Treatment Outcomes of Patients With Colorectal Cancer Enrolled in a Comprehensive Benefits Program of the National Insurance System in the Philippines: Data From the Pilot Site

Blood-Based FTIR Spectroscopy as a Minimally Invasive Diagnostic Method for Colorectal Cancer: A Meta-Analysis

OBJECTIVE

This meta-analysis aims to pool the results of existing studies to obtain more precise estimates on the diagnostic efficiency of the Fourier transform infrared (FTIR) spectroscopy in detecting CRC using blood-based samples.

METHODS

A comprehensive database search identified 4,931 studies that were screened for eligibility. Relevant data were then extracted and collated and analyzed using Meta-DiSc 1.4 to measure the pooled diagnostic accuracy, sensitivity, specificity, likelihood ratio, and diagnostic odds ratio and presented in forest plots.

RESULTS

The pooled sensitivity across all six data entries was 86.10% (p = 0.20), and the specificity was 91.2% (p < 0.001). The pooled positive likelihood ratio was 9.84 (p < 0.001), indicating a strongly moderate diagnostic value, while the negative likelihood ratio was 0.16 (0.12), suggesting moderately decreased efficacy of FTIR spectroscopy in ruling out the disease. The pooled AUC was found to be at 0.94 which indicate excellent discriminating potential of FTIR of the method.

CONCLUSION

Overall, the study suggests that FTIR spectroscopy has potential as minimally invasive diagnostic method for CRC using plasma samples.

Geographic Distribution of Cancer Care Providers in the Philippines

PURPOSE

In the Philippines, a lower middle-income country in Southeast Asia, 6 of 10 Filipinos die without seeing a doctor. To ensure universal access to cancer care, providers must be equitably distributed. Therefore, we evaluated the distribution of oncologists across all 17 regions in the Philippines.

METHODS

We gathered data from the official websites of national medical societies on their members' regional area of practice: Philippine Society of Medical Oncology, Philippine Radiation Oncology Society, Surgical Oncology Society of the Philippines, Society of Gynecologic Oncologists of the Philippines, and Philippine Society of Hospice and Palliative Medicine. We compared this with the regional census to determine the number of board-certified oncologists per 100,000 Filipinos.

RESULTS

For a population of almost 110 million, the Philippines has a total of 348 medical oncologists, 164 surgical oncologists, 99 radiation oncologists, 142 gynecologic oncologists, and 35 hospice and palliative medicine (HPM) specialists. This translates to 0.32 medical oncologists, 0.15 surgical oncologists, 0.09 radiation oncologists, 0.13 gynecologic oncologists, and 0.03 HPM specialists for every 100,000 Filipinos. The number of oncologists is highest in the National Capital Region in Luzon and lowest in the Bangsamoro Autonomous Region in Muslim Mindanao. All regions have at least one medical and gynecologic oncologist. Two regions (12%) have no surgical oncologists, five regions (29%) have no radiation oncologists, and eight regions (47%) have no HPM specialists.

CONCLUSION

Efforts are needed to increase the number of oncologists and improve equity in their distribution to ensure universal access to cancer care in the Philippines.

MutL homolog 1 methylation and microsatellite instability in sporadic colorectal tumors among Filipinos

BACKGROUND

Colorectal cancer (CRC) ranks third in terms of incidence and second in mortality worldwide. In CRC, the silencing of mismatch repair genes, including the mutL homolog 1 (hMLH1) has been linked to microsatellite instability (MSI), the lengthening or shortening of microsatellite repeats. Very limited data have been presented so far on the link of hMLH1 methylation and MSI in Southeast Asia populations with sporadic CRC, and on its clinical significance.

AIM

To investigate the significance of the MSI status and hMLH1 methylation in CRC Filipino patients.

METHODS

Fifty-four sporadic CRC patients with complete clinical data were included in this study. Genomic DNA from CRC tumor biopsies and their normal tissue counterparts were profiled for MSI by high resolution melting (HRM) analysis using the Bethesda Panel of Markers (BAT25, BAT26, D2S123, D5S346, and D17S250). hMLH1 methylation screening was performed using bisulfite conversion and methylation specific polymerase chain reaction. Statistical analysis was conducted to calculate their associations to clinicopathological characteristics and survival relevance (Kaplan-Meier curves and the log-rank test).

RESULTS

hMLH1 methylation was observed in 9% and 35% of CRC and normal samples, respectively. Higher incidence of consistently methylated hMLH1 found in both normal and CRC was noticed for relation to location of tumor (P < 0.05). As for MSI status, D2S123 the most common unstable microsatellite and MSI-high (MSI-H) was the most common MSI profile, counted for 46% and 50% of normal and CRC tissues, respectively. The presence of MSI-low (MSI-L) and microsatellite stable (MSS) was 43% and 11% for normal, and 31% and 19% for CRC samples. The mean month of patients’ survival was shorter in patients whose normal and tumor tissues had methylated compared to those with unmethylated hMLH1 and with MSI-H compared to those with MSI-L/MSS (P < 0.05). This was supported by significant difference in Kaplan-Meier with log-rank analysis. This data indicated that hMLH1 methylation and high MSI status have prognostic value.

CONCLUSION

This study showed the clinical significance of hMLH1 methylation and MSI status in sporadic CRC Filipino patients, especially in the normal part of the tumor.

The role of the medical oncologist in the holistic care of patients with cancer in the Philippines

In the past decade, cancer care in the Philippines has advanced in response to the complex heterogeneity inherent to the disease and the constantly increasing number of patients. Central to this development is the increased awareness and universal acceptance of the multidisciplinary team (MDT) approach in providing cancer care to optimize outcomes where medical oncologists play a vital role. This position paper summarizes the unique and multifaceted roles of the medical oncologist in ensuring that the best possible care is given to patients with cancer by actively participating in the whole spectrum of the patient’s journey—from diagnosis, treatment, supportive care, until providing palliative care and addressing end-of-life issues

Implications of financial toxicity in the lives of cancer patients: a reflection

OBJECTIVE

To reflect on the understanding of financial toxicity, as an adverse event of cancer diagnosis and treatment, and its implications on the quality of life of these patients.

METHOD

Reflexive study, based on the international literature about the concept of financial toxicity and its relationship with quality of life.

RESULTS

Financial toxicity is related to the financial difficulties associated with cancer and its treatment, which occur in the lives of patients and family members. Its consequences include: possible worsening of the clinical symptoms, indebtedness, loss of professional opportunities, changes in family habits and decline in quality of life.

FINAL CONSIDERATIONS

Measures to minimize financial toxicity should also be a concern of the state and be part of the therapeutic itinerary of cancer patients. Dialogue can become an essential tool for the health team to clarify the therapeutic options and their costs. This attitude shows respect and preserves the patient's autonomy, which can minimize the feeling of helplessness in the face of the disease.