Cancer in My Community: Overcoming Cancer Care Barriers in the Philippines

June 27, 2019
Ann Meredith Garcia Trinidad, MD, MCMMO, FPCP, FPSMO

Cancer in My Community is a Cancer.Net Blog series that shows the global impact of cancer and how people work to care for people with cancer in their region. Dr. Ann Meredith Garcia Trinidad earned her medical degree and master’s degree from the University of the Philippines and pursued her residency and fellowship training at the UP-Philippine General Hospital. She is a board-certified internist and medical oncologist with a special interest in health care social media. Her Facebook page dedicated to raising cancer awareness among Filipinos has over 100,000 followers. You can follow her on Twitter.

Why I care for people with cancer

Despite the numerous medical advances that are continuously being made globally, many people still think cancer is a death sentence. The physical, mental, and emotional burden, and the financial strain that comes with it, can cause fear, anxiety, and hopelessness. But I’m able to witness firsthand how people with cancer can still continue to live, laugh, love, and hope with the right treatment and a good support system. Seeing my patients go back to living their lives, spending more time with their loved ones, and doing the things that they enjoy gives me a special sense of fulfillment and happiness. I feel that it’s a special privilege to be trusted and to be let into patients’ lives during their most trying times, caring for them, and easing their suffering, even when it is most difficult.

What the cancer experience is like in the Philippines

Cancer is the second leading cause of death among Filipinos.share on twitter The most common cancers are breast, lung, colorectal, liver, and prostate. Among Filipino women, there are still high rates of cervical cancer. Only breast cancer is more common. Effective screening and prevention strategies already exist for many of these cancers, so the data may reflect the need to intensify our country’s cancer screening programs and public health education efforts.

It is not uncommon for us to see people who are already in the more advanced stages of cancer. Based on my personal experience, the usual story begins with a mass or symptoms that someone tries to ignore for a long time. They may be afraid of being told that they have cancer, not know that their symptoms need immediate medical attention, or be anxious about becoming a burden on their loved ones because of the costs of medical care. Often, it’s the last 2 reasons. Low health literacy and the high costs of diagnosing and treating cancer are major problems affecting how cancer is treated and prevented in the Philippines. Because of poor access to health care, the many advances being made in cancer are still unattainable to many, especially for those who live below the poverty line.

Many people with cancer use complementary and alternative medicine, particularly herbal and dietary supplements, in the Philippines. In a study done at the Cancer Institute of the Philippine General Hospital, 89% of the people with cancer in the survey used herbal or dietary supplements during the course of their illness. Around 25% of patients initially relied on just herbal and dietary supplements alone, which led to a delay in getting cancer treatment. I think that this is a growing public health problem that needs to be addressed.

How does the cost of cancer care impact Filipinos?

Most people in low- and middle-income countries, including the Philippines, pay for health care out of their own pockets. Thus, there is a high probability of facing a financial catastrophe if someone is diagnosed with cancer, especially for our poor and unemployed people. A 2012 study explored the economic impact of a cancer diagnosis in Filipino families. The study found that more than 40% of the families experienced financial toxicity, with about 25% falling into the lowest income bracket.

I’ve encountered patients who were forced to borrow money from loan sharks to pay for their cancer treatment. I’ve encountered patients who had to sell whatever few livestock, farm animals, or agricultural lands they have. Some had to stop sending their kids to school. On social media, it is not unusual to see posts about people with cancer or their family members selling various goods on the streets to earn money for their medical funds. I’ve had a number of patients who were able to start but not finish treatment because they ran out of money.

These things happen in spite of our country having its own National Health Insurance Program (NHIP) under the Philippine Health Insurance Corporation (PhilHealth) since 1995. PhilHealth pays a portion of the health care expenses for its paying members. Only government-sponsored members, such as poor and older patients, don’t have to pay their hospital bills. But most PhilHealth benefits are not able to pay for all of the costs of cancer care.

How is the Philippine government working to improve access to cancer care?

The recently signed Universal Health Care Act automatically enrolls all Filipino citizens into the NHIP. This act aims to improve current PhilHealth benefits and expand the capacities of rural medical clinics and government hospitals nationwide.

Another important law, the National Integrated Cancer Control Act, was also recently signed. This law establishes a Philippine Cancer Center and Regional Cancer Centers and aims to improve cancer care across the country. In addition, the law mandates the creation of a cancer assistance fund to help pay for treatment, expand PhilHealth benefit packages in cancer, train more oncology professionals, and support bigger cancer awareness campaigns.

Although the rules and regulations of both laws are still being drafted, I am hopeful that both laws will greatly contribute to a better health care system in the Philippines.

Local cancer support resources in the Philippines

People with cancer in the Philippines can get financial assistance from several government offices and agencies. They include the Philippine Charity Sweepstakes Office, the Department of Social Welfare and Development, and the Philippine Amusement and Gaming Corporation. Financial assistance also comes from several non-governmental organizations, such as the Philippine Cancer Society and the Andres Soriano Foundation.

Free consultation services, including the expertise of cancer specialists from the Philippine Society of Medical Oncology, are also available in many government hospitals nationwide. Cancer treatment can also be provided for free or partially free in some of the larger government hospitals, particularly in designated cancer centers under the Department of Health. In addition, the Philippine Society of Medical Oncology provides a list of patient support programs and patient support groups.

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