Filipino cancer patients deserve better

I also believe that most Filipino cancer patients have supportive families who guide and uplift them. I sometimes get concerned that I spend more time talking to the families instead of the patients, but the process of cancer diagnosis, disclosure, and treatment can be long and arduous and I’m just glad that the families are there to diffuse and cushion.

But I also believe that Filipino cancer patients endure things that they don’t have to endure. They worry about things that they shouldn’t be worrying about, like the reality that a substantial amount of cancer treatment in the Philippines is paid for out-of-pocket.

For example, a stage 4 liver cancer patient has to buy “targeted drugs” worth P200,000 every month for as long as the drugs are working, a sort of deluxe “maintenance meds.” A minimum wage earner with pancreatic cancer has to pay not only for his surgery, radiation, and chemotherapy, but also for the frequent imaging tests, pain medications, and hospital fees. Or a man with metastatic colon cancer has to submit ten medical abstracts and line up in different offices to get a “guarantee letter” for chemotherapy. As a retiree, his pension is only enough for food and rent.

These are old stories about poverty, mendicancy, and injustice. They are so old that they have become the norm, making it more imperative for us, the patients and the health workers, to insist on never getting used to it. To never accept that this is how things will always be. Patients already endure so much crap and they should primarily be worried about their health, not the lack of resources.

The good news is that more and more we see glimmers of hope in terms of policies and programs. There is the National Integrated Cancer Control Act of 2019, the Universal Health Care Act, the Cancer and Supportive-Palliative Medicines Access Program, and the increased Philhealth coverage for cancer. These policies and programs have started to improve accessibility to cancer management, and things have definitely gotten better compared to ten years ago. A woman with an aggressive form of breast cancer can now receive the antibody treatment trastuzumab for free as long as it’s available in the pharmacies of certain DOH hospitals. This drug used to cost P1,000,000 per year when I was in medical training almost a decade ago.

But there’s a long, long way to go. Patients still die because they don’t have cash. The patients need these policies to become implemented optimally, stat!

When I went into private practice I thought that financial problems would be less of an issue among patients, but I was wrong. In my first few years of practice, I had an elderly patient who came in for consult. Her son could not come with her because he could no longer afford to file a leave in the factory where he was working.

After the rather long consultation, her face suddenly exhibited that look, that familiar look indicating that she would not be able to pay the consultation fee. I expected that she would probably ask for a discount, or ask if she could pay some other time. She had been my patient for quite a number of years at that time and I was ready to say that she doesn’t have to worry about it. I was quite surprised, though, when she grabbed my hand, broke into tears, and said that not only could she not pay me, but that she would also like to borrow one thousand pesos from me. All of their family’s savings had been used up for her treatment, and she could not even afford food and rent.

She stopped seeing me after that. She stopped all forms of treatment, not out of choice, and I heard that she died at home soon after. It was an early heartbreak in my first few years of private practice, and I knew that it would be a series of heartbreaks from then on. I just try to convince myself that if the patients are strong, optimistic, and hopeful, then so should we.