagnosed with cancer every year • Leukemia, Lymphoma & Retinoblastoma (cancer of the eye) – most common cancers • Accounts for 60% of all childhood cancers among Filipino children • At least 80% could be potentiallycured ….. • Only 16-20% actually attainlong-term survival • More than 2/3 late stages at diagnosis

8. …and therefore receive medical attention in the late stages of the disease…

9. …when cure is usually no longer possible.

10. …or is possible only with intensive and expensive treatment most could not afford, and usually are not available outside the major centers in Manila. Why are we getting them at the late stages ???

11. Barriers to early detection and diagnosis • Issues of ignorance and/or indifference of the general public

12. Barriers to early detection and diagnosis Inefficient referral system

13. Barriers to early detection and diagnosis Lack of access to information

14. Barriers to early detection and diagnosis Ignorance of available resources for care

15. Barriers to early detection and diagnosis Low index of suspicion among frontline healthcare workers

16. For the 1/3 in early stages, as much as 80% will not continue treatment and will be lost to follow up. Why is there such a high rate of treatment abandonment???

17. Barriers to optimal management High cost of treatment and medical support

18. Barriers to optimal management Majority of well-established cancer centers and specialists are in Metro Manila, Cebu and Davao

19. ACCESS PROBLEM: • Geographical inequity,where rural and isolated communities receive less and lower quality health services, and socioeconomic inequity,when thepoor 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

20. 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

21. Almost all will not survive their first year with the disease. The poor will not opt for treatment anymore.

22. Staggering amount of pain and suffering of children, and despair and hopelessness of parents No one can bear doing nothing of the situation.

23. MY CHILD MATTERS PHILIPPINES Anak ko, Buhay ko, Pananagutan ko My Child, My Life, My Responsibility We will go out of PCMC and find these patients even before they come to the hospital

24. Synthesis of potential levers Follow-up 1st symptoms 1st consultation Diagnosis Treatment I S S U E S • Gold standards available but not standardized • Strongly modified for charity patients • Quality of life can still be improved • At least 2 cases out of 3 are not diagnosed • If diagnosed, only at a stage where curative treatment is more difficult • Lack of baseline data • Low survival rates for charity patients L E V E R S Training frontliners Setting-up reference protocols Building a referral network Fostering palliative care Setting-up practice guidelines Reducing the cost of treatment Providing funding solutions Providing reliable epidemiological data Providing information and support for families

25. Expanding Access To Treatment And Improving Care To Filipino Children with Cancer My Child Matters Philippines Program 1 GENERAL OBJECTIVE IMPROVEMENT OF THE SURVIVAL RATE OF CHILDHOOD CANCER IN THE PHILIPPINES 3 AXES FOR ACTIONS Improving Quality Of Care Nationwide Developing A Strong Referral Network Establishing Epidemiological Research to Guide Future Planning

26. 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

27. PUBLIC AWARENESS: MEDIA CAMPAIGNS

28. PUBLIC AWARENESS: PRINT MEDIA

29. COMMUNITY MOBILIZATION

30. BUILDING PARTNERS

31. Dr. Lydia Ramirez Dr. Alvin Balatbat Dr. Jane Stewart Dr. Marieleise Afable Dr. Miriam Quimpo Dr. Kathy Pascual Dr. Marita Mimay Dr. Vincent Alba Dr. Genaro Bermudez Dr. Aliw Paulino Dr. Tess Fajardo Dr. Enriquetta Salvador Dr. Enriquetta Salvador Dr. Cynthia Melicor Dr. Bernadela Sancover Dr. Lita Fe Paclibar Dr. Maria Victoria Dela Cruz Dr. Crispin Dalisay Dr. Jo Ann Gomez Dr. Mae Conception Dolendo Graduates Fellow Involved 20 pediatric oncologists in 13 participating hospitals NATIONAL REFERRAL NETWORK

32. My Child Matters PhilippinesImprove survival of Filipino children with cancer Chemotherapy Provider Courses Trained 208 nurses and medical residents from 24 hospitals

33. My Child Matters PhilippinesImprove survival of Filipino children with cancer Unified Leukemia Protocol A Locally-Developed Uniform Protocol for the Treatment of Acute Lymphocytic Leukemia in Filipino Children Requires at least PhP 185,690 per child

34. PEDIATRIC CANCER AND HEMATOLOGY CENTER AT THE PHILIPPINE CHILDREN’S MEDICAL CENTER

35. DOH-NCPAM ALLMAP CHEAP TO FREE CHEMOTHERAPY DRUGS TO SERVICE PATIENTS

36. Pediatric Oncology Network Organized by My Child Matters Philippines with PCMC-Trained Pediatric Oncologists as the Back Bone of the System Ma. Victoria Abesamis, MD Joseph Vincent Alba, MD Maria Cecilia Leongson-Cruz, MC Reynaldo De Castro, MD Rosemarie Fajardo. MD Beatriz Gepte, MD Julius Lecciones, MD Eustacia Rigor, MD Michelle Rodriguez, MD Philippine Children’s Medical Center Ma. Victoria Dela Cruz, MD Cagayan Valley Sanitarium and Hospital Ma. Teresa S. Fajardo, MD Cabanatuan Genaro Bermudez, MD Amy Goleta-Dy, MD Pacita Lopez, MD St. Luke’s Medical Center Kathyrine Pascual, MD Clinica Pascual, Tarlac Expansion to 35 pediatric oncologists in 24 participating hospitals where free chemo drugs are available Marieleise Afable, MD World Citi Medical Center Maileen Roa, MD Aliw Paulino, MD Cecilia Fernandez, MD Ma. Enriqueta Salvador, MD Mary Mediatrix Medical Center Batangas Ma. Lita Fe Paclibar, MD Western Visayas Regional Medical Center Chang Melicor, MD Shiela Marie Flores, MD Silliman Medical Center, Dumaguete City Crispin Dalisay, MD Jo Ann Gomez, MD Pediacare Clinic, General Santos City

37. 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

38. 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%

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

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