Philippines: Cheaper Pediatric Cancer

Drugs Raise Child Survival Rates

By IRIN News | Editorials

March 30, 2012

An NGO-government partnership in the Philippines has improved access to

treatment for pediatric cancer, a leading cause of death in children aged 1-14,
according to the Department of Health.

AsianScientist (Mar. 30, 2012) An NGO-government partnership in the Philippines

has improved access to treatment for pediatric cancer, a leading cause of death in
children aged 1-14, according to the Department of Health (DOH).
The first results suggest that our program has raised the survival rate for childhood
acute lymphoblastic leukemia (ALL) from 20 to 50 percent. To achieve this, we
addressed two issues: the high price of medicines in the country, and unaffordable
out-of-pocket payments for families, Pia Cayetano, a parliamentarian, told IRIN in
the capital region of Metro Manila.
There are 3,500 cancer cases in children younger than 15 each year in the
Philippines, and around half of them are ALL, a cancer that affects the blood and

bone marrow, according to the Manila-based NGO Cancer Warriors Foundation, Inc.
(CWFI).
Nationwide, eight of every 10 children with pediatric cancer died in 2008 (a total of
2,800 deaths).
The first obstacle to saving more children from ALL in the Philippines was the prices
of drugs among the highest in Asia, said Carmen Vallejo Auste, co-founder of
CWFI.
Management Sciences for Health, an NGO based in Boston in the United States,
studied the prices paid for 42 essential cancer medicines in 2010 by the
governments of low- and middle-income countries.
For ten of the medicines, some governments paid as much as ten times more than
others did, while for 23 more drugs some governments paid double the price
compared to others.
The wide price variations were caused preferential deals offered by drug companies
to buyers who were able to negotiate lower prices.
The Philippines is in a region that has some of the worlds highest of out-of-pocket
costs to patients, according to the World Health Organization (WHO). In 2009, the
government passed a law that put a price ceiling on 21 of the essential medicines on
the WHO list of these drugs.
The government also successfully negotiated with drug companies, bringing down
by 50-75 percent the prices of nine pediatric chemotherapy drugs used to treat ALL,
and the savings were passed on to patients.
According to the DOH, 14 public hospitals have provided these medications at no
cost to children with ALL since 2009.
CWFIs role was to collect and disseminate information about health issues, to
instigate negotiation between all the actors of the health sector, and to provide
limited financial support, said Auste.

Childhood cancers are relatively rare, representing around three percent of all
cancers in the countrys general population, but they are among the top three killers
of children aged 5-14.
Worldwide, every year there are 175,000 new childhood cancer cases in youngsters
under the age of 15, and 96,000 deaths, according to the U.S. National Cancer
Institute (NCI).
Childhood cancers are often very different from those seen in adults, and the NCI
says the causes are largely unknown.
What is known is their burden on the often overstretched health care systems of
developing countries, where some 55 percent of 12.7 million new cancer cases and
64 percent of 7.6 million cancer deaths occurred in 2008, according to the Harvardbased initiative, Global Task Force on Expanded Access to Cancer Care and Control
in Developing Countries.

Source: IRIN; Photo: Jason Gutierrez/IRIN.

http://www.asianscientist.com/2012/03/features/pediatric-cancer-drugs-philippines-departmentof-health-cancer-warrior-foundation-inc-2012/

In a person with leukemia, the bone marrow produces abnormal white blood cells
that are called leukemia cells and leukemic blast cells. The abnormal cells cant
produce normal white blood cells.
Leukemia cells divide to produce copies of themselves. The copies divide again and
again, producing more and more leukemia cells.
Unlike normal blood cells, leukemia cells dont die when they become old or
damaged. Because they dont die, leukemia cells can build up and crowd out normal
blood cells. The low level of normal blood cells can make it harder for the body to
get oxygen to the tissues, control bleeding, or fight infections.
Also, leukemia cells can spread to other organs, such as the lymph nodes, spleen,
and brain.

http://www.cancer.gov/cancertopics/wyntk/leukemia/page3

Blood cell formation, or [hematopoiesis], begins with stem cells in the bone marrow.
Stem cells are undifferentiated cells that give rise to specialized cells. Bone marrow
stems cells first mature into either of two lines:
Myeloid stem cells which form the [red blood cells], [platelets] and the
granulocyte or monocyte types of white blood cells; or
Lymphoid stem cells, which become lymphocytes, another type of white blood
cells.
In leukemia, abnormalities occur during the development of these stem cells.
http://health.wikipilipinas.org/index.php/Leukemia

All blood cells are produced by blood stem

cells. The myeloid pathway leads to red blood cells, platelets, and white blood cells,
and the lymphoid pathway leads to different types of while blood cells.
Risk factors for leukemia include smoking, exposure to
certain chemicals such as benzene, exposure to radiation,
past treatment with chemotherapy or radiation therapy,
having certain inherited diseases or blood disorders, and
family history. There are no standard screening tests for

leukemia. Depending on the type of leukemia, standard

treatments include watchful waiting, chemotherapy,
targeted therapy, biological therapy, radiation therapy,
surgery, donor lymphocyte infusion, and chemotherapy with stem cell transplant.

Age. About 70% of patients diagnosed with leukemia are over

50 years old.
Radiation. Exposure to high levels of radiation makes a
person more prone to developing leukemia. This has been
observed in survivors of atomic bomb explosions in Hiroshima
and Nagasaki during World War 2. Radiation therapy and
diagnostic radiation such as x-rays are other sources of
radiation exposure.
[Benzene]. Benzene, a sweet-smelling toxic solvent, is
common in chemical industries. It is also found in cigarette
smoke, gasoline, and crude oil. Prolonged exposure to benzene
has been linked to AML and CLL.
Chemotherapy. Chemotherapy for cancer has been linked
with the development of ALL and AML several years later.
[Smoking]. Cigarette smoking increases the risk for AML.
Down Syndrome and other hereditary disorders. These
increase the risk of developing acute leukemias.
Familial history of leukemia. This risk factor, though
uncommon, has been seen in CLL cases.
(NCI)

Taking Part in Cancer Research

Cancer research has led to real progress in leukemia treatment. Because of research, adults and children with
leukemia can look forward to a better quality of life and less chance of dying from the disease. Continuing
research offers hope that, in the future, even more people with this disease will be treated successfully.

Doctors all over the country are conducting many types of clinical trials(research studies in which people
volunteer to take part). Clinical trials are designed to answer important questions and to find out whether new
approaches are safe and effective.
Doctors are studying methods of new and better ways to treat leukemia, and ways to improve quality of life.
They are testing new targeted therapy, biological therapy, and chemotherapy. They also are working with
various combinations of treatments.
Even if people in a trial do not benefit directly, they still make an important contribution by helping doctors learn
more about leukemia and how to control it. Although clinical trials may pose some risks, doctors do all they can
to protect their patients.

Supportive Care
Leukemia and its treatment can lead to other health problems. You can have supportive care before, during, or
after cancer treatment.
Supportive care is treatment to prevent or fight infections, to control pain and other symptoms, to relieve the
side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You may
receive supportive care to prevent or control these problems and to improve your comfort and quality of life
during treatment.
Infections: Because people with leukemia get infections very easily, you may receive antibiotics and other
drugs. Some people receive vaccines against the flu and pneumonia. The health care team may advise you to
stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it
can be serious and should be treated promptly. You may need to stay in the hospital for treatment.
Anemia and bleeding: Anemia and bleeding are other problems that often require supportive care. You may
need a transfusion of red blood cells or platelets. Transfusions help treat anemia and reduce the risk of serious
bleeding.
Dental problems: Leukemia and chemotherapy can make the mouth sensitive, easily infected, and likely to
bleed. Doctors often advise patients to have a complete dental exam and, if possible, undergo needed dental
care before chemotherapy begins. Dentists show patients how to keep their mouth clean and healthy during
treatment

http://www.medicinenet.com/leukemia/page10.htm#taking_part_in_cancer_research
http://www.medicinenet.com/leukemia/page8.htm#supportive_care

Blood Tests to Diagnose Leukemia

To diagnose leukemia, a number of blood tests are performed. These tests are used to
evaluate the type and quantity of blood cells that are present, the blood chemistry, and
other factors.

Full blood count is used to establish the numbers of different blood cell types in the
circulation. A low number of red or white blood cells is described as anemia or
leukopenia, respectively. A low number of "young" red blood cells (reticulocytes) is
called reticulocytopenia. A high leukocyte or reticulocyte count is called leukocytosis
or reticulocytosis. A lack of mature neutrophils (bacteria-destroying white blood cells)
is known as neutropenia or granulocytopenia. Thrombocytopenia is the term used for
a low number of blood-clotting platelets, and thrombocytosis refers to a high number
of platelets.
Differential blood count (DBC) is used to determine the relative proportion of blood
cell types within the bloodstream. In particular, the percentage of immature leukemic
"blast" cells is noted. People with acute leukemia (either acute lymphocytic leukemia
[ALL] or acute myelogenous leukemia [AML]) often have too many leukocytes
(white blood cells), too few erythrocytes (red blood cells) and/or too few platelets. In
many of these patients, the leukocytes are immature "blast" cells.
Hematocrit assay is used to determine the proportion of the blood that is occupied by
erythrocytes (red blood cells). In adult men, normal is about 46% (39.852.2) and in
adult women, it is about 40.9% (34.946.9).
In the hemoglobin level test, the level of oxygen-carrying pigment in the erythrocytes
is measured. In men, normal levels are 15.5 g/dL blood (13.317.7) and in women,
normal levels are 13.7 g/dL blood (11.715.7).
Blood coagulation variables are used to determine whether there are problems with
clotting. These variables include prothrombin time, partial prothrombin time (PPT),
clotting time, coagulation factors II, V, VII, IX, X, XI, and XII, plasminogen, and
plasminogen activator.
Blood morphology and staining is used to identify abnormalities in cell shape,
structure, and the condition of the cell nucleus. Some abnormalities common to red
blood cells include anisocytosis (excessive variations in size), poikilocytosis

(abnormal red blood cell shapes), and macrocytosis (abnormally large cells).
Neutrophils often show nuclear and cell-based abnormalities, as well as loss of
granulation. Platelets may show giant forms that are deficient in granules.
In blood chemistry tests, the type and amount of enzymes, minerals, and other
substances within the blood are measured. Typical tests include measuring the serum
enzyme lactic dehydrogenase; measuring the leukocyte enzyme alkaline phophatase,
especially for the diagnosis of chronic myelogenous leukemia, or CML; measuring
serum vitamin B12, which can be increased to roughly 15 times normal in CML
patients; and measuring serum levels of calcium, potassium, phosphate, and uric acid
(excess uric acid in the blood, or hyperuricemia, is common in lymphocytic leukemia
and lymphoma). These tests are used to identify kidney or liver damage that may be
caused by leukemic cell breakdown or by drugs used for chemotherapy.
Publication Review By: Stanley J. Swierzewski, III, M.D.
Published: 14 Aug 1999
Last Modified: 24 May 2011

Leukemia is a form of cancer of the blood-forming elements of the bone marrow which is often times
characterized by the presence of an increased number of immature cells known as blasts. The uncontrolled
proliferation of these abnormal cells result in decreased production of normal red cells, white cells and
platelets, with release of leukemia or blast cells in the blood.
Depending on the cellular elements affected, leukemias may be classified as myeloid or lymphoid, and may be
acute or chronic. The acute leukemias progress rapidly, and when left untreated may result to death within
weeks to months in most subtypes. The chronic leukemias have a protracted course from several months to a
few years. Breakthroughs in trials on T cell immunotherapy are ongoing for the lymphocytic disorders.
Chronic myelogenous leukemia (CML) usually occurs during or after middle age, and rarely occurs in children.
In the past, CML patients often die within several months to a few years after diagnosis. The definitive
management then, which was HSCT was beyond the reach of most Filipino CML patient. Thanks to
breakthroughs in cancer treatment, such as targeted therapy, today most patients survive a decade or even
beyond after being diagnosed with CML.
Targeted therapy uses drugs or other substances to identify and attack specific cancer cells without harming
normal cells. Tyrosine kinase inhibitors are targeted therapy drugs used to treat CML. Locally, these include
imatinib, nilotinib and dasatinib, which may be used as initial treatment for newly diagnosed patients with
chronic-phase CML.

Cancer treatment is very expensive. Unfortunately, our countrys social health insurance is still being enhanced.
As such, most Filipinos pay for their healthcare expenses out of pocket. A patients financial status definitely
influences cancer treatment choice and duration. The sad reality is that Filipinos who belong in the lower to
middle socioeconomic bracket will not be able to afford optimal cancer treatment.
Fortunately, there are government agencies and private companies that help Filipino patients gain access to
cancer treatments. The Philippine Charity Sweepstakes Office (PCSO) provides financial assistance to enable
qualified cancer patients to receive chemotherapy and radiotherapy. Although limited, the Philippine Health
Insurance Corp. or PhilHealth provides benefit packages for childhood lymphoid leukemia.
Established by the late Dr. Alendry Caviles, the Leukemic Indigents Fund Endowment (LIFE) based in Fe Del
Mundo Medical Center supports the treatment of underprivileged children with leukemia as well as provides
emotional and spiritual counseling to patients and their families. Rarely, Filipino cancer patients are able to
avail of free treatments through international clinical trials in which the Philippines is one of the participating
study sites.
For the past 10 years, the pharmaceutical company Novartis has been implementing an innovative sharedcontribution access program that helps underprivileged Filipino patients receive effective cancer treatments.
The Glivec International Patient Assistance Program (Gipap) was launched in the Philippines in 2003 and
broadened in 2008 to the Novartis Oncology Access (NOA) program. To ensure program sustainability and
continuous assistance to needy patients, NOA works on a principle of partnership in which patients (under a copay plan) contribute a small amount while Novartis shoulders the substantially bigger portion of their treatment
cost.
Without patient access programs, approximately less than 20 percent of Filipino patients will be able to afford
cancer treatment. Access programs definitely improve the quality of life and survival of Filipino leukemia
patients.
Dr. Ma. Angelina Mirasol is the president of the Philippine Society of Hematology and Blood Transfusion
(PSHBT). The ONCOURAGE Health Information Advocacy promotes public awareness and continuing medical
education on the prevention, detection and management of cancer and blood disorders. It is a collaboration
between the Philippine Society of Medical Oncologists, PSHBT, Philippine Charity Sweepstakes Office,
Philippine Foundation for Breast Care-Kasuso, Touched by Max Philippines, Balikatang Thalassemia and
Novartis Oncology Philippines.

http://business.inquirer.net/146005/improving-access-to-leukemia-treatments