Improving access to leukemia treatments

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 country’s social health insurance is still being enhanced. As such, most Filipinos pay for their healthcare expenses out of pocket. A patient’s 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 shared-contribution 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 co-pay 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.