黑料社

(First of two parts)

MANILA, Philippines鈥擳argeted therapy, which has been available in the country for years, holds promise as a more effective way of treating cancer. However, certain barriers limit many breast cancer patients鈥� access to it.

Aside from standard treatment options鈥攃hemotherapy, hormone therapy, and immunotherapy鈥攁nother kind of breast cancer treatment called targeted therapy is being offered to patients worldwide鈥攊ncluding those in the Philippines.

According to the Philippine Cancer Society, targeted therapy uses drugs that work differently than standard chemotherapy drugs and often have different or less severe side effects. Among the prescribed targeted cancer drugs are trastuzumab, lapatinib, and bevacizumab (generic names).

In a radio interview on Tuesday (June 14), Kasuso Philippines Foundation for Breast Care Inc. volunteer Aileen Antolin explained that unlike chemotherapy, which targets cancer and possibly even non-cancer cells, targeted therapy focuses only on eliminating cancer cells.

鈥淲hat we used to know is the typical chemotherapy, which causes side effects such as balding or extreme hair loss, fatigue, and difficulty in recovering after treatments,鈥� Antolin said in Filipino.

鈥淲hat鈥檚 good with targeted therapy is that it has no side effects. Patients don鈥檛 experience major hair loss. They don鈥檛 [feel sick] after their treatment,鈥� she added.

In the Philippines, targeted therapy has been an available treatment option for breast cancer patients since 2011. Antolin said there has been 鈥済reat success鈥� in terms of the prognosis of breast cancer patients who received the treatment.

Unfortunately, while it has existed in the country for some time now, not all breast cancer patients have access to targeted drugs鈥攅specially impoverished patients who rely mostly on government programs.

Factors hindering access to treatment

According to Antolin, among the possible reasons that access to targeted therapy and innovative drugs for breast cancer remains limited for many patients are high costs and the process of issuing licenses for these medicines before doctors can prescribe them.

鈥淲e have this thing called the essential medicines list. This list includes medicines available in our pharmacies that the doctors can prescribe. But before [these medicines] can be included in the list, a law should cover it,鈥� she explained.

鈥淸These medicines will also undergo] regulation. Our country鈥檚 regulating body will approve those drugs first,鈥� she added.

Last month, Philippine Society of Medical Oncology (PSMD) president Dr. Rosario Pitargue called on the government to prioritize and fast-track the inclusion of new cancer drugs in the Philippine National Drug Formulary (PNDF).

鈥淭hese are the drugs that we really need to be able to help our patients,鈥� she said.

Pitargue explained that the process for including these medicines would need approval from the Health Technology Assessment Council and would take one to three years.

Dr. Kenneth Samala, a medical oncology fellow at the University of the Philippines-Philippine General Hospital (UP-PGH), noted that new cancer medicines should be included in the PNDF first before the Department of Health (DOH) can procure them for the government鈥檚 cancer control program.

Samala previously said that they had already applied various cancer medicines to be added to the formulary, 鈥渂ut nothing happened.鈥�

READ: Access to new cancer medicines remains limited for poor patients鈥攅xperts

In fact, Antolin shared that when trastuzumab鈥攁 targeted cancer drug鈥攅ntered the country, it was not immediately made available through the government鈥檚 Breast Cancer Medicine Access Program (BCMAP).

鈥淚t was not included in the free chemo program of the government because it is so expensive,鈥� said Antolin.

鈥淚t was only in 2016 or 2017 when it was included in the access program. Still, the high cost remained a huge factor. The requirement of supply versus demand of patients who need it is not immediately met,鈥� she added.

According to data from the Department of Health鈥檚 (DOH) Drug Price Reference Index, a 600 mg/5 mL vial of trastuzumab costs approximately P26,000.

A 2019 study published in the BMC Health Services Research detailed that revolutionary therapies such as trastuzumab have been listed in the PNDF since 2008, 鈥渂ut with no current evidence yet on its value for money to date.鈥�

鈥淗ence, despite several policy enablers, its accessibility remains to be limited as the current government insurance case rate for breast cancer does not cover the treatment for HER2-positive type; public hospitals cannot afford to procure and make it available in their facilities due to its high cost; and, while it has been recently included in the list of subsidized medicines under the DOH Breast Cancer Medicine Access Program (DOH BCMAP) under a negotiated reduced price for national hospitals, the access sites and medicine stocks are limited.鈥�

READ:

Patients 鈥榙eprived鈥�

When asked whether the roadblocks that limit access to innovative cancer drugs somewhat deprive many breast cancer patients, Antolin agreed, stressing that many impoverished patients will benefit from making those drugs available and affordable through government programs.

鈥淚 guess so. We can say that not making it available to patients is also depriving [them], especially since most of the patients who will benefit from it are poor and are availing programs under the public healthcare system,鈥� she said.

鈥淭hose patients are also the ones who will benefit the most from the medicines that will be recommended and prescribed by doctors based on the essential medicines,鈥� she added.

While Antolin noted that cancer affects everyone regardless of their financial capabilities, she emphasized that there is still a gap between the treatment and opportunity offered to privileged people.

鈥淭hose who have money can purchase cancer medicines overseas. Meanwhile, indigent patients who are reliant on the public health care system can鈥檛 do anything,鈥� she said, adding that even doctors鈥� hands are often tied.

Statistics revealed that at least 7 in 10 cancer patients in the country 鈥渄rop out of treatment regimen鈥� due to lack of funds.

In the Philippines, the cost of cancer treatment can range from 鈧�120,000 to as much as over 鈧�1 million. The estimated chemotherapy cost per session, depending on the cancer type, starts at 鈧�20,000 up to over 鈧�120,000.

READ: PH cancer patients lack access to preventive screening, costly treatment

At the UP-PGH, which serves around 60,000 to 70,000 cancer patients in a year, Dr. Jorge Ignacio, oncologist and chair of the UP-PGH Cancer Institute, estimated that at least 40,000 cancer patients are poor.

鈥淲e still rely on chemotherapy because this is, in a way, affordable,鈥� Ignacio said, stressing that indigent patients would not be able to avail themselves of the new cancer medicines that are more expensive.

A study published in 2018 in Acta Medica Philippina鈥攁 peer-reviewed general medical and health science journal published by the University of the Philippines (UP)鈥攈ighlighted the economic impact of cancer diagnosis in families.

The study, which analyzed 909 cancer patients in the Philippines, found that 40.6 percent of cancer patients鈥� families experienced financial toxicity鈥攐r financial problems鈥攄ue to the high cost of medical care.

The researchers also found that the mean combined out-of-pocket expenses of respondents at 3 and 12 months after diagnosis amounted to 鈧�181,789.00.

READ: 鈥楩inancial toxicity鈥� hurting PH cancer patients

(Next: Revisit PH cancer programs, budget remains an issue.)

TSB