Introduction: Colorectal cancer is a common malignancy. Emotional, social, financial difficulties and physical symptoms due to disease and treatment impair the quality of life (QoL) of cancer patients. This study assesses the over-all QoL of colorectal cancer stoma patients at the Cancer Institute, Philippine General Hospital (PGH-CI). Method: This is a cross-sectional study. Patients at the medical oncology inpatient/ outpatient charity clinic of the PGH-CI who underwent surgical resection and colostomy, and upon full consent, answered a 33-item QoL scale questionnaire (English/Filipino) covering 5 subset s : physical wellness , emotional wellness ,socioeconomic status, cognitive ability and self-care. Sociodemographic data were gathered from medical records and interview. Data analysis was done using STATA v6. Results: One hundred seventeen patients answered the University of the Philippines-Department of Health (UPDOH) QoL questionnaire (100% response rate). Majority were males (69%), married (79%), with rectal cancer (59%), stage IIB (36%), aged 41-50 yrs. old (26%). Twenty-eight percent were employed in sales/ service but 91% were unemployed at the time of study. All patients underwent surgery and colostomy, 36% chemotherapy alone and 16% chemoradiotherapy. Overall, QoL was high for physical, social and cognitive dimensions . Emotional and self - care dimensions were moderate. Males had high over-all QoL versus moderate among females, especially cognitive dimension. Colorectal cancer patients reported moderate over-all QOL with all dimensions having similar scores. Patients with cancer of 6-12 months and >12 months exhibited high over-all QoL scores while those with cancer of <6 months had moderate over-all QoL scores, reflected in physical, emotional and cognitive dimensions. Conclusion: Colorectal cancer patients at the PGH-CI have high quality of life. Patients with early and locally advanced disease had better QoL, regardless of tumor site and sex. Patients with longer disease duration scored higher in over-all QoL, physical, emotional and self-care dimensions.

INTRODUCTION: Over the last two decades, psychosocial research has explored the experience of cancer patients. This study evaluated if demographic, socio-economic and cancer-specific factors impact and correlate with quality of life (QoL) scores at the time of first consult of newly-diagnosed cancer patients seen at medical oncology clinics of the University of the Philippines¬Philippine General Hospital (UP-PGH) Cancer Institute from 2012-2013.
METHODS: Review of charts and interview with a pre-approved and validated questionnaire were done after informed consent. Age, gender, marital status, number of close friends, household income band, employment status, cancer site and stage were recorded. Outcomes were cancer-specific QoL EORTC QLQ-C30 questionnaire and generic QoL EQ5D questionnaire. Scores were correlated with demographic, socio-economic, and cancer¬specific factors.
RESULTS: 535 patients were included, 257 male and 278 female. Mean age was 52 years (SD 13.5 years; range20-92 years). Majority (28.7%) belonged to income bracket P4,293-P8,583/month. Majority were married (74.31%) and unemployed (58.4%). Top 5 cancers were colorectal (28.09%), breast (20.70%), head and neck (16.63%), lung (9.97%), lymphoma (7.94%). According to EORTC QLQ-C30, physical functioning (p=0.0037) and cognitive functioning (p=0.003) were significantly correlated with younger patients while role functioning (p=0.04) and emotional functioning (p=0.03) showed negative correlation with older patients. Fatigue was less in female patients (p=0.0005) while being the household head (p=0.0005) was significantly correlated with increased fatigue. According to EQ5D, single patients (p=0.016) had better mobility than the rest of patients. Having 5  family members significantly reported less pain (p=0.038). Breast cancer patients had best QOL while bladder cancer patients had the worst QOL. As cancer stage increased, QOL decreased.
CONCLUSION: This is a first baseline study on self-reported QOL among newly-diagnosed Filipino cancer patients, an important relevant reference in the field of psychosocial issues among low-resourced cancer patients in the Philippines.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Quality Of Life ; Marital Status ; Lymphoma ; Neoplasms ; Patients ; Philippines

INTRODUCTION: A promising strategy for HER2-negative metastatic breast cancer (mBC) is to target the veascular endothelial growth factor receptor using bevecizumab. Several randomized controlled trials (RCTs) have consistently demonstrated improvement in progression-free survival (PFS).
METHODS: This meta-analysis was undertaken to determine the added benefit of bevacizumab (BV) to chemotherapy in HER2-negative locally recurrent and mBC. RCTs that compared the efficacy and safety of BV+chemotherapy to placebo+chemotherapy in the first- or second-line setting were selected. The primary outcome was PFS. The secondary outcome measures were overall survival (OS) and objective response rate (ORR). Analysis of safety was done by pooling grades 3-5 toxicities. Four RCTs were included in the meta-analysis: E2100, AVADO, RIBBON-1, and RIBBON-2.
RESULTS: The use of BV+chemotherapy showed statistically significant improvement in PFS (HR 0.73 [0.65, 0.82] 95% Cl, p<0.0001); subgroup analysis of triple-negative breast cancer (TNBC) also showed statistically significant increase in PFS (HR 0.56 [0.47, 0.67] 95% Cl, P<0.00001). The ORR was statistically significant with a risk ratio of 1.36 in favour of BV (P<0.00001). OS did not reach statistical significance (HR 0.85 [0.56, 1.27] 95% Cl, p=0.42). Grades 3-5 toxicities were consistently higher in the BV arm with a risk ratio of 1.90 (p<0.00001).
CONCLUSION: BV prolongs PFS and increases ORR in patients with HER2-negative locally-recurrent and mBC. OS was comparable in both arms. Toxicities significantly increased with the addition of BV to chemotherapy, but fatal reactions were rare in all four trials. The addition of BV to conventional first- or second-line chemotherapy is justified in TN mBC since there is still no standard treatment fot this. 

Progression Free Survival ; Bevacizumab ; Breast Neoplasms ; Risk Ratio ; Arms

INTRODUCTION: The difficulty of obtaining accurate and reproducible assessment of HER2 status in the Philippines, despite the predictive value of the test for HER2 positive breast cancer patients, may be sufficiently addressed if an effective multidisciplinary approach to HER2 testing is carried out. This may be accomplished by identifying disparities and similarities in HER2 testing for breast cancer.
METHODS: This is a cross-sectional study which included medical oncologists who had used trastuzumab for HER2-positive patients. Surgeons, who belonged to the same tertiary hospital as the medical oncologists were also interviewed. The survey questionnaires were administered via face-to-face, mail, or fax. Responses were kept confidential. Questionnaire responses were analysed using summary statistics.
RESULTS: There were 35 medical oncologists and 37 surgeons - 93% stated that all women diagnosed with breast cancer should be tested for HER2 at the point of diagnosis; 61% stated that the greatest barrier to initiating HER2 testing was inadequate patient funds. 57% medical oncologists and 65% surgeons believed that HER2 testing for all breast cancer patients at the point of clinical diagnosis was being observed at their hospital. 69% stated that medical oncologists or surgeons should request for HER2 test whoever saw the patients first; 59% stated that whoever saw the patient first provide the patient information about HER2 testing whereas 28% stated it is the medical oncologist who should provide information about HER2 testing. 47% medical oncologist and 63% surgeons stated that surgeons should arrange for breast tissue sample collection; 27% medical oncologists and 20% surgeons stated that pathologists should do this.
CONCLUSION: Medical oncologists and surgeons were similar in the opinion that all women diagnosed with breast cancer should be tested for HER2 at the point of diagnosis, financial capability was the greatest barrier for initiating HER2 testing, and whoever saw the patient first should provide patient education. There was disparity on who should request and who should arrange for tissue collection.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Philippines ; Breast Neoplasms ; Oncologists ; Surgeons ; Surveys And Questionnaires

INTRODUCTION: In the Philippines, lung, breast, colon-rectum, and oral cavity cancers are among the top 10 most common cancers. This study evaluates the risk factors for these cancers among Filipinos.

METHODS: This age-matched case-control study included incident primary cancers (histologically-diagnosed) of the lung, breast (also matched for sex), colon-rectum and oral cavity. Controls (clinically free and no history of cancer) were obtained from the same tertiary hospitals as the cases. Target sample size was 283 cases and 283 controls per cancer type. Conditional logistic regression was done.

RESULTS: Exposure to cigarette/tobacco was a significant risk factor for lung (OR of current smoker compared to non-smoker [95% Confidence Interval]: 3.6 [1.6-7.9]) and oral cavity cancers (2.0 [1.2-3.3]); family history (1st degree) for lung (4.3 [1.314.2]) and breast cancers (3.0 [1.2-7.5]); every year increase in age at first pregnancy for breast cancer (1.06 [1.02-1.11]). Other risk factors for oral cavity were passive smoking (2.8 [1.6-5.1]), chewing tobacco (5.2[1.4-19.5]) and inverted cigarette smoking (3.2[1.3-8.1]). Fish sauce (patis) was found to be a protective factor for breast cancer (0.34 [0.22-0.51]) and oral cavity (0.44 [0.25-0.78]) and use of shrimp paste (bagoong) (0.48 [0.27-0.84]) for oral cavity.

CONCLUSION AND RECOMMENDATIONS: Except for family history of cancer, the identified risk factors for lung, colon-rectum, and oral cavity cancers are preventable. Proper diet and lifestyle, avoidance of cigarettes and tobacco, and environmental safety in the workplace are key cancer prevention measures. Public awareness campaign and continuing healthcare provider education must always be part of a cancer prevention program.

Pregnancy ; Tobacco ; Tobacco, Smokeless ; Tobacco Smoke Pollution ; Cigarette Smoking ; Rectum ; Smokers ; Smoking ; Breast Cancer 3 ; Breast Neoplasms ; Mouth Neoplasms ; Health Personnel ; Colon

INTRODUCTION: A multidisciplinary approach is essential to optimize patient care. In the practice of oncology, surgeons, medical oncologists, and pathologists are essential for the histology-based diagnosis of cancer patients. In breast cancer, hormone receptor and HER2 positivity are both predictive and prognostic, and so testing for these has been strongly recommended for every newly diagnosed breast cancer patient. A unique but meaningful information that can be provided by medical oncologists, as customers, is their satisfaction to the services (e.g. HER2 testing) and product (e.g. reports) of the pathology laboratory. Any quality initiative effort to improve HER2 testing can also be extended to hormone receptor (ER/PR) testing. This study measures the general satisfaction of medical oncologists practicing in Metro Manila with local HER2 testing services and reports.
METHODS: This cross-sectional study had survey questionnaires distributed to medical oncologists practicing in Metro Manila chosen on the basis of their considerable experience with requesting HER2tests and with the use of anti-HER2 therapy in their management of breast carcinoma patients. Demographics, practice information, rating of satisfaction per laboratory service category, and a checklist of elements of IHC/FISH reports were collected.
RESULTS: 32 medical oncologists participated in the survey, most of whom were from tertiary hospitals. Breast carcinoma cases make up around 26-50% of cancer cases in their practice. More than half request HER2 testing for their breast cancer patients. Medical oncologists are generally satisfied with the services for IHC and FISH HER2 testing (composite scores >2) provided by the laboratories. Overall, medical oncologists were very satisfied with diagnostic accuracy and completeness of relevant information in the report. Laboratory services were mostly rated good, with the exception of pathologists' responsiveness to problems and notification of equivocal results. For both IHC and FISH, patient/physician identification, date of service, specimen identification/ site/ type, results, and interpretation were reported to be included in the reports. However, time to/duration of/ type of fixation, method and image analysis method, antibody clone/ vendor, and comment that an FDA-approved method was used, were reported missing by the many.
CONCLUSION: For both IHC and FISH, overall satisfaction was found to be moderately directly correlated with diagnostic accuracy. In a country like the Philippines where quality initiatives of laboratories may still be far from ideal, medical oncologists can demand inclusion of their preferences into assessments processes by laboratories and correct assumptions of laboratory managers as to what element of the services and products they value most. Measurement of customer satisfaction can be integrated into the quality assurance programs of laboratories and corresponding hospitals.  

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Patient Care ; Oncologists ; Surgeons ; Breast Neoplasms ; Surveys And Questionnaires ; Pathologists

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

BACKGROUND: Health-related quality of life is an important aspect of cancer research. Studies in the Philippines documenting this among survivors are limited in scope and number.
OBJECTIVE: To document quality of life indicators of Filipino cancer survivors starting at 12 months from diagnosis and identify predictors of these changes.
METHODS: The ACTION study is a prospective longitudinal study examining the economic and health impact of cancer in the Southeast Asian Region. A country-specific analysis for Filipino patients was conducted.
RESULTS: Of the 909 Filipinos included in the study, 462 survived month 12 and had health-related quality of life (HRQoL) data. HRQoL data showed significant improvement from baseline (0.73, SD: 0.15) to month 12 (0.79, SD: 0.24) as measured by the EQ-5D weight score. Similar trends were seen in the EQ5D VAS Scores and the QLQ30 Global function scores. There was, however, an increase in the proportion of respondents experiencing significant problems related to EQ5D domains by month 12. Data disaggregated according to cancer type showed a decrease in QLQ30 GF scores from baseline to month 12 for all types except breast cancer. Individuals at risk of anxiety and depression increased from 15.37% to 25.54% and 18.83% to 32.25%, respectively. Predictors of worsening HRQOL include experiencing economic hardship, progression of disease, and higher stage at baseline.
CONCLUSION: HRQOL scores were found to increase despite experiencing more difficulties in function among Filipino cancer survivors one year after diagnosis.

Human ; Male ; Female ; Adult ; Depression ; Quality Of Life ; Survivors ; Anxiety ; Surveys And Questionnaires ; Depressive Disorder ; Breast Neoplasms

INTRODUCTION: Cost has become a limiting factor for indigent breast cancer patients at the Philippine General Hospital (PGH). The Department of Health-Philippine Cancer Society Inc (DOH¬PCSI) Access Program for Breast Cancer Medicine provided free chemotherapy through a patient navigation system in PGH starting January 2012 to improve breast cancer treatment quality. This study looked into the differences of quality care in the non-metastatic setting among enrolled patients in the first 6 months compared to patients outside of the program from 2011-2012.
METHODS: This retrospective cohort used follow-up rates and 19 quality care indicators linked to improved outcomes to look into quality of care among patients who were enrolled (n=58) and those who were not (n=118 for 2011 and 2012). Subgroup analyses compared patients in the program and those who were not included in the same period (n=28). Another analysis compared 2011 patients (n= 90) with those in 2012 (n=86). Z¬test for the difference of proportions was done.
RESULTS: Attrition rate decreased from 62% in 2011 to 18% in 2012 (p<.0001). There was a significant improvement in 12 quality care indicators in the program (95% Cl), with the greatest differences in the initiation of treatment (58.7%) and appropriate neo-adjuvant chemotherapy administration (58.3%). Similar trends were seen in the subgroup analyses.
Conclusion. The DOH-PCSI Access Program for Breast Cancer Medicine program improved care among breast cancer patients in PGH, noted as early as within its first six months.

Human ; Male ; Female ; Breast Neoplasms ; Patients ; Drug Therapy ; Breast ; Philippines

INTRODUCTION: Current international consensus confirms that certain histopathologic factors such as tumor morphology, histologic grade and presence of lymphovascular invasion are correlated with prognosis. This retrospective cohort study evaluated the correlation between histopathologic profile and time to disease progression (UP) within the first 1-2 years follow-up of Filipino Stage I-Ill early breast cancer patients.
METHODS: This is a retrospective cohort study which included breast cancer patients enrolled in the Department of Health¬Breast Cancer Medicine Access Program (DOH-BCMAP) at the medical oncology clinics of two tertiary hospitals in Manila. Clinical and histopathologic factors were gathered from patient records, and the patients were grouped according to the modified St. Gallen definition of risk categories for patients with breast cancer. Kaplan-Meier survival analysis determined the average UP as well as progression-free survival (PFS). Multivariate logistic regression determined factors contributing to disease progression.
RESULTS AND CONCLUSION: Of the 326 patients enrolled in this study, 18% showed progression, with a median HP of 14 months. UP was comparable among the low-, intermediate- and high-risk groups. PFS during the 1st 1-2 years follow-up was estimated to be at 78% for the high-risk group, 83% for the intermediate-risk group, and 86% for the low-risk group. During this 1st 1-2 years follow-up, no studied factors of interest were shown to be significantly correlated with outcome among this predominantly intermediate to high risk for recurrence breast cancer patients. Follow-up of this patients up to 5 or more years would define sustained gains from the DOH-BCMAP.

Human ; Male ; Female ; Breast ; Breast Neoplasms ; Consensus ; Neoplasms ; Prognosis ; Medical Oncology