Background: The standard treatment of patients with advanced nasopharyngeal carcinoma is concurrent chemoradiotherapy followed by chemotherapy. The voluminous number of patients with this disease and the constraints of limited facilities to accommodate such number of patients in our institution have brought about treatment modifications. This pilot study compared the 3-year progression-free survival (PFS) and overall survival (OS) of patients with advanced nasopharyngeal cancer who received concurrent chemoradiotherapy as induct ion fol lowed by chemotherapy ver sus chemotherapy fol lowed by concurrent chemoradiotherapy. Patients and Methods: From 2005 to 2007, 30 patients with biopsy-proven stage III to IV-B nasopharyngeal cancer seen at the Medical Oncology Outpatient/Inpatient unit of the Philippine General Hospital were randomized to receive cisplatin (25 mg/m2 D1-4) on weeks 1, 4 and 7 of radiotherapy (70 Gy for 7 weeks) followed by cisplatin (20 mg/m2 D1-4) and 5-fluorouracil (1000 mg/m2 D1-4) on weeks 11, 15 and 19 (standard arm) or to receive cisplatin (20 mg/m2) on D1-4 and 5-fluorouracil (1000 mg/ m2 on D1-4) on weeks 1, 5 and 9 followed by concurrent chemoradiotherapy. started after 4 weeks of the 3rd cycle of chemotherapy (week 13) with cisplatin (25 mg/ m2 on D1-4) given on weeks 13, 16 and 19 of treatment every 3 weeks dur ing radiotherapy (investigative arm).Treatment modifications were done based on creatinine clearance and toxicities. Carboplatin (AUC 5) was substituted for cisplatin for creatinine clearance < 30 ml/min or grade 3 hearing impairment. Results: Baseline characteristics were comparable except for age and histology. Median PFS was 19.6 months (standard arm) versus 25.7 months (investigative arm). 3-year PFS rates were 25% and 63%, respectively with hazard ratio 2.64 (p= 0.176). Median OS were 17.5 months and 21.5 months, respectively. 3-year survival rates were 36% and 25.4%, respectively with hazard ratio 0.92 (p= 0.889). The complete response rate was 18.7% (standard arm) versus 28.5% (investigative arm), partial response rate was 31.2% vs 21.4% and progressive disease was 31.2% and 28.5% respectively. Anemia, anorexia, nausea, vomiting and xerostomia were the most frequent grade 3 adverse events. Conclusion: Induct ion chemotherapy fol lowed by concur rent chemoradiotherapy appears to be comparable to the standard of concurrent chemoradiotherapy followed by chemotherapy in terms of PFS and OS. However, no final conclusion can be drawn due to the small sample size and poor follow-up.

INTRODUCTION: Chromosomal mutations are casual events in neoplasia development. Biomarker cytogenetic assays can determine exposure to mutagenic agents in occupational settings. This study assessed early biological marker chromosomal aberrations among health workers in the chemotheraphy oncology wards/ clinics, exploring its association to the subjects' occupational, environmental and baseline profile.
METHODS: This was an IRB approved cross-sectional exploratory study among hospital personnel working in the chemotherapy oncology facility of a tertiary government hospital, who underwent structured interview and blood extraction for cytogenetic assay after informed consent. Study funds only permitted assay of 44 specimens of 144 planned sample size, hence, Stata 6.0 only analyzed data from 44 subjects.
RESULTS: All 44 subjects had varying exposure to chemotherapy drug infusions. Of these, 79% had 1.0 breaks per cell (hypersensitive). Predominantly chromatid breaks (CTB), chromatid gaps (CTG), sister chromatid exhanges (SCE) were seen. No significant association was shown between mutagenic sensitivity and baseline characteristics, but with small sample size.
CONCLUSION: 21% borderline to hypersensitive mutagenic sensitivity among oncology workers at the tertiary government hospital is relatively significant, despite small sample size, connoting a must preventive promotive practice of chemotherapy administration in the workplace.

Human ; Male ; Female ; Chromosome Aberrations ; Chromosomes ; Drug Therapy ; Personnel, Hospital ; Cytogenetics ; Chromatids ; Mutagens

Introduction: Cancer registries contain information essential to any rational program of evidence-based cancer control, including cancer epidemiology and outcomes, and can be site-specific, hospital-based, or population-based. The creation of a national population-based cancer registry and hospital-based cancer registries was mandated in the National Cancer Control Act of 2019. This paper reports on the creation and maintenance of the Cancer CARE Registry and Research Philippines (CARE PH) app, the country's first hospital-based cancer registry system, and its future directions in registry and research.

Methods: A cancer registry in the form of a web-based application was developed through the collaboration between a clinician and a health information technology specialist. This registry was designed to follow the cancer patient's journey from diagnosis to staging to treatment and cure, relapse, or progression into death. Patient information is collected in a structured and secure process from designated catchment areas in each hospital by trained tumor registrars, with the main catchment area being the hospital's Surgical Pathology department. The CARE PH application is given to member hospitals for free through the support of grants given to the CARE PH Foundation, Inc.

Results and discussion: Today, 31 member hospitals in the CARE PH system have recorded a collective total of 9,880 new cancer patients for the year 2020. The most common cancer types recorded in CARE PH for 2020 include breast, colorectal, cervical, and head and neck cancers. In addition, the registry captures a myriad of information that can potentially answer questions relevant to the individual cancer patient and clinicians, and hospital administrators.

Conclusion: HBCRs are an indispensable part of effective cancer control programs as they facilitate making evidence-based decisions that would result in better healthcare for Filipino cancer patients.

Philippines ; Neoplasms ; Epidemiology

Background: Pooled testing has been implemented on a limited scale, mainly for screening and surveillance in populations with a low prevalence of COVID-19 to save on limited resources. Objective: To determine the diagnostic accuracy of pooled compared with individual RT-PCR testing for SARS-CoV-2 in individuals suspected of COVID-19. Methods: We searched websites of living CPGs on COVID-19 (Australian COVID-19, COVID NMA, CEBM Oxford), Philippine DOH HTA, databases (PubMed, CENTRAL, medRXIV/bioRXIV), and Clinicaltrials.gov for studies that used pooled testing on individuals suspected of COVID-19. When appropriate, we pooled data for sensitivity and specificity and obtained the range and median of other data, such as positive predictive value and resource savings. We did a priori subgroup analysis for pool size, presence or absence of symptoms and use case, type of specimen, cutoff for positivity, type of kit, and post hoc subgroup analysis for method of pooling and timing of processing. Results: We included 21 studies: 6 diagnostic accuracy studies, and 15 clinical validation studies. Studies had varying populations, index test kit and performance characteristics, positivity rate (0.02 to 15%), and pool size (5 to 16). There was moderate pooled sensitivity, 81% (95% CI 72, 88; I2=73.6%; 6 studies, 776 pools) and high pooled specificity, 99% (95% CI, 98 to 100; I2=1.84%; 5 studies, 666 pools). Positive predictive value based on 21 studies ranged from 67% to 100%. Resource savings in the number of test kits used ranged from 49 to 89%. Identified harms of pooled testing were delayed turnaround time for positive samples and laboratory errors. Conclusion There is moderate sensitivity and high specificity with pooled testing for the screening of individuals with suspected COVID-19. We recommend further studies to validate the utility based on community prevalence and other test variables.
COVID-19 ; Coronavirus

Epstein-Barr virus positive diffuse large B-cell lymphoma (EBV+ DLBCL) is prevalent among Asians but is underreported in the Philippine setting. We report the case of an 88-year-old male who presented with difficulty swallowing. CT scan showed an ill-defined soft tissue focus with calcifications in the supraglottic to hypopharyngeal region measuring approximately 2.6 x 1.7 x 1.5 cm, and multiple lymphadenopathies in the head and neck. Biopsy of the masses at the left tonsil, left arytenoid mucosa, pyriform sinus, and aryepiglottic fold showed large lymphoid cells with several Reed-Sternberg-like cells in a background of small lymphocytes, neutrophils, few eosinophils and histiocytes. A panel of immunohistochemical stains and EBER-ish were performed to differentiate among six entities that were morphologically similar to the patient’s case, namely, classic Hodgkin lymphoma, T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL), DLBCL, NOS, anaplastic variant, B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classic HL (gray zone lymphoma), and infectious mononucleosis (IM). The neoplastic cells expressed CD20, CD30, CD45, PAX5, CD10, MUM-1, BCL6, BCL2, and c-myc, while CD3, CD15 and ALK-1 were negative. The cells of interest also showed nuclear staining (30-40%) on Epstein-Barr virus encoding RNA in-situ hybridization (EBER-ish). The Ki-67 showed a proliferation index of 40-50%. Given the differences in prognosis and treatment among these diseases, judicious use of immunostains and EBER-ish is recommended for accurate diagnosis.
Immunohistochemistry ; Philippines ; Herpesvirus 4, Human

Background: Social Innovation in Health Initiative Philippines introduced the community engagement self-monitoring strategy in two community-managed social innovations in 2021. Phase 1 demonstrated the strategy's viability by identifying community “local monitors,” selecting indicators, monitoring, and conducting feedback sessions. In 2022, a second phase was implemented to improve the process by integrating capacity-building activities and praxis sessions, and gathering insights on the strategy’s sustainability. Objective: In this paper, we sought to describe the stages of the CE-SM strategy applied within a Philippine local health system in geographically isolated and disadvantaged contexts. Specifically, we: 1) Identified the key competencies of the local CE-SM monitors; 2) facilitated capacity building to strengthen their skills and abilities; 3) explored sustainability mechanisms; and 4) identified integration points of the CE-SM in strengthening local health systems. Methods: Two communities in a rural municipality implementing a social innovation called the “Seal of Health Governance'' were chosen for the expanded community engagement self-monitoring (CE-SM) pilot. Profiling of local monitors and self-assessment of competencies were facilitated. Capacity-building activities were conducted for community engagement, data processing, and data analysis, complemented by praxis sessions guided by people-centered principles. Results: Local monitors from both communities showed determination in performing their responsibilities but differed in their levels of participation. Their appreciation of their role increased as it broadened from merely collecting data to understanding and using it to advocate for their community’s needs. The minimum resources for communities to implement the strategy include financial mechanisms to ensure the availability of resources. Local monitors have improved their ability to analyze their communities' realities, particularly regarding health leadership and governance. Conclusions Community engagement self-monitoring is a feasible and sustainable strategy for monitoring and evaluating health interventions if adequate support is provided and complemented by capacity-building and praxis sessions. It promotes listening to the community and empowering them to participate in decision-making, which are vital in fostering ownership and sustainability of social innovations in health.
Philippines ; Health