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: The special needs of cancer patients offer unique challenges in treating them for venous thromboembolism (VTE). Dabigatran is a novel oral anticoagulant (NOAC) that may be comparable to warfarin in clinical benefit and risks of bleeding. A meta-analysis and systematic review was performed to compare efficacy of prevention of VTE recurrence and risks of bleeding with dabigatran compared to warfarin. Methods: Randomized-controlled trials (RCTs) from various sources comparing dabigatran with warfarin for the prevention of recurrence of VTE were then retrieved and analyzed. The efficacy outcomes looked into was recurrence of VTE and mortality related to VTE while the primary safety outcome looked into was major bleeding. Results: This meta-analysis, which included the studies, RECOVER I, RECOVER II, REMEDY showed that VTE and VTErelated deaths occurred in six out of 174 (3.4%) of cancer patients treated with dabigatran while four out of 166 (3.6%) cancer patients treated with warfarin with a relative risk of 1.44 with a 95% CI of 0.41, 5.03 showing no significant difference between dabigatran and warfarin. The REMEDY trial included a total of 60 cancer patients from a total of 1,430 patients in the dabigatran group versus 59 cancer patients from a total of 1,426 patients in the warfarin group. Under the outcome of major bleeding event, among all patients who received dabigatran, 13 patients had major bleeding events, while among those who received warfarin, 25 patients had major bleeding events with a hazard ratio of 0.52 and 95% CI of 0.27-1.02. With the RECOVER I, and RECOVER II, among cancer patients analysed, four patients of the 105 who received dabigatran had major bleeding; while three of the 100 patients who received warfarin had major bleeding with a HR of 1.23 (95% CI of 0.28-5.5). Conclusion The authors conclude that dabigatran is comparable to warfarin in the prevention of recurrence of VTE among cancer patients in terms of both benefits and risks.
Venous Thromboembolism ; Neoplasms