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Mitigating the impact of the COVID-19 pandemic on cancer care

In March 2020, the Philippine General Hospital (PGH) was designated by the Department of Health (DoH) as one of the three coronavirus disease 2019 (COVID-19) referral centers in Metro Manila. As a result, a substantial proportion of the hospital’s logistics and manpower was allocated to caring for COVID-19 patients. 

The PGH Cancer Institute, among other non-emergency outpatient specialty services of the hospital, ceased operations for one week to ensure the safety of cancer patients who are mostly immunocompromised and therefore have a higher risk of getting infected with the novel coronavirus. (“Treatment of cancer patients during the COVID-19 pandemic in the Philippines,” Ecancermedicalscience, May 8, 2020.

“[Before the pandemic], we would see an average of 120 patients for checkup, cater to 40–50 patients on outpatient chemotherapy, 80–100 patients on radiotherapy, and take care of 20–25 patients admitted for inpatient chemotherapy regimens on a regular workday. This past week, most of our time was spent answering phone calls and text messages from patients, explaining to them the unfortunate scenario of closed clinics and suspended services, and facilitating the transfer of their care,” wrote PGH Cancer Institute consultants Drs. Frederic Ivan Ting, Aveline Marie Ylanan, and Dennis Lee Sacdalan. (“The Pain of Sending Away Cancer Patients Amidst the COVID-19 Pandemic,” Eurasian Journal of Medicine and Oncology, April 2020.)

Patient advocate Fatima Garcia-Lorenzo shared the same concern when she spoke during the Health for Juan & Juana webinar forum. “Around 20% of our cancer patients have not been able to receive their regular treatments, and many have relapsed. Aside from the lack of public transportation, cancer patients with weakened immune systems also have to contend with the lack of non-COVID wards in some hospitals, forcing them to pass through the same entrances and corridors used by COVID-19 patients,” said Ms. Garcia-Lorenzo, executive director of Kythe Foundation and president of the Philippine Alliance of Patient Organizations (PAPO).

Due to the overwhelming impact of the pandemic on cancer patients, the Cancer Coalition Philippines (CCPh) and members of the Pharmaceutical and Healthcare Association of the Philippines (PHAP) together with the Department of Health and BusinessWorld as a media partner, is holding a series of virtual fora to put a spotlight on the current plight of cancer patients in the country. Together with us in the forum series are pharmaceutical companies MSD, Pfizer, Roche, Takeda, Boehringer Ingelheim, Novartis, and Johnson & Johnson. 

The CCPh, on the other hand, is composed of the I Can Serve Foundation, Philippine Cancer Society, Cancer Warriors Foundation, Philippine Society of Oncologists, Project: Brave Kids, Carewell Community Foundation, and the Philippine Society of Medical Oncology. 

A forum held on Feb. 4, titled “Cancer Conversations: Navigating Cancer with Patients,” aimed to support patients, increase understanding, and update information on where to get assistance during the pandemic.  

The forum also revisited the implementation of the National Integrated Cancer Control Act (NICCA), an internationally acclaimed law for comprehensively mapping the path forward to strengthen cancer control, increase cancer survivorship and reduce the burden on patients and families. 

“This pandemic has underscored the importance of a strong and reliable healthcare system for any given country, but with landmark laws such as the National Integrated Cancer Control Act and the Universal Healthcare Law, we will ensure that we build a health system that provides quality healthcare without financial hardship for every Filipino, including our cancer patients. As we continue fighting the pandemic, the DoH, together with its partners, shall continue to provide early and sufficient access to cancer medicines and ensure the highest possible chance of survival among people with cancer,” Health Secretary Francisco T. Duque III said.

“The COVID-19 pandemic revealed the strengths and weakness of our healthcare system. Over the years, cancer awareness groups have been advocating cancer care prevention, screening, early detection, and access to palliative care. Through this forum, cancer patients can share the challenges they faced during the pandemic and what resources became available to them. In addition to this, cancer patients and their families are looking forward to a hopeful life journey because equitable and affordable cancer treatment and care are provided for under the cancer law. We share in the call for its full implementation so that patients need not wait anymore,” noted Paul Perez, president of the CCPh and Project Brave Kids founder.

The COVID-19 pandemic affected healthcare systems globally and resulted in the interruption of usual care in many healthcare facilities, exposing vulnerable patients with cancer to significant risks. This was the key finding of a global collaborative study that used a validated web-based, 51-item questionnaire to assess the impact of the COVID-19 pandemic on cancer care. A total of 356 centers from 54 countries across six continents (including Asia) participated in the study between April 21 and May 8, 2020. These centers serve more than 700,000 new cancer patients a year. (“Impact of the COVID-19 Pandemic on Cancer Care: A Global Collaborative Study,” JCO Global Oncology, Sept. 28, 2020.)

Most of the centers (88.2%) reported facing challenges in delivering care during the pandemic. Although more than half (55.34%) reduced services as part of a preemptive strategy, other common reasons included an overwhelmed system (19.94%), lack of personal protective equipment (19.10%), staff shortage because of infection (17.98%), and restricted access to medications (9.83%). Almost half of the centers (46.31%) reported at least one cycle of therapy was missed by more than 10% of their patients. Participants reported patient exposure to harm from interruption of cancer-specific care (36.52%) and noncancer-related care (39.04%), with some centers estimating that up to 80% of their patients were exposed to harm. (“Impact of the COVID-19 Pandemic on Cancer Care: A Global Collaborative Study,” JCO Global Oncology, Sept. 28, 2020.)

When the Cancer Institute reopened in April 2020, it implemented key strategies as part of a comprehensive approach to facilitate care delivery and meet the challenges imposed by the pandemic. This approach was informed by guidelines and recommendations to clinicians on the care of cancer patients during this pandemic issued by the American Society of Clinical Oncology, the European Society of Medical Oncology, and the Philippine Society of Medical Oncology. 

We can use the lessons learned during this difficult time to better prepare and create a more resilient healthcare system to manage future pandemics and health emergencies. 

TEODORO B. PADILLA is the executive director of the Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP and its member companies represent the research-based pharmaceutical and healthcare sector in the country.

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