OBJECTIVES

The aim of the study is to estimate the cost of breast cancer diagnosis, treatment, and management in the Philippines. Specifically, it aims to identify the resource requirements and interventions related to breast cancer diagnosis, treatment, and management, measure resource volumes (number of units), learn to value resource items (unit costs), and determine the total cost of treatment per disease stage.

The study covered nine tertiary hospitals, seven of which were government hospitals and two were private hospitals, with all tertiary hospitals providing breast cancer services and accredited by Philippine Health Insurance Corporation (PHIC or PhilHealth) for the Z-Benefit Package. Interventions and services related to breast cancer included radiographic procedures, laboratory and imaging tests, chemotherapy drugs and medications, medical and surgical supplies, surgical rates (for breast surgery), accommodation, staff time and salary/professional fees, and other procedure fees. The study conducted in 2022, examined cost prices of breast cancer interventions and services from stage 1–3B.

Purposive and convenience sampling were used based on PhilHealth accreditation and willingness of hospitals to participate in the study. The study conducted a focus group discussion with oncologists, radiologists, anesthesiologists, and other health care providers to validate the clinical guideline used and to solicit inputs to the costing design, analysis framework, and tools for data collection. Data collection of financial cost information (charge price) was conducted using a set of costing matrices filled out by the various departments of the hospitals. Costs and median rates were calculated across hospitals on diagnostics and imaging tests, surgery costs of both public and private facilities, medical treatment, and radiotherapy.

Breast MRI, Breast Panel, and Chest CT Scan are the top 3 most expensive diagnostic procedures ranging from PhP 8,102.00 to PhP 9,800.00 per procedure. Surgical procedures for breast cancer at private hospitals and public hospitals showed huge differences in costs. The cost of a cycle of chemotherapy ranges from PhP 596.70 to PhP 3,700.00 per session, while the cost of targeted therapy can cost up to PhP 46,394.21 per session. A year of hormone therapy ranges from PhP 3,276.00 with the use of Tamoxifen, and up to PhP 68,284.00 with Goserelin. Aromatase inhibitors such as Anastrozole and Letrozole cost from PhP 18,000 to PhP 36,000, respectively. Multiple cycles depending on the diagnosis are prescribed per patient and used in combination with other chemotherapy medications or other therapies such as targeted therapy and hormone therapy are usually taken daily up to 5 to 10 years. Conventional radiotherapy can cost up to PhP 88,150.00 covering 28 sessions, CT simulation, and CT planning.

This cost study provides relevant information and better perspective on benefit development for the PHIC, policy development for Department of Health on where and how to focus their support for the patient’s financial preparedness to address medical and f inancial catastrophes.

PhilHealth needs to guide the health care providers of their costing method and to develop their own integrated, interoperable, and comprehensive cost data library.

It recommends that the government allocate budget and cover for screening and assessment for earlier stage diagnosis of patients and lower health expenditure costs on cancer treatment.

BACKGROUND AND OBJECTIVE

Medication errors pose substantial risks in hospitals, particularly concerning patient safety. These errors, occurring throughout the medication use process, are one of the most common causes of morbidity and mortality in clinical practice. In the Philippines, there is a lack of evidence on the prevalence and effects of medication errors, emphasizing the need for further investigation. This study evaluated the prescribing, transcribing, and monitoring errors among inpatients under the Pulmonary Medicine Service of the Department of Medicine in the Philippine General Hospital.

This cross-sectional retrospective records review used the total population purposive sampling technique to examine eligible charts of inpatients with asthma and/or COPD from August 1 to December 31, 2022. The frequency, type, and severity of medication errors were determined. Linear regression and Cox proportional hazards models were used to examine the relationship between patient-related factors and medication errors, and length of hospital stay and mortality.

Fifty (50) out of 226 medical records were processed and analyzed. Included patients were predominantly older male adults. More than two-thirds of the patients were diagnosed with COPD while approximately one-fourth suffered from asthma. All patients were practicing polypharmacy and the vast majority presented with comorbidities. A total of 6,517 medication errors, predominantly prescribing errors (99.1%), were identified. Despite the high prevalence of medication errors, the majority were classified as “error, no harm” (98.8%), while only 1.17% were deemed as “error, harm.” As the frequency of prescribing errors increases in the power of three (rough approximation of e), from 1 to 3 to 9 to 27, etc., the expected hospital stay increases by 2.078 days (pCONCLUSION

All eligible patient charts had at least one medication error, with the majority being prescribing errors. Among the variables, prescribing errors significantly affected the length of stay, while severity of transcribing errors had a marginally significant effect. It is essential to develop comprehensive education and training initiatives and adopt a systematic approach to mitigate medication errors and promote patient safety.

BACKGROUND

Since the advent of chemotherapy, cure rates for gestational trophoblastic neoplasia (GTN) have improved significantly. With increased survival, patients must cope with long-term sequelae of their treatment, including early menopause. Unlike natural menopause, treatment-induced menopause may cause a sudden and dramatic decline in estrogen, which can lead to more severe symptoms.

This study aimed to evaluate the prevalence of menopausal symptoms among young GTN survivors and to determine the impact of these symptoms on their health-related quality of life (QoL).

Ninety GTN survivors (RESULTS

A total of 90 patients were enrolled in the study with a mean age of 33.06 years. Majority (81.1%) reported at least one menopausal symptom. The most prevalent symptoms were psychological symptoms, followed by somatic, then urogenital problems. Among those with an intact uterus, 8.2% reported permanent amenorrhea. Only Stage III/IV and the presence of total hysterectomy were significantly associated with menopausal symptoms. The presence of menopausal symptoms was significantly associated with poorer health-related QoL among the respondents.

Menopausal symptoms are prevalent among young GTN survivors, and these negatively affect their health-related QoL. Emphasis should be placed on recognizing and addressing these symptoms. Adjunctive procedures, especially hysterectomy, should be carefully considered because these are significantly associated with menopausal symptoms.

BACKGROUND

With the increasing cancer burden in the country, nurses’ exposure to chemotherapy is inevitable as they belong to the workforce responsible for its preparation, administration, and disposal. These drugs are hazardous and necessitate special precautions to avoid direct exposure. Essentially, their competency must be aligned with the recommended safety guidelines to maintain quality patient outcomes while ensuring their safety.

The primary aim was to determine the competency level of Oncology nurses in terms of knowledge, skills, and attitude. The results were used to develop a training program framework for competency enhancement.

A descriptive correlational quantitative study was utilized. The study was conducted from December 2023 to February 2024 across three regions in Luzon, Philippines. The study included 203 Oncology nurses who fit the inclusion criteria. Data were collected via a four-part online questionnaire. Data were analyzed using frequency distribution, mean, standard deviation, and Pearson and Spearman correlation coefficients.

Oncology nurses exhibited excellent knowledge (x̄ = 16.18) and skills (x̄ = 3.86) but only fair attitudes (x̄ = 2.92). Knowledge correlated negatively with skills (ρs = -0.45, pCONCLUSIONS

Oncology nurses demonstrate comprehensive knowledge and accurate and efficient skills but maintain a neutral attitude toward handling chemotherapeutic drugs. These results relate to the complex interplay between the competency dimensions. There are still gaps and areas needing improvement that should be addressed and supported to align their competencies, especially along the skills and attitude dimensions. Training programs anchored on evidence-based practices and regulatory standards, and promoting a favorable practice environment are vital for their competency development.

OBJECTIVES

The aim of the study is to estimate the cost of breast cancer diagnosis, treatment, and management in the Philippines. Specifically, it aims to identify the resource requirements and interventions related to breast cancer diagnosis, treatment, and management, measure resource volumes (number of units), learn to value resource items (unit costs), and determine the total cost of treatment per disease stage.

The study covered nine tertiary hospitals, seven of which were government hospitals and two were private hospitals, with all tertiary hospitals providing breast cancer services and accredited by Philippine Health Insurance Corporation (PHIC or PhilHealth) for the Z-Benefit Package. Interventions and services related to breast cancer included radiographic procedures, laboratory and imaging tests, chemotherapy drugs and medications, medical and surgical supplies, surgical rates (for breast surgery), accommodation, staff time and salary/professional fees, and other procedure fees. The study conducted in 2022, examined cost prices of breast cancer interventions and services from stage 1–3B.

Purposive and convenience sampling were used based on PhilHealth accreditation and willingness of hospitals to participate in the study. The study conducted a focus group discussion with oncologists, radiologists, anesthesiologists, and other health care providers to validate the clinical guideline used and to solicit inputs to the costing design, analysis framework, and tools for data collection. Data collection of financial cost information (charge price) was conducted using a set of costing matrices filled out by the various departments of the hospitals. Costs and median rates were calculated across hospitals on diagnostics and imaging tests, surgery costs of both public and private facilities, medical treatment, and radiotherapy.

Breast MRI, Breast Panel, and Chest CT Scan are the top 3 most expensive diagnostic procedures ranging from PhP 8,102.00 to PhP 9,800.00 per procedure. Surgical procedures for breast cancer at private hospitals and public hospitals showed huge differences in costs. The cost of a cycle of chemotherapy ranges from PhP 596.70 to PhP 3,700.00 per session, while the cost of targeted therapy can cost up to PhP 46,394.21 per session. A year of hormone therapy ranges from PhP 3,276.00 with the use of Tamoxifen, and up to PhP 68,284.00 with Goserelin. Aromatase inhibitors such as Anastrozole and Letrozole cost from PhP 18,000 to PhP 36,000, respectively. Multiple cycles depending on the diagnosis are prescribed per patient and used in combination with other chemotherapy medications or other therapies such as targeted therapy and hormone therapy are usually taken daily up to 5 to 10 years. Conventional radiotherapy can cost up to PhP 88,150.00 covering 28 sessions, CT simulation, and CT planning.

This cost study provides relevant information and better perspective on benefit development for the PHIC, policy development for Department of Health on where and how to focus their support for the patient’s financial preparedness to address medical and f inancial catastrophes.

PhilHealth needs to guide the health care providers of their costing method and to develop their own integrated, interoperable, and comprehensive cost data library.

It recommends that the government allocate budget and cover for screening and assessment for earlier stage diagnosis of patients and lower health expenditure costs on cancer treatment.

Rationale/Objective: Neoadjuvant chemotherapy (NAC) is recommended for locally-advanced breast cancer (LABC) to improve resectability and provide in-vivo tumor response assessment. This study aimed to describe the clinical and pathologic tumor response of LABC patients after response-guided NAC. Methods: This is a retrospective cohort analysis of 128 LABC patients who underwent NAC using sequential doxorubicin/cyclophosphamide (AC) – docetaxel (T) regimen at the Philippine General Hospital Breast Care Center. Clinical and pathologic response rates were analyzed according to clinicopathologic variables including tumor intrinsic subtype. Results: Objective clinical response (complete and partial) was observed in 88% (111/128) of patients with 11% (14/128) achieving pathologic complete response (pCR). The hormone receptor-negative/ Her2-enriched (HR-/Her2+) subtype had the highest pCR rate (23.5%) followed by triple negative subtype (HR-/Her2-) at 19%. The hormone receptor-positive/Her2-positive (HR+/Her2+) subtype had the lowest pCR (4.7%). Two patients with initial poor response to AC but had good response upon shifting to T achieved pCR. Twelve patients (9.4%) had poor response to AC and T chemotherapy. Patients who were pre-menopausal (p=0.04), had ductal histology (p=0.03), with a HR-/Her2- (p=0.002) or HR+/Her2+ subtype (p=0.03) had good response to AC. Intrinsic subtype was not significantly associated with treatment response in those who received docetaxel. There was strong association between the pathologic and clinical responses (Spearman’s Rho score 0.69, p-value <0.0001). Conclusion Clinical and pathologic response to NAC was highly dependent on tumor subtype. Clinical response was predictive of pathologic response. Response-guided NAC allowed direct and early evaluation of tumor treatment response that allowed for treatment modifications.
Breast Neoplasms ; Neoadjuvant Therapy ; Drug Therapy

Objective: To compare the efficacy and safety of the combination of Dexmedetomidine (Dex) and Ketamine (Ket) administered via the intranasal (IN) route on sedation of children aged 0 to 12 years old prior to elective surgery or procedural sedation as compared to Intranasal Dexmedetomidine. Methods: Relevant studies were identified after a literature search on electronic databases as PubMed, Cochrane Library, Google Scholar and Science Direct. Meta-analyses of mean differences were performed to examine differences in sedation onset and recovery times between IN Dex-Ket and IN Dex. Meta-analyses of proportions were performed to estimate the incidence of sedation success, satisfactory sedation at parental separation and mask induction, and incidence of adverse events. Review Manager 5.4.1 was used for statistical analysis. Results: Six articles (388 patients) were included. The overall incidence of sedation success was higher among children premedicated with IN Dex-Ket (RR = 1.05; 95%CI = 0.97,1.13; P = 0.27, I2 = 20%) however was not statistically significant. Children given IN Dex-Ket had faster sedation onset time (WMD = -7.17; 95%CI = -12.44, -1.89; P=0.008) with greater incidence of satisfactory sedation at mask induction (RR = 0.71; 95%CI = 0.53, 0.94; P = 0.02). There was no significant difference as to recovery time and incidence of adverse events among the groups. Conclusion Premedication with IN Dex-Ket is as safe as IN Dex but of better efficacy as evidenced by faster sedation onset time and smoother inhalational induction without increasing clinically relevant adverse events.
Dexmedetomidine ; Ketamine ; Premedication

Background and Objective: Medication errors pose substantial risks in hospitals, particularly concerning patient safety. These errors, occurring throughout the medication use process, are one of the most common causes of morbidity and mortality in clinical practice. In the Philippines, there is a lack of evidence on the prevalence and effects of medication errors, emphasizing the need for further investigation. This study evaluated the prescribing, transcribing, and monitoring errors among inpatients under the Pulmonary Medicine Service of the Department of Medicine in the Philippine General Hospital. Methods: This cross-sectional retrospective records review used the total population purposive sampling technique to examine eligible charts of inpatients with asthma and/or COPD from August 1 to December 31, 2022. The frequency, type, and severity of medication errors were determined. Linear regression and Cox proportional hazards models were used to examine the relationship between patient-related factors and medication errors, and length of hospital stay and mortality. Results: Fifty (50) out of 226 medical records were processed and analyzed. Included patients were predominantly older male adults. More than two-thirds of the patients were diagnosed with COPD while approximately one-fourth suffered from asthma. All patients were practicing polypharmacy and the vast majority presented with comorbidities. A total of 6,517 medication errors, predominantly prescribing errors (99.1%), were identified. Despite the high prevalence of medication errors, the majority were classified as “error, no harm” (98.8%), while only 1.17% were deemed as “error, harm.” As the frequency of prescribing errors increases in the power of three (rough approximation of e), from 1 to 3 to 9 to 27, etc., the expected hospital stay increases by 2.078 days (p <0.001) (e.g., 32 = 9 errors with LOS of around 4 days); meanwhile, more severe transcribing errors increase the length of stay by 4.609 days (p = 0.034) All independent variables were noted to have a lack of significance and thus no meaningful patterns in the data related to patient mortality were identified, primarily due to the insufficient amount of observed mortality in the included sample. Conclusion All eligible patient charts had at least one medication error, with the majority being prescribing errors. Among the variables, prescribing errors significantly affected the length of stay, while severity of transcribing errors had a marginally significant effect. It is essential to develop comprehensive education and training initiatives and adopt a systematic approach to mitigate medication errors and promote patient safety.
medication errors ; patient safety ; pulmonary medicine

Background: With the increasing cancer burden in the country, nurses’ exposure to chemotherapy is inevitable as they belong to the workforce responsible for its preparation, administration, and disposal. These drugs are hazardous and necessitate special precautions to avoid direct exposure. Essentially, their competency must be aligned with the recommended safety guidelines to maintain quality patient outcomes while ensuring their safety. Objective: The primary aim was to determine the competency level of Oncology nurses in terms of knowledge, skills, and attitude. The results were used to develop a training program framework for competency enhancement. Methods: A descriptive correlational quantitative study was utilized. The study was conducted from December 2023 to February 2024 across three regions in Luzon, Philippines. The study included 203 Oncology nurses who fit the inclusion criteria. Data were collected via a four-part online questionnaire. Data were analyzed using frequency distribution, mean, standard deviation, and Pearson and Spearman correlation coefficients. Results: Oncology nurses exhibited excellent knowledge (x̄ = 16.18) and skills (x̄ = 3.86) but only fair attitudes (x̄ = 2.92). Knowledge correlated negatively with skills (ρs = -0.45, p <0.001) and positively with attitude (ρs = 0.71, p <0.001), while skills negatively correlated with attitude (ρs = -0.70, p <0.001). Higher education levels strongly correlated with knowledge (χ2 = 213.28, p<0.001) and attitude (χ2 = 214.08, p <0.001) but not skills (χ2 = 25.48, p >0.001). Training in chemotherapy showed significant correlations with knowledge (χ2 = 241.77, p <0.001), skills (χ2 = 106.93, p <0.001), and attitude (χ2 = 276.51, p <0.001). The practice environment had strong positive correlations with all competency dimensions as knowledge (χ2 = 368.60, p <0.001), skills (χ2 = 2850.87, p <0.001), and attitude (χ2 = 1020.64, p <0.001). Conclusions Oncology nurses demonstrate comprehensive knowledge and accurate and efficient skills but maintain a neutral attitude toward handling chemotherapeutic drugs. These results relate to the complex interplay between the competency dimensions. There are still gaps and areas needing improvement that should be addressed and supported to align their competencies, especially along the skills and attitude dimensions. Training programs anchored on evidence-based practices and regulatory standards, and promoting a favorable practice environment are vital for their competency development.
Human ; chemotherapy ; drug therapy

Langerhans Cell Histiocytosis (LCH) is a rare disorder characterized by the abnormal proliferation of histiocytes, predominantly affecting the bones and skin. However, it can also involve the bone marrow, liver, spleen, lungs, pituitary gland, central nervous system, and other organs. The disorder is named for the neoplastic cells that resemble dendritic Langerhans cells found in the skin and mucosa.

We present the case of a 2-year-old Filipino female diagnosed with recurrent LCH, highlighting the diagnostic challenges and therapeutic interventions encountered. The patient initially presented with characteristic papules and plaques indicative of LCH. Initial treatment involved multi-agent chemotherapy, which resulted in significant clinical improvement. However, following the cessation of therapy, the patient experienced recurrence of symptoms, necessitating reevaluation. A skin punch biopsy confirmed the diagnosis of LCH, reinforcing the decision to reinitiate chemotherapy. Complications arose during treatment, including febrile neutropenia, which required hospitalization and adjustments to the management plan. After completing the chemotherapy cycles, the patient demonstrated marked clinical improvement, with the resolution of systemic symptoms and a reduction in the severity of cutaneous lesions.

This case underscores the complexities in managing recurrent LCH in pediatric patients. A comprehensive diagnostic evaluation, vigilant monitoring for treatment-related complications, and prompt therapeutic interventions are critical for achieving optimal outcomes. Effective management requires a multidisciplinary approach to address the unique challenges presented, ensuring timely interventions to improve patient outcomes.