BACKGROUND

The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer.

OBJECTIVE

The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices.

METHODS

This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12.

RESULTS

A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed.

CONCLUSION

The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.

Human ; Therapeutics ; Survival ; Patients ; Neoplasms ; Philippines ; Health Expenditures ; Breast Neoplasms

BACKGROUND

The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer.

OBJECTIVE

The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices.

METHODS

This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12.

RESULTS

A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed.

CONCLUSION

The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.

Human ; Therapeutics ; Survival ; Patients ; Neoplasms ; Philippines ; Health Expenditures ; Breast Neoplasms

Introduction: The coronavirus disease 2019 (COVID-19) have spread globally and reached the Philippines in late January 2020. This study is the first local and nationwide research on admitted COVID-19 adult patients: their clinic-demographic profiles, managements, and clinical outcomes. We aim to determine the associated factors with mortality among COVID-19 patients. Methods: This was a retrospective, multicenter, observational cohort study of rt-PCR confirmed and admitted COVID-19 adult patients in 89 hospitals in the Philippines from February to July, 2020. The data on admission of patient’s demographic, clinical, laboratory, pre-hospital and during hospital treatment management and in-hospital clinical outcomes were gathered. The data were described and analyzed using multiple logistic regression analysis. Results: There were 2884 rt-PCR confirmed and admitted COVID-19 adult patients included in the study. Majority were Filipinos (99·4%), with slightly more males (54.4%) than females. 21% were healthcare workers (HCWs). Mortality was higher among non-HCWs at 16% versus 2% among HCWs. 63% of the patients had a co-morbidity, which included hypertension (69%), diabetes mellitus (48%) and chronic kidney disease (26%). The significantly associated factors with mortality in this Philippine cohort were: age >60 years, hypertension as co-morbidity, tachypnea (> 22/minute), WBC count > 10 x 109 /L, and elevated serum lactate dehydrogenase (LDH) (all p<0.05). Elevated serum LDH was the strongest factor associated with mortality (OR of 8.74, p=0.004). Conclusion This study identified that age, hypertension, tachypnea, elevated WBC count, and elevated serum LDH were associated with mortality among COVID-19 adult patients and results were consistent with results from studies done in other countries. We recommend that early detection and awareness of exposures and symptoms will improve the management and clinical outcomes of COVID-19 adult patients. Also, a long follow-up of the outcomes of COVID-19 to determine the effectiveness of treatment is recommended for further study.
Philippines ; Mortality

INTRODUCTION: Colo-cutaneous fistula is a very rare complication of colonic diverticular disease, occurring in approximately one percent of cases either spontaneously or after surgical or drainage procedure. Herein we describe a patient with a colo-cutaneous fistula from the sigmoid to the appendiceal stump in a post-appendectomy patient which also exits to the skin at the post-operative site. CASE PRESENTATION: The patient is a 76-year-old Filipino male who had appendectomy five months earlier and a history of diverticulitis, and presented with a subcutaneous abscess at the post-operative site. The abscess was drained, a colocutaneous fistula was radiographically established, and the surgical site was explored. Intraoperative findings showed the presence of multiple colonic diverticuli and a sigmoidcutaneous fistula on the right lower abdominal quadrant. Interestingly, an incidental descending colon mass was also noted at the splenic flexure measuring approximately 2x3 cm to which frozen section revealed adenocarcinoma which was not seen in pre-operative CT scans. An extended left hemicolectomy was performed, and no postoperative complications were noted. At present three years later, he fares well without any signs and symptoms of the disease. CONCLUSION: Diverticulitis is a common condition in the older age group that needs to be considered in patient management. Colo-cutaneous fistula may be a rare complication of the disease but should be part of our differentials as internists in working up patients presenting with persistently draining superficial wound that either occurs spontaneously or post-operatively. Patients with diverticulitis also have increased risk of colorectal cancer and diagnostic imaging may not always differentiate the two entities, thus colonoscopy should be done if possible.
Cutaneous Fistula ; Diverticulitis ; Colon

Introduction: Febrile neutropenia (FN) is a common complication of immunocompromised patients – whether due to infection, cancer, drug-induced, or other bone marrow failure states. With the incidence of patients with immunocompromised states on the rise, this life threatening complication is also increasing. The importance of initiating the appropriate empiric antibiotic therapy can prove to be lifesaving, thus we examined how the initial choice of antibiotics influenced patient outcomes. This study aims to determine the effect of adherence to guideline-based antimicrobial therapy for adult febrile neutropenia patients in terms of patient outcomes. Methods: This is a 10-year cross-sectional analytical study which was conducted at the Dr. Pablo O. Torre Memorial Hospital (DPOTMH) by doing a retrospective chart review involving adult patients with FN from 2007 to 2016. We determined use of guideline-based antibiotics, examined the factors that influenced adherence, and investigated the effect of initial treatment on patient outcome. Results: Among the 257 adult patients with FN included in the study, Infectious Diseases Society of America (IDSA) guideline-based antibiotics were administered to 65%. On multivariate analysis, the most powerful predictor of adherence to guideline-based antibiotics was the type of risk (p=0.000), with high risk patients thrice more likely to be given guideline-based antibiotics. Other predictors were physician specialty (p=0.036) and hematologic malignancy (p=0.045). This study showed that among low risk patients with FN, a trend towards patient discharge was observed (OR 1.18, CI=0.16–8.63). However overall, adherence to guidelinebased empiric antibiotic in treating adult FN patients did not correlate to patient discharge (p=0.134, OR 0.557, 95% CI=0.260-1.205). Conclusion Our data suggest that adherence to guidelinebased antibiotics in managing adult Filipino patients with febrile neutropenia does not correlate to better outcomes such as patient discharge. Significant factors associated with adherence to guideline-based antibiotics are physician specialty, hematologic malignancy, and type of risk.
Guideline ; Anti-Bacterial Agents ; Febrile Neutropenia ; Neoplasms ; Patients