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
11th 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 3rd
among the leading causes of
morbidity & mortality
CHILDHOOD CANCER PROBLEM IN
THE PHILIPPINES:
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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
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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
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Only 1000 children out of 3500 will be diagnosed
and cared for:
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Concentration of resources in Metro Manila
Less developed in the provinces, particularly in public
hospitals
ACCESS PROBLEM:
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No Pediatric Oncology referral unit - children are
seen in many hospitals (public/ private); all
benefit from the same highly qualified specialists
as consultants.
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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
The poor will not opt for
treatment anymore.
Almost all will not survive
their first year with the
disease.
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
Synthesis of potential levers
1st symptoms
1st consultation
Diagnosis
Follow-up
Treatment
I
S
S
U
E
S
• At least 2 cases out of 3
are not diagnosed
• If diagnosed, only at a
stage where curative
treatment is more difficult
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
• Gold standards available
but not standardized
• Strongly modified for
charity patients
• Quality of life can still be
improved
Providing funding solutions
Providing reliable epidemiological data
Providing information and support for families
• Lack of baseline
data
• Low survival
rates for charity
patients
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
Developing A
Strong Referral
Network
Improving Quality
Of Care Nationwide
Establishing
Epidemiological
Research to Guide
Future Planning
MY CHILD MATTERS PROGRAM:
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National public awareness campaign that
childhood cancer is curable if detected early and
treated effectively
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Community mobilization and advocacy to bring
the issue in the forefront of public agenda
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Organize the different sectors to collaborate so
that concrete actions can be taken
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Focus on solutions to barriers to effective
childhood cancer control and management
program
PUBLIC AWARENESS: MEDIA CAMPAIGNS
PUBLIC AWARENESS: PRINT MEDIA
COMMUNITY MOBILIZATION
BUILDING PARTNERS
Dr. Lydia Ramirez
NATIONAL REFERRAL
NETWORK
Dr. Alvin Balatbat
Dr. Jane Stewart
Dr. Marieleise Afable
Dr. Miriam Quimpo
Dr. Marita Mimay
Involved 20 pediatric
oncologists in 13
participating hospitals
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
Dr. Kathy Pascual
Dr. Vincent Alba
Dr. Genaro Bermudez
Dr. Aliw Paulino
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
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
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
Expansion to
35 pediatric
oncologists in
24 participating
hospitals where
free chemo
drugs are
available
PHILHEALTH Z-PACKAGE FOR
LEUKEMIA
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Catastrophic disease
insurance package
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Increased reimbursements
of up to PhP 210k for three
years of treatment
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Patients need to commit to
finish treatment
RESULTS OF
THE LAST SIX YEARS
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Late diagnosis reduced to
30% from 70%
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Treatment abandonment
rate decreased to only
10% from 80%
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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.
A CESO as a public servant makes a
difference in people’s lives.