COUNTRY REPORT: PHILIPPINES Dr. Miriam Joy C. Calaguas

Population (estimate): 75 Million Male-Female ratio is almost unity The Philippines

CANCER ranks 3rd in incidence, following communicable diseases and cardiovascular diseases

CANCER affects 10 million people and 6 million deaths annually

In 1998 alone, about 71, 526 new cancer cases were recorded: 43,248 males 45, 158 females

About 189 persons per 100,000 Filipinos now living will eventually have cancer

One of every 5 Filipinos who live to age 74 will get cancer

In 1998, about 37,623 cancer cases died: 103 people a day and about 4 per hour died of cancer

Leading CANCER sites in the Philippines in both sexes (1998): 1. Lung15.7 % 2. Breast13.3 % 3. Liver7.4 % 4. Cervix6.4 % 5. Leukemia4.5 % 6. Colon4.2 % 7. Thyroid3.7 % 8. Stomach3.6 % 9. Nasopharynx3.1 % 10. Lymphomas 3.0 %

Leading CANCER sites in the Philippines (1998) MALES 1. Lung26.7 % 2. Liver12.3 % 3. Prostate6.4 % 4. Leukemia5.2 % 5. Colon4.9 %

Leading CANCER sites in the Philippines (1998) FEMALES 1. Breast25.9 % 2. Cervix12.6 % 3. Lung7.4 % 4. Thyroid 5.8 % 5. Ovaries5.7 %

LDR Brachytherapy Census According to Diagnosis Source: Philippine General Hospital (Jan to Mar. 2001) Leading LDR Facility in the Philippines 1. Cervix 86.6 % 2. Endometrium 1.1 % 3. Vaginal, Vulvar, others 12.3 %

LDR Brachytherapy Census According to Histopathology Source: Philippine General Hospital (Jan to Mar. 2001) 1. Squamous Cell Carcinoma 93.4 % 2. Adenocarcinoma 5.3 % 3. Others 1.3 %

HDR Brachytherapy Census According to Treatment Site Source: St. Luke’s Medical Center (2000 to 2001) Leading HDR Facility in the Philippines 1. Cervix, Endometrium 69 % 2. Nasopharynx 12 % 3. Prostate 7 % 4. Other Head and Neck cases 6 % 5. Others 6 %

About 65% of teletherapy machines (Co- 60 and Linacs) and all brachytherapy units are in the National Capital Region (NCR). Private hospitals with radiotherapy facilities comprise 75 % of all the teletherapy units and 75 % of brachytherapy systems

HEALTH CARE FINANCING IN THE PHILIPPINES Individual Accounts = 41 % (Out-of-pocket and HMO) National Government = 22 % Local Government = 19 % Social Insurance= 7 % Others= 11 % Total Health Expenditure in 2000 = US$ 2 or 3.25 % of GNP

HEALTH CARE FINANCIAL IS LARGELY FOCUSED ON CURATIVE (PERSONAL) CARE: 74 % of the Total Health Expenditure in 2000 was spent on curative care

THE NATIONAL HEALTH INSURANCE SYSTEM (PHILHEALTH) exists but the coverage in terms of the population is limited (70 %).

PHILHEALTH MEMBERS 1. All formally employed individuals, government and private 2. Voluntary or individually-paying members 3. Informed sector/self-employed 4. Indigent Members

PHILHEALTH BENEFITS 1. Room and Board 2. Drugs and Medicines 3. X-ray, Laboratory, etc. 4. Professional Fees 5. Others (Operating Room, etc.)

COUNTRY NEEDS IN RADIOTHERAPY

IMPROVEMENT OF KNOWLEDGE IN RADIOTHERAPY AND ENHANCED HUMAN RESOURCES 1. Training Courses and Workshops for all Radiotherapy Personnel (Radiation Oncologists, Physicists, Dosimetrists, Technologists, Nurses, Engineers) 2. Expert Missions 3. Fellowships

IMPROVEMENT/UPGRADE OF FACILITIES AND TECHNOLOGY 1. Availability of more radiotherapy machines 2. Availability of more quality assurance tools and equipment 3. Funding of spare parts, maintenance and continuous upgrades

INCREASED PUBLIC AWARENESS IN RADIATION ONCOLOGY 1. Project Planning and Scientific Visits for Key Country Leaders 2. Public Information Seminars

INTENSIFIED CLINICAL QUALITY ASSURANCE IN RADIOTHERAPY 1. Treatment Guidelines and Protocols 2. Local Research Projects 3. Clinical Trials 4. Regional and International Cooperative Trials 5. Improved Follow-ups of Patients

Presentation - 2

IMPROVEMENT IN QUALITY OF RADIOTHERAPY FOR FREQUENT CANCERS IN THE REGION (RAS/6/040) MIRIAM JOY C. CALAGUAS, M.D. PHILIPPINES

Overall Objective: To improve the quality of radiotherapy in recipient RCA Member States.

Specific Objectives: 1. To improve brachytherapy treatment of frequent cancers in the region; 2. To train radiotherapy technologies in improved patient care; 3. To build the regional capability for radiotherapy equipment maintenance and repairs

Projected Project Outputs and Country Work Plans

1. Increase in the number of professionals trained in brachytherapy treatment for common types of cancers in the regions a. Philippine Participation in RAS Regional Training Course related to this project - at least 2 Philippine participants in any Regional Training Course per year. Since this project will last for 4 years, it is expected that at least 8 Philippine participants would have participated in the regional training courses.

b. Setting up of “Echo Seminars and Trainings” by the Professional Organizations/Societies for the trained participants to “transfer” gained knowledge to his/her colleagues.

2. Establishment of adequate quality assurance programs for the clinical practice of brachytherapy a. Strengthening of the clinical aspects in the quality assurance programs of local radiotherapy centers by soliciting the active participation of the radiation oncologist. (Quality assurance is in place in most local radiotherapy centers, however, quality assurance is defined more as a quality control performed by the physicists only).

b. Setting up of a Comprehensive Quality Assurance Program in one of the local radiotherapy centers in the Philippines that will serve as the model or “center of excellence” in all issues related to QA c. Soliciting support from the IAEA for the resources ( equipment, tools, instruments ) in the identified local center for QA.

3. Establishment of harmonized protocols for treating cancer a. Discussion of brachytherapy protocols by the members of the professional Society in Radiation Oncology. b. Formulation of brachytherapy protocols that take into consideration the local resources.

c. Publication of these protocols in hand- outs or pamphlets and distribution to all practicing radiation oncologists. d. Initial implementation of these protocols in the local radiotherapy centers.

4. Establishment of a continuing education and training program for radiotherapy technologists based on the AFRA-RCA syllabus a. Philippine participation in RAS Regional Training Courses for radiotherapy technologists - at least 2 Philippine participants in any Regional Training Course per year. Since this project will last for 4 years, it is expected that at least 8 radiotherapy technologists would have participated in the regional training courses.

b. Setting up of “Training the Trainers” Workshops for these trained radiotherapy technologists. c. Setting up of “Echo Seminar and Trainings” by the Professional Organizations/Societies for the trained radiotherapy technologists to “transfer” gained knowledge to his/her colleagues. d. Active participation of the radiotherapy technologists in the Quality Assurance Programs of the local radiotherapy centers.

5. Assessment of the capabilities regarding the radiation oncology equipment repairs and maintenance in the RCA region a. Identifying local radiotherapy equipment and instruments that require maintenance but are not covered by any maintenance programs or vendor contracts. b. Identifying sources of spare parts and local manufacturers of spare parts if any specially for those non-maintained equipment.

c. Soliciting support from the IAEA for the supply of scarce local resources ( machine parts, other resources ) d. Participation in RAS Regional Training Courses on maintenance and repair of equipment and, consequently, “Training the Trainers” and “Echo Seminars and Workshops”

Thank You!