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 AND OBJECTIVES

The burden of acute myeloid leukemia (AML) is felt worldwide with increasing number of diagnosed cases. A recommended treatment option for a longer remission is hematopoietic stem cell transplantation after chemotherapy with cytarabine and an anthracycline antibiotic, either Idarubicin or Daunorubicin. In the Philippines, Doxorubicin, a cheaper and more accessible option for chemotherapy among those who have financial incapabilities. It is no longer part of the National Comprehensive Cancer Network (NCCN) recommendation for use however; it remains to be part of the Philippine National Clinical Practice Guideline in the treatment of AML. This leads us to wonder what the difference in outcome of patients who have received doxorubicin compared to those who received Idarubicin as induction chemotherapy.

This is a retrospective cohort study. Data was collected through chart review of AML patients admitted for induction chemotherapy. Descriptive statistics was used to analyze the sociodemographic and clinical profile of patients. Survival analysis was done using the Kaplan-Meier computation. The t-test for two proportions was used to compare outcomes between the two groups.

This study included 65 participants, 55 received idarubicin and 10 received doxorubicin. The average age of diagnosis in the Idarubicin group is 41.38 years, and 34.9 years in the Doxorubicin group. Majority of participants are females (58.18% vs 80%) and married (67.27% vs 60%). They are predominantly nonsmokers (89.09% vs 80%), with no maintenance medications (61.82% vs 70%), and comorbidities (70.91% vs 90%). There was no significant difference in the median overall survival of both groups (507 days vs 428 days, logrank test = 0.74).

Outcomes of this study leads us to conclude that Doxorubicin is not inferior to Idarubicin in terms of survival.

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 influence of weight change on the response to neoadjuvant chemotherapy (NAC) among adult Filipino patients with breast cancer remains unclear. Currently, there has been increasing evidence that weight gain during NAC is associated with increased recurrence risk and decreased survival. This study aimed to investigate this relationship and identify significant predictors of pathologic complete response (pCR), overall survival (OS) and disease-free survival (DFS).

This is a retrospective study using data from 52 female patients who received NAC for stage II or III breast cancer and had complete records of weight before and after NAC. Significant predictors of pCR such as host factors and tumor characteristics and associations between weight change and pCR, OS and DFS were examined using univariate and multivariable logistic regression analyses.

The average weight of all patients before NAC was 57.0 kg while the average weight of all patients after NAC was 59.5 kg. The average BMI of all patients before NAC was 25.8 kg/m2. In total, 29 patients (55.8%) were classified in the overweight/obese (OW/OB) group, and the rest were classified in the normal weight/underweight (NW/UW) group. The pCR rate was 51.3% in the OW/OB group versus 48.7% in the NW/UW group (p = 0.11). Initial BMI was a significant factor for achieving pCR (hazard ratio, 3.85; 95% confidence interval [CI], 1.72-8.60, p = 0.001), suggesting that a higher initial BMI was associated with an increased likelihood of achieving pCR. Initial BMI was also an independent prognostic factor for OS (p = 0.0006) and DFS (p = 0.0005). On the other hand, no significant correlation was seen between pCR rates as well as OFS and DFS (p = 0.0551) among patients whose weight changed during the course of treatment.

These findings suggest that while initial weight may significantly predict pCR rates and affect DFS and OS, weight change during treatment may not be as influential. Further research is needed to validate these findings in more diverse and larger patient populations.

Background: Ovarian, fallopian tube, and peritoneal cancer patients with advanced-stage diagnosis or recurrences spread to the peritoneal surface of the abdomen. Hyperthermic intraperitoneal chemotherapy (HIPEC) can penetrate and eradicate tumors that are microscopic up to those with a diameter of 2.5 cm from the peritoneal surface following cytoreductive surgery (CRS). Objectives: The study aimed to determine the efficacy and safety of CRS with HIPEC versus CRS alone for patients with epithelial ovarian, fallopian tube, and peritoneal cancer. Materials and Methods: This retrospective cohort study included 50 patients (20 patients underwent CRS + HIPEC, while 30 patients underwent CRS alone). Records of these patients from January 2014 to June 2020 were reviewed, tabulated, and analyzed. Results: The difference in recurrence rate between CRS with HIPEC and CRS alone was not statistically significant (50% vs. 43%, P = 0.774). The median time to recurrence was 10 and 9 months, respectively (P = 0.636). Five percent in the HIPEC group succumbed to the disease, while 13% died in the CRS alone group (P = 0.636). More post-operative complications were noted in the HIPEC group (45% vs. 10%, P = 0.007), but among these, only 2 cases had grade 3 to 4 complications (10%). The addition of HIPEC in the management of these patients resulted in a longer operative time (360 vs. 240 min, P < 0.001) and postoperative hospital stay (8 vs. 6 days, P = 0.026). There were no intra- or peri-operative mortalities in both groups. Conclusion CRS with HIPEC and CRS alone showed similar time to recurrence and recurrence rate. CRS with HIPEC had low risk of grade 3-4 complications and may still be considered as a treatment option for advanced, progressive, and recurrent epithelial ovarian, fallopian tube, and peritoneal cancer.
Cytoreduction Surgical Procedures ; Hyperthermic Intraperitoneal Chemotherapy ; Ovarian Neoplasms

BACKGROUND

Studies reported survival benefits from early initiation of adjuvant chemotherapy from the time of mastectomy among breast cancer patients.

The researchers aimed to determine if early initiation of adjuvant chemotherapy among early-stage breast cancer patients undergoing modified radical mastectomy at Bataan General Hospital and Medical Center has increased the patient’s survival. We also want to asses if the Bataan General Hospital and Medical Center department of Oncology is rendering adjuvant chemotherapy as compared to the international standards. We also want to know the factors affecting the timing of initiation of adjuvant chemotherapy among the subjects.

A retrospective cohort study involving chart review covering the year May 2015 to January 2020 for stage 1 to 3 breast cancer patients, with a histopathologic confirmation, underwent definitive/curative breast surgery, and had started on adjuvant cytotoxic chemotherapy are included in the study.

In this retrospective study, we observed that time to initiation of adjuvant chemotherapy among breast cancer patients at Bataan General Hospital and Medical Center does not significantly improve overall survival of patients. The BGHMC Department of Oncology service is trailing the cut off 12 weeks or 84 days of initiation of adjuvant chemotherapy from the date of mastectomy. We also used the factors that affects the timing of initiation of adjuvant chemotherapy and found out that these variables cannot predict whether it will increase the patient’s survival since our sample size is too small.

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.

Objectives: This study aimed to determine the clinical outcomes of ultra high-risk gestational trophoblastic neoplasia (GTN) patients managed with and without induction chemotherapy in the Division of Trophoblastic Diseases, Department of Obstetrics and Gynecology, Philippine General Hospital. Methods: Clinical and demographic data were collected retrospectively from ultra high-risk GTN patients admitted in the Division of Trophoblastic Diseases, Department of Obstetrics and Gynecology, Philippine General Hospital from January 2015 to December 2021. Rate of remission and early death of those who received induction chemotherapy were compared to those who did not. Results: A total of 21 patients with ultra high-risk GTN were included in the study, nine of whom underwent induction chemotherapy while 12 had no induction chemotherapy and was given the standard EMACO regimen. There was no significant difference in the rate of early death as well as the rate and time to achieve remission between those who received induction chemotherapy compared to those who were immediately started on EMACO. Conclusion A firm conclusion cannot be drawn from the results considering the small population included in the study. Further studies with larger sample size and prospective study design are recommended.
Induction Chemotherapy ; Gestational Trophoblastic Disease