It’s Novembeard! Grow your beard to fight cancer

MANILA, Philippines — For the whole month of November, US ambassador to the Philippines Harry Thomas Jr will grow his moustache to observe Novembeard, a global campaign against cancer.

The annual movement, which is popular in the US, originated in Australia in 2003, when a group of men competed in a challenge to grow their facial hair. They were inspired by some females promoting breast cancer awareness. 

Thomas lost his father to prostate cancer and a cousin to breast cancer. His former boss, former US Secretary of State Condoleezza Rice, lost her mother to breast cancer, Thomas said.

“(Cancer) is a long, slow killer but there are ways to combat that,” Thomas stressed.

The World Health Organization (WHO) has raised the cancer alarm, saying that global deaths from the disease will rise from 7.6 million in 2010 to 17 million by 2030 if not urgently addressed.

But Mary Gospodarowicz of the Union for International Cancer Control claimed there were 12.5 million new cases of cancer and nearly 7 million deaths in 2008. She predicted that by 2030, there would be nearly 27 million new cancer cases and 13 million deaths from cancer if current trends continue unabated.

Gospodarowicz spoke during the recent “Health Care in Asia 2012” conference which tackled “serious health-related challenges faced within Asia as the disease burden shifts more onto non-communicable diseases (NCDs)” such as cancer.

Cancer in the Philippines

Nearly 56,670 Filipino patients have succumbed to malignant neoplasm, more commonly known as “cancer,” according to a recent National Statistics Office (NSO) report. 

The top 10 causes of cancer deaths identified by the Department of Health in 2010 included the following: 

• breast cancer
• lung cancer
• liver cancer
• cervical cancer
• colon cancer 
• thyroid cancer
• rectal cancer
• ovarian cancer
• prostate cancer 
• non-Hodgkin’s lymphoma

The NSO report revealed that the malignant disease has remained the 3rd leading cause of death in the country between 2007-2009.

During the said period, cancer was one of the Top 5 causes of deaths that “remained on their posts and proved to be fatal among other causes of deaths,” the NSO report noted in July 2012. 

The number of people affected by the dreaded disease grows by 5% annually according to DOH. 

Preventable but prevalent 

The Economist recently published its documentation of the “Health Care in Asia” conference in Singapore last March. The gathering involved more than 200 participants from across the globe, including health ministers, policymakers, practitioners, senior pharmaceutical executives, and representatives from the academe.  

Gospodarowicz described cancer as one of the most preventable and treatable diseases today, but lamented that it is prevalent not only in rich countries but also in poor ones.

She debunked the notion that cancer is a disease of developed countries, noting that the majority of cancer-related deaths happen in developing countries. 

As life expectancy increases in the developing world, so cancer rates will rise, Gospodarowicz said.

She added that “the cost of the disease is such that inaction makes no economic sense.” She pegged the cost of cancer between 2% and 4% of Gross Domestic Product, the aggregate value of goods and services that an economy produces. 

But developing countries receive less than 6% of all cancer investments, according Gilberto Lopes, senior consultant and medical oncologist at Johns Hopkins Singapore International Medical Centre.

“In these countries, a majority of patients succumb to cancer within 5 years of diagnosis. This is certainly something that needs to be addressed in the future,” The Economist quoted Lopes as saying.

Lopes further described the disparity between developing and developed countries. He cited the case of the US, where 75% of childhood cancer patients now have a chance to be cured and more than two-thirds of patients diagnosed with cancer could even live for more than 5 years compared with less than 50% 40 years ago, when the Nixon administration started to fund cancer research.

Health outcomes

According to Lopes, decreasing cancer deaths by 20 per 100,000 patients in Asia over the next 20 years will be a long shot. But he believes that it is achievable. 

The WHO reported as early as 2008 that about 70% of all cancer deaths happened in low- and middle-income countries.
Lopes recommended simple and cost-effective measures that include early detection, tobacco control, and vaccination against preventable cancers.

“It is time for governments to set specific goals for non-communicable diseases,” Lopes said.

Lopes challenged governments in Asia to re-focus their health systems to reduce the burden of cancer by using a new approach that focuses on health outcomes. Already practiced in UK, Finland, Singapore, and other high-income countries, this approach is patient-focused, evidence-based, and cost-effective.

In a workshop, other participants of the health conference in Singapore identified the following outcomes of cancer treatment: 

• Establishment of up-to-date standards of care in each country and region
• Involvement of professional societies, government bodies, care providers, payers and patient advocacy groups in the creation of standards
• Implementation of the most cost-effective options available in a step-wise fashion especially in countries with more limited resources
• Greater use of price-tiering, generics and innovative access programs that may help increase availability of cancer therapies
• Creation of a global fund to fight cancer and an international finance facility to sponsor high-value cancer drugs 
• Adoption of modern standards and accreditation of cancer hospitals to address concerns on the quality of care. Optimal cancer treatment requires robust infrastructure for surgery, imaging and pathology, radiation therapy, and chemotherapy. 
• Use of modern technologies to improve the access and quality of cancer care

Arguing over an outcomes-based approach, Peter Sheehan, health economist from Victoria University, said that clinical outcomes are meaningful for patients. 

Sheehan explained that interventions that show improved outcomes among patients, not to mention being cost effective, “should be at the heart of reform as Asia’s health systems continue to evolve.”

Catastrophic illneses

Assistant Health Secretary Nemesio Gako, who represented the Philippines in the conference, said that the DOH devolved preventive efforts to the regions. He also stressed that the government’s priority in NCDs is to diagnose patients earlier, particularly those with diabetes. 

In July 2012, President Aquino launched the Z-Benefit Package of PhilHealth (Philippine Health Insurance Corporation), the country’s health insurance program.

In the alphabet of PhilHealth’s case-types for diseases, Type Z diseases are described as catastrophic illnesses — illnesses that are literally catastrophic to one’s health, to one’s financial situation, and to one’s emotional and psychological well-being.

“Our people should not try to overcome these illnesses alone, and this idea is at the heart of our universal healthcare program,” Aquino said.

According to Aquino, diseases that will initially be covered include only early stage breast cancer, standard risk childhood acute lymphoblastic leukemia, and low- to intermediate-risk prostate cancer.

“For the first time in its history, PhilHealth now provides benefits that can cover the treatment of diseases that cost roughly P100,000 to P200,000,” Aquino said.

PhilHealth allotted P3 billion for the Z-Benefit package in 2012. Less than half of the amount will benefit 12,000 people afflicted with cancer.

Unmet growing health needs

But according to Dr Beng Rivera-Reyes, secretary general of the Health Alliance for Democracy, the program is deceptive.
“The Z-Benefit package is riddled with limitations that only very few patients can benefit from it. To avail of the package you have to be diagnosed at an early stage,” Rivera told Rappler. 

Rivera noted that a big percentage of cancer patients will be excluded because most patients are diagnosed already in the later stages of the cancer. She explained that most patients do not seek medical help immediately because of lack of funds or because they lack information about the disease.

Rivera also said the subsidy cannot shoulder the actual cost of cancer treatment.

“It cannot even cover the initial sessions of chemotherapy. My estimate in the treatment of breast cancer, for instance — from mastectomy (surgery) to laboratory work-ups and chemotherapy — the minimum is P500,000,” Rivera explained.

She stressed that NCDs are more costly because they are the chronic types, explaining that they are treated in specialized hospitals that require specialized medical personnel, modern equipment and expensive medicines. 

“But most government or public tertiary and specialized hospitals are ill-equipped and understaffed. This is because the government does not provide enough subsidy to make these hospitals more responsive to the growing health needs of Filipinos,” the activist-doctor lamented. 

The Philippines spends only about US$68 (at the 2009 market exchange rate of about P47-$1) for the health of every Filipino, The Economist Intelligence Unit noted in its 2011 report, “Challenges Facing Healthcare in Asia.”

The country only surpassed the levels of $60 in Indonesia and $39 in Vietnam, but lagged behind those of Singapore ($1,414),  Malaysia ($297), and Thailand ($124). 

Thomas said, “Diet, exercise, prevention, early access to health care, especially neo-natal care [are needed]. And the other thing is dental care. That is a great need here.” – Rappler.com