It has long been a reality in our
country that poor or uninsured breast cancer patients receive little or minimal
medical attention. This is the reason why the Department of Health launched in
May 2011, the Patient Navigation Program to promote early breast cancer
screening particularly among poor women and providing assured access to chemotherapy.
The program is meant to show that breast cancer is a curable disease when
detected, treated and managed early.
With the
launching of the Type Z Benefit Package in the presence of President Noynoy Aquino in Malacanang Palace on July 2nd, members
of PhilHealth will now be entitled to a package rate of P100,000 for the entire
treatment course for early breast cancer. Coming from PhilHealth’s huge reserve
fund of Php 30 billion, just 10% could easily cover 30,000 cases (more than
double of government estimated cases in 2010). The opposite could then be the
scenario for insured breast cancer patients who may likely be over-treated (receive
drugs and procedures that can cause real harm) and even misdiagnosed.
Numerous
studies have shown that early detection of breast cancer does not necessarily
translate to saving more lives. Finding ever smaller cancerous lesions, even
down to small clusters of cells can lead to over-diagnosis for if left alone
but managed and observed over a period of time, would never have grown to
endanger a woman’s life. Of the most common type of breast cancer, at least 50%
of ductal carcinoma are non-invasive and can be safely managed without surgery
or chemotherapy. Over-diagnosis leads to over-treatment.
For more
than 15 years, the PBCN has seen all forms of misdiagnosis and mistreatments –
unnecessary surgeries, chemotherapy and radiation. As a matter of fact, even
among the ranks of medical practitioners there are varied, even opposing
opinions in the diagnosis and treatment of breast cancer. To address this, the
leading breast cancer practitioners have just recently formed their own society to educate
doctors and hopefully arrive at standardized protocols and treatments among themselves precisely
to avoid misdiagnosis and mistreatment of breast cancer cases.
Today, one
out of 13 women will develop breast cancer in her lifetime and not three out of
100 as stated by the Department of Health. In fact, one out of 49 is likely to
die and not one out of every 100 as stated again by the DoH. This is why the
Philippines is not only among the countries with the highest incidence rate of
breast cancer in Asia but the highest!
According
to the Department of Health, the breast cancer survival rate in the Philippines
is below 40 percent but according to PhilHealth’s Robert So, MD – one of the
reasons for selecting Jose Reyes Memorial Medical Center as its Reference Hospital is
its experience of an 80% cure rate. This will be the lead hospital and along with
the UP-PGH and the Philippine College of Surgeons will provide the standards and
guidelines in the treatment of breast cancer.
Though standard
treatment protocols/clinical guidelines shall be adopted from the current state
of the art- internationally accepted treatment guidelines (such as the NCCN
Cancer Treatment Guidelines updated each year) based on scientifically-sound
body of evidence depicting the lowest recurrence rates, survival rates must be over
a 5-year period and not only two years as stated - especially that early stages are mostly to be addressed.
The Type Z Benefit Package will be implemented nationwide by contracted government hospitals in each region - all of which are training hospitals largely lacking in funds and personnel. The world's 3rd leading pharmaceutical, Paris-based Sanofi-Adventis agreed to extend an 83% discount for their chemo drug Docetaxel (from P40,000 to P6,930). With the advent of PhilHealth members availing of the P100,000 breast cancer package, these government hospitals can now expect a significant market share previously dominated by private hospitals. No longer hindered by costs, their doctors will not think twice in performing mastectomy, chemotherapy and radiation.
The Type Z Benefit Package will be implemented nationwide by contracted government hospitals in each region - all of which are training hospitals largely lacking in funds and personnel. The world's 3rd leading pharmaceutical, Paris-based Sanofi-Adventis agreed to extend an 83% discount for their chemo drug Docetaxel (from P40,000 to P6,930). With the advent of PhilHealth members availing of the P100,000 breast cancer package, these government hospitals can now expect a significant market share previously dominated by private hospitals. No longer hindered by costs, their doctors will not think twice in performing mastectomy, chemotherapy and radiation.
Precautionary
measures must be instituted in the Type Z Benefit Package, particular to cases
of breast cancer. These must include among others:
1. How
is a woman said to have breast
cancer? Invasive or non-invasive?
Aggressive or not?
cancer? Invasive or non-invasive?
Aggressive or not?
2. How is a woman’s case said to require
surgery, chemotherapy and radiation?
3. When
surgery is necessary, will it be a lumpectomy?
Modified or radical mastectomy?
Modified or radical mastectomy?
4. When chemo is considered necessary, how is a drug chosen? (by availability?) Will it be single or multiple chemo drugs? Will it be done before or after surgery? Will there be an oral maintenance chemo drug to be prescribed or not?
5. When radiation is considered necessary, will it be by linear acceleration or cobalt?
6. And most important of all, has the total course of treatment been thoroughly explained to the patient (including limitations, risks and adverse reactions), not simply having her sign a lengthy form of consent without being fully informed?
These precautionary concerns are meant to prevent the over-diagnosis and over-treatment
of breast cancer cases from the expected surge of patients resulting from the
P100,000 package of PhilHealth’s Type Z Benefit Package launched on July 2nd, 2012. Only by the end of President Noynoy Aquino’s term in 2016, will it
then be known whether or not PhilHealth’s well-meaning intervention in an economically
and medically “catastrophic” disease like breast cancer will have realized
better health outcomes or resulted in shorter survival rates and higher
mortality rates.
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