By Mylene C. Orillo

Worldwide, nearly one in six deaths is caused by cancer-related illnesses. According to the World Health Organization, 70 percent of these deaths occur in low- and middle-income countries.

In Philippine Charity Sweepstakes Office (PCSO) alone, chemotherapy ranks number 2 in the most requested cases, next to confinement/hospitalization.

“As of first quarter this year, the agency has already received 8,313 requests amounting to P386.15 million for chemotherapy,” reported PCSO General Manager Alexander Balutan.

The amount of assistance is based on the classification system established by the program. But all Filipino can request assistance personally or by sending a representative if they are confined in any health facility and receiving healthcare management as outpatients.

“Those who want to seek management in foreign countries can avail of IMAP, as long as, no health facility within the Philippines is capable of providing such procedure,” clarified Balutan.

Requests for chemotherapy sessions fall under the Individual Medical Assistance Program (IMAP) of PCSO. IMAP is the flagship program of the agency, which was institutionalized in 1995 to provide timely and responsive financial assistance to individuals with health-related problems.

As an alternative, patients can go directly to At-Source-Ang-Processing (ASAP) Desks located in hospitals and health facilities, instead of going to PCSO Main Office or Lung Center of the Philippines.

PCSO also has 63 branches across the country with the opening of seven new branches last year in the provinces of Lanao del Norte, Catanduanes, Sultan Kudarat, Eastern Samar, Biliran, Davao del Norte, and Ifugao.

“We issue guarantee letters addressed to health facilities (hospitals, dialysis centers, etc.,) where PCSO assumes the obligation of a specific amount due from the client for the services rendered,” explained Dr. Krisch Trine Ramos, medical officer at the Office of the Assistant General Manager for Charity Sector of PCSO.

Chemo vs immuno-targeted therapies

Breakthrough cancer treatments such as immunotherapy and targeted therapies could be seen as a new lease on life for patients suffering from cancer. They are increasingly becoming cancer treatment options.

Targeted therapy, as the name indicates, “target” specific cancer cells. They alter the inner workings of the cell focusing on the part of the cancer cell that makes it different from the normal, healthy cell.

Immunotherapy, on the other hand, uses the body’s immune system to fight cancer cells. It stimulates the immune system. It may be used with other types of treatment or by itself.

“The immune system once they recognize the cancer cells they can remember. They’ve got memory cells,” explained Prof. Morteza Aghmesheh, medical oncologist in Wollongong Hospital in Australia who spoke during the “Hope from Within: Test, Talk, Take Action” forum at Crowne Plaza Hotel in Ortigas Center.

While chemotherapy, as a general rule, targets the cells that are rapidly growing but unfortunately it cannot differentiate between cancerous and healthy cells.

Most of the cancer cells are rapidly growing and chemotherapy tries to kill them. The side effects are because the cells such as those in gastrointestinal tract have fast growing cells, they could get affected.

“That’s why the nausea, diarrhea, and hair loss happen because chemotherapy might target normally fast growing cells by mistake. Chemotherapy doesn’t directly target cancer cells,” said Aghmesheh.

However at present, immunotherapy is being offered only for certain diseases such as lung cancer, melanoma, Hodgkin’s lymphoma, bladder, head, and neck cancers and at certain stages based on the recommendation of a medical oncologist helps the patient understand when it is feasible to use it.

“It is sad that we cannot offer this to our patients left and right because of the financial constraints. But we have a very good network nowadays [such as Philippine Alliance of Patient Organizations (PAPO), Department of Health, PCSO, PhilHealth, academic societies – working together to be able to bring new treatment approaches and assistance to the patients,” said Dr. Mary Claire V. Soliman, President of the Philippine Society of Medical Oncology.

In 2017, one newspaper reported that families spend an average of P150,000 per cancer treatment alone, while immunotherapy is estimated at P300,000 per session.

Early detection is key

In a Globocan data prepared by the Philippine Cancer Society in 2015, there are estimated 11,000 new cancer cases.

Leading new cancer cases from both sexes are breast, lung, colorectal, liver, and cervical cancers. In terms of new cancer deaths, the top is lung, liver, and breast cancers.

Apart from highlighting the treatment options, Soliman emphasized the need to go back to the basics, live healthier, and avoid “instant” foods.

Early detection is also important in winning the war against cancer, and when one has already diagnosed with cancer, he has to look for a cancer center that has multi-modality and multi-disciplinary team approaches in managing and promoting the patient’s better survival.

“All cancers are treated by a group of specialists composed of surgical oncologist, general surgeons, colorectal surgeons, ears-nose-throat doctors, gynecologists, radiation oncologists, and other specialists who meet together to discuss and decide the manner of treatment/sequence in the way the patient is managed,” said Soliman.

She clarified, however, that having a team of specialists doesn’t mean the patient has to consult each one of them or pay for each of the doctor’s consultation/professional fees, which are one of the major concerns of patients.

“Sometimes we present a patient’s case in a discussion/conference to the tumor board. We just try to pick each other brains to ask what modality to use to make this patient live longer,” clarified Soliman.

As for cancer cells that may already be present in one’s body and were only triggered by certain factors, Aghmesheh said it is a possibility.

“It is quite possible that all of us have cancer cells, but the body has so many defense layers that this can sustain us unless they can become smart and can get through all those layers of defense to be able to grow,” he said.

He further explained that for cancer cells to become a tumor, it needs to go to so many steps and also to go under the radar of the immune system in order for the cancer to grow.

A patient may have some abnormality in the immune system. Some immune deficiencies in the early childhood that can get different conditions but in general, 60 percent of cancer happens over the age of 60.

“Elderlies, I think, like any other organ in the body over time can become weak, like heart, kidneys, lungs, the immune system wears off in time as well and may become weaker as one grows older and may fail to defend the body,” said Aghmesheh.