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: Anthracycline is a cornerstone in the treatment of various cancers. One major limitation to its use is cardiotoxicity. Renin angiotensin system (RAS) inhibitors have been shown to attenuate myocardial injury, initial data is promising in its use as prophylaxis for anthracyclineinduced cardiotoxicity. The aim of the study is to determine effectiveness of prophylactic RAS inhibitors in preventing anthracycline-induced cardiotoxicity and adverse cardiac events among adult cancer patients

METHODS: Systematic search of databases PUBMED, MEDLINE, EMBASE, and CENTRAL was done. Selection criteria were: 1) randomized controlled trials (RCT) 2) adult cancer patients with normal ejection fraction and without heart failure symptoms 3) RAS inhibitors as prophylaxis versus placebo 4) development of cardiac events, all-cause mortality and left ventricular ejection fraction (LVEF) reduction as outcomes. Two reviewers independently assessed the trials. Disagreements were resolved with a third reviewer. Test for effect of intervention, heterogeneity, trial quality and risk of bias were assessed using the Cochrane Review Manager Software version 5.3.

RESULTS: Five RCTs involving 530 adult patients, with average age of 50± two years old, and average follow-up from six months to three years were included. Combined clinical outcomes of heart failure, cardiac events and all-cause mortality showed an RR of 0.27[95%CI 0.18, 0.40],p<0.00001, in favor of RAS inhibitors. There is same benefit in LVEF preservation with mean difference of 4.37%[95%CI 1.20, 7.55;p=0.007]. Exploratory subgroup analysis showed significant benefit in LVEF preservation with combined RAS inhibitor and beta-blocker, with mean difference of 2.45%[95%CI 1.27, 3.63]. There is overall significant heterogeneity (I2=95%). Excluding one article with high-risk population, after sensitivity analysis, showed same benefit but reduced heterogeneity.

CONCLUSION: Renin angiotensin system (RAS) inhibitors may be used as prophylaxis for cardiotoxicity. As prophylaxis, it reduced the clinical outcome of cardiac events, heart failure, and all-cause mortality among cancer patients needing anthracycline. Combined RAS inhibitor and betablocker limits LVEF reduction.

Human ; Male ; Female ; Cardiotoxicity ; Renin-angiotensin System ; Medline ; Stroke Volume ; Patient Selection ; Follow-up Studies ; Anthracyclines ; Pubmed ; Heart Failure ; Adrenergic Beta-antagonists ; Neoplasms

BACKGROUND: Cancers are among the top causes of mortality in the Philippines. The treatment regimens are also costly and put Filipinos at risk of financial catastrophe. The economic impact, however, has not been documented.

OBJECTIVE: This analysis aimed to describe the economic impact of cancer in the Philippines and analyze predictors of financial catastrophe among Filipino cancer patients.

METHOD: The analysis used the dataset from the ASEAN costs in oncology study, a prospective study of adult cancer patients in Southeast Asia. Cancer patients were recruited at time of diagnosis and were monitored in terms of health outcomes, costs, and quality of life. Multinomial regression models were generated to assess predictors of death and financial catastrophe.

RESULTS: Information from 909 respondents in the Philippines was included in the analysis. Overall, 240 (26.4%) of the cohort were dead at the end of the study while 40.6% were still alive at Month 12 but had experienced financial catastrophe. Mean combined Month 3 and Month 12 out-of-pocket expenditure was PhP181,789.00 (n = 458, sd = 348,717.47). Belonging to higher income groups (vs. belonging to the lowest two) was significantly associated with lower risk of financial catastrophe. Insurance did not confer significant change in risk of death or financial catastrophe.

CONCLUSION: Cancer can be a significant economic burden for Filipinos leading to financial catastrophe. Insurance mechanisms at the time of study failed to protect against catastrophe.

Human ; Neoplasms ; Cohort Studies ; Healthcare Financing ; Philippines

Background and Objective: The burden of treatment delay in breast cancer is high, especially among developing countries. Despite adversely affecting morbidity and mortality, treatment delay remains unexplored in the Philippines. This study aimed to determine treatment delays among breast cancer patients in a tertiary hospital during surgery, neoadjuvant chemotherapy, and adjuvant chemotherapy, and to identify predictors of delay. Methods: A cross-sectional study was conducted among breast cancer patients seen between January 1, 2012 to December 31, 2018. The following outcomes were investigated: ≥90 days from initial diagnosis to surgery, ≥8 weeks from diagnosis to initiation of neoadjuvant chemotherapy, and >120 days from diagnosis to initiation of adjuvant chemotherapy. Summary statistics were reported as percent for categorical data and as mean for continuous data. The individual correlations were performed using Chi-square for qualitative data and t-test for quantitative data while predictors were determined through logistic regression. Results: A total of 324 patients were included in this study. The majority of the patients were less than 65 years old living in urban areas. More than half of the patients were overweight or obese, hypertensive, and diabetic. The following delays were observed: 61.1% (n = 198) with any type of delay, 23.8% (n = 53) with delay in surgery, 53.8% (n = 120) with delay in adjuvant chemotherapy, and 74.3% (n = 75) with delay in neoadjuvant chemotherapy. The patients noted to have any type of delay were more likely to be hypertensive (p = 0.046) and residing in urban areas (p = 0.041). There were no differences in the distribution of age, body mass index, and presence of co-morbid conditions such as hypertension, diabetes mellitus, coronary artery disease, and heart failure among those with any form of delay compared with no delay. Conclusions The present study shows the presence of treatment delay among breast cancer patients and may be used to enact policy changes to optimize breast cancer care delivery. Further studies may be done to identify other factors affecting these delays and policy changes are recommended to address these gaps in surgery and chemotherapy administration among breast cancer patients.
breast cancer ; quality of care ; treatment delays