Transcript Barriers to early detection and diagnosis
IMPROVING AND EXPANDING ACCESS TO CARE FOR CHILDHOOD CANCER IN THE PHILIPPINES
Julius A. Lecciones, MD Executive Director Philippine Children’s Medical Center Quezon Avenue, Quezon City 1100, Philippines www.pcmc.gov.ph
11 th CES Annual Conference Zamboanga City, 14-16 November 2012
As a pediatric oncology private practitioner…
Saving a child with cancer one patient at a time
As PCMC Executive Director…
Saving as many children with cancer in the community
The story of the struggles of these brave kids and their ultimate triumph against all odds…
…and the story of all those who fought hard for their survival.
Worldwide, cancer kills more than malaria, TB and HIV combined. In the Philippines, cancer ranks 3 morbidity & mortality rd among the leading causes of
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 potentially cured …..
Only 16-20% actually attain long-term survival More than 2/3 late stages at diagnosis
…and therefore receive medical attention in the late stages of the disease…
…when cure is usually no longer possible.
…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 ???
Barriers to early detection and diagnosis
Issues of ignorance and/or indifference of the general public
Barriers to early detection and diagnosis
Inefficient referral system
Barriers to early detection and diagnosis
Lack of access to information
Barriers to early detection and diagnosis
Ignorance of available resources for care
Barriers to early detection and diagnosis
Low index of suspicion among frontline healthcare workers
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???
Barriers to optimal management
High cost of treatment and medical support
Barriers to optimal management
Majority of well-established cancer centers and specialists are in Metro Manila, Cebu and Davao
ACCESS PROBLEM:
Geographical inequity, where rural and isolated communities receive less and lower quality health services
,
and socioeconomic inequity, when the poor 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
ACCESS PROBLEM:
No Pediatric Oncology referral unit as consultants.
- children are seen in many hospitals (public/ private); all benefit from the same highly qualified specialists The gap between private and public is huge poor will have difficulties to afford care and treatment
.
the main barrier
:
paying patients will benefit from up-to-date and high quality facilities and treatment while the The civil society try to fill-in this gap but this support is not sufficient. Cost remains
Almost all will not survive their first year with the disease.
The poor will not opt for treatment anymore.
Staggering amount of pain and suffering of children, and despair and hopelessness of parents No one can bear doing nothing of the situation.
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
L E V E R S I S S U E S
Synthesis of potential levers
1 st symptoms 1 st consultation Diagnosis Treatment Follow-up
• At least 2 cases out of 3
are not diagnosed
• If diagnosed, only at a
stage where curative treatment is more difficult
• Gold standards available
but not standardized
• Strongly modified for
charity patients
• Quality of life can still be
improved
• Lack of baseline
data
• Low survival
rates for charity patients Training frontliners Building a referral network Setting-up reference protocols 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
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
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 program to effective childhood cancer control and management
PUBLIC AWARENESS: MEDIA CAMPAIGNS
PUBLIC AWARENESS: PRINT MEDIA
COMMUNITY MOBILIZATION
BUILDING PARTNERS
NATIONAL REFERRAL NETWORK
Involved 20 pediatric oncologists in 13 participating hospitals Dr. Alvin Balatbat Dr. Jane Stewart Dr. Marita Mimay 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. Lydia Ramirez Dr. Marieleise Afable Dr. Miriam Quimpo Dr. Kathy Pascual Dr. Vincent Alba Dr. Genaro Bermudez Dr. Aliw Paulino Dr. Crispin Dalisay Dr. Jo Ann Gomez Dr. Mae Conception Dolendo Graduates Fellow
My Child Matters Philippines
Improve survival of Filipino children with cancer
Chemotherapy Provider Courses
Trained 208 nurses and medical residents from 24 hospitals
My Child Matters Philippines
Improve 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
PEDIATRIC CANCER AND HEMATOLOGY CENTER AT THE PHILIPPINE CHILDREN’S MEDICAL CENTER
DOH-NCPAM ALLMAP
CHEAP TO FREE CHEMOTHERAPY DRUGS TO SERVICE PATIENTS
Pediatric Oncology Network Organized by My Child Matters Philippines with PCMC-Trained Pediatric Oncologists as the Back Bone of the System
Ma. Victoria Dela Cruz, MD
Cagayan Valley Sanitarium and Hospital
Ma. Teresa S. Fajardo, MD
Cabanatuan
Kathyrine Pascual, MD
Clinica Pascual, Tarlac
Maileen Roa, MD 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
Genaro Bermudez, MD Amy Goleta-Dy, MD Pacita Lopez, MD
St. Luke’s Medical Center
Marieleise Afable, MD
World Citi Medical Center
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
Expansion to 35 pediatric oncologists in 24 participating hospitals where free chemo drugs are available
Crispin Dalisay, MD Jo Ann Gomez, MD
Pediacare Clinic, General Santos City
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
RESULTS OF THE 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%
The children can now expect to have not just one Christmas or two, but as many as everybody else.