Colorectal Cancer in the Philippines

In this impactful session of the Global Cancer Movement, initiated by OncoDaily, Dr. Roselle De Guzman highlights the challenges and advancements in colorectal cancer care in the Philippines. The virtual event, held on December 6-8, 2024, gathered experts to discuss the multifaceted barriers to treatment and the ongoing efforts to improve cancer care in a low-resource setting.

Thank you very much for the kind introduction and a pleasure to be here. And thank you to those who are attending. So let me share my slides.

I just want to make sure if you can see the slides now and if you can hear me well. Yes, thank you. So, colorectal cancer in the Philippines is one of the most challenging cancers currently the country is facing.

We know that it’s a global health problem and the challenge is greater in a low and middle income country like the Philippines. So what is very alarming in terms of cancer care overall in the country is that the Philippines has the highest premature deaths in the ASEAN region and this is because of expensive treatments and the healthcare system is mainly out of pocket and the financial toxicity being experienced by the patients, their families often lead to treatment abandonment. And particularly for those who are in the younger age group, this has a macro level impact in terms of the country’s economy.

Colorectal cancer is the third most common cancer following breast and lung and the increasing prevalence is related to the aging population with more than 9 million of Filipinos aged 60 and above as well as changes in the lifestyle, urbanization and exposure to air pollution and other environmental factors.

So there are multifactorial challenges that the country is currently facing in terms of not only in colorectal cancer care but in cancer care in general. Most of the cases of colorectal cancers are diagnosed in the late stage and this is because of still inadequate awareness and the difficulty in accessing not only diagnostics but treatment as well because of affordability issues, funding issues and the difficulty in accessing the expertise of specialists.

And all of these factors together with inadequate national data and infrastructure issues put severe challenges to the current healthcare system. Now with more than 110 million population, the country lacks a widespread cancer screening program and lacks a national level registry. If you look at the map of the Philippines, it’s composed of several thousands of islands and this geographic challenge is mainly because of the access issues, not only access to diagnostics and access to medications but access to cancer care specialists as well.

Most of the oncologists are situated practicing in urban areas or urban cities or in the national capital region, even hospice and palliative care specialists are not very much accessible in the rural communities. And most of the patients in the higher socioeconomic status access private services in contrast to the rest of the population which avail services and care through public or government-owned hospitals. Now, in terms of the use of biomarker for colorectal cancer, there’s a survey among medical oncologists to show that even the minimal biomarkers needed to treat colorectal cancer is not ordered by oncologists 100%.

And this is because there are driving factors and barriers to the use of biomarkers or ordering of biomarkers. The most common driving factor for biomarker use is the test being based on clinical practice guidelines as well as when patients are diagnosed with advanced rheumatostatic disease, most commonly clinicians or oncologists would request for biomarkers. And of course, when patients are included in clinical trial, however, the biggest barrier is when patients experience financial constraints, again, because most of the patients do out-of-pocket payments even for diagnostics.

Now, on a national level, what we can see is that there have been, especially in the past years, there’s no dedicated governance in bringing NGS into healthcare landscape because we know the importance of precision medicine, it’s the best way to manage your patients and provide them with better outcomes. And there are issues in terms of confidentiality implementation, legitimacy in terms of purposes of the test, and the absence of political support, lack of awareness, some complexity in value assessment, and inadequate financial investments. So, the Philippine Genome Center is a genome-based multidisciplinary unit of the University of the Philippines, which is a state-owned university.

And with the existence now of the Philippine Genome Center, which is now actively promoting and exerting efforts on the genomic landscape of the country, now we are hopeful that from single biomarker testing, not only for colorectal cancer, but for other cancers as well, we will be moving on to a more comprehensive genomic profiling. Over the years, there’s expanding use of molecular diagnostics by different groups, private groups, and we are hoping as well that this will be transformative in terms of translating to better outcomes for our patients. Now, Philippines is one country that’s very active in terms of universal healthcare commitment.

And from 1969 to the current year, the universal healthcare commits to providing universal access to medical care to all Filipino citizens. And the government’s commitment can be reflected also with the signing of the cancer law, which is the National Integrated Cancer Control Act, the framework of which is aimed at reducing overall morbidity and mortality from cancer, reducing the incidence of cancer, providing timely access to medications, diagnostics. And what is groundbreaking in terms of the treatment and care for colorectal cancer is that the PhilHealthC benefit package covers the financial payments for early-stage and locally-advanced colorectal cancer.

So this initiative reduced the out-of-pocket expenses as well as equitable distribution of cost of care for patients. And the core elements of the PhilHealthC benefits is that for patients to be included and to be covered by this program, there should be a multidisciplinary care approach, making sure that patients are being seen by all the multidisciplinary specialists. They should be following standard treatment protocols as well as it includes also the promotion of early diagnosis and treatment.

Now the impact of the C package shows that in an institutional study that the survival rate increased compared to local historical controls, although it may not be as high as those seen in more developed countries, but we have seen improvement when patients are included in this groundbreaking initiative. So one of the provisions as well of the cancer law is the Philippine Cancer Center establishment, which has a pivotal role in not only providing screening and early detection management as well as in terms of cancer research. And in fact, just last week, the Philippine Cancer Center has launched the cancer research agenda until 2028.

So, so far there are achievements and progress. We are seeing this in terms of the efforts being exerted by the national government as well as institutional initiatives. We are seeing active campaigns from the Department of Health on healthy lifestyle, lifestyle changes and cancer prevention.

And we are more actively doing cancer research locally and participation in regional and international clinical trials. So these successes in terms of the health care improvement and ongoing efforts to provide and focusing on cancer care, which used to be not in the focus of the government because it used to be infectious diseases. Now, cancer is already in the priority of the Department of Health.

And the factors are mainly because there are political champions that drive the political agenda. There’s a strong advocacy movement with support groups and there’s active engagement of cancer organizations and medical societies, particularly the oncology societies. And there are championing voices of cancer patients and making use of the existing global agreements and structured national discussions.

So to conclude, there’s an important effort to continue addressing the clinical and systemic barriers in colorectal cancer care in the Philippines. And there’s still a need for a stronger and more coordinated efforts between all the stakeholders, the government, health care providers, the researchers and the oncologists and other specialists. And of course, with the ongoing journey of the universal health care and the cancer law, we are hopeful that there will be a commitment as well to advance cancer molecular technology, because this is something that we still have to push through and improve to better the outcomes of our patients with colorectal cancer.

So thank you very much for your attention.