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Ho FDV, De Luna DV, Cubarrubias DLPF, Ong EP, Abello RMR, Ansay MFM, Taliño MKV, Robredo JPG, Eala MAB, Dee EC. Palliative and Supportive Care in the Philippines: Systems, Barriers, and Steps Forward. J Palliat Care 2024; 39:87-91. [PMID: 36740938 DOI: 10.1177/08258597231153381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although integral to alleviating serious health-related suffering, global palliative care remains systemically and culturally inaccessible to many patients living in low- and middle-income countries. In the Philippines, a lower-middle income country in Southeast Asia of over 110 million people, up to 75% of patients with cancer suffer from inadequate pain relief. We reviewed factors that preclude access to basic palliative care services in the Philippines. PubMed and Google Scholar were searched thoroughly; search terms included but were not limited to "palliative care," "supportive care," "end-of-life care," and "Philippines." We found that a limited palliative care workforce, high out-of-pocket healthcare costs, and low opioid availability all hinder access to palliative care in the archipelago. Religious fatalism, strong family-orientedness, and physician reluctance to refer to palliative care providers represent contributory sociocultural factors. Efforts to improve palliative care accessibility in the country must address health systems barriers while encouraging clinicians to discuss end-of-life options in a timely manner that integrates patients' unique individual, familial, and spiritual values. Research is needed to elucidate how Filipinos-and other global populations-view end-of-life, and how palliative care strategies can be individualised accordingly.
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Affiliation(s)
| | | | | | - Erika P Ong
- College of Medicine, University of the Philippines, Manila, Philippines
| | | | | | | | | | - Michelle Ann B Eala
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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2
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Feliciano EJG, Ho FDV, Yee K, Paguio JA, Eala MAB, Robredo JPG, Ng K, Lim J, Pyone KT, Peralta CA, Flores JA, Yao JS, Santos PMG, Ang CDU, Lasco G, Chan JSK, Tse G, Tangco ED, Kingham TP, Chitapanarux I, Bhoo-Pathy N, Legaspi GD, Dee EC. Cancer disparities in Southeast Asia: intersectionality and a call to action. Lancet Reg Health West Pac 2023; 41:100971. [PMID: 38053740 PMCID: PMC10694578 DOI: 10.1016/j.lanwpc.2023.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/27/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Erin Jay G. Feliciano
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Department of Medicine, NYC H+H/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, USA
| | | | - Kaisin Yee
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - Joseph A. Paguio
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Michelle Ann B. Eala
- University of the Philippines College of Medicine, Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G. Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Kenrick Ng
- Department of Medical Oncology, St Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Jasmine Lim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khin Thuzar Pyone
- Radiation Oncology Department, Yangon General Hospital Yangon, Myanmar
| | | | | | - J. Seth Yao
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Patricia Mae G. Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Daniel U. Ang
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Gideon Lasco
- Development Studies Program, Ateneo de Manila University, Quezon City, Philippines
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
| | | | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Kent and Medway Medical School, Canterbury, UK
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Enrico D. Tangco
- Department of Radiation Oncology, The Medical City, Pasig City, Philippines
| | - T. Peter Kingham
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gerardo D. Legaspi
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines Manila, Philippine General Hospital, Metro Manila, Philippines
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Dee EC, Eala MAB, Robredo JPG, Ramiah D, Hubbard A, Ho FDV, Sullivan R, Aggarwal A, Booth CM, Legaspi GD, Nguyen PL, Pramesh CS, Grover S. Leveraging national and global political determinants of health to promote equity in cancer care. J Natl Cancer Inst 2023; 115:1157-1163. [PMID: 37402623 PMCID: PMC10560599 DOI: 10.1093/jnci/djad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Anne Hubbard
- American Society for Radiation Oncology, Arlington, VA, USA
| | | | - Richard Sullivan
- Kings Health Partners Comprehensive Cancer Centre, King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Institute of Cancer Policy, King’s College London, London, UK
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA
| | - C S Pramesh
- Tata Memorial Hospital, Thoracic Surgery (Surgical Oncology) at Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Puyat CVM, Robredo JPG, Tiam-Lee JGA, Domingo AFE, Hemedez-Gonzales RR, Eala MAB, Dans AL. E-Cigarette Regulation: Lessons From the Philippines. Pediatrics 2023; 151:190670. [PMID: 36794440 DOI: 10.1542/peds.2022-057825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 02/17/2023] Open
Affiliation(s)
| | | | | | | | | | | | - Antonio L Dans
- Department of Internal Medicine, Philippine General Hospital, Manila, Philippines
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5
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Dee EC, Robredo JPG, Eala MAB, Suanes PN, Bhoo-Pathy N. The ripple effect: Cancer-related financial toxicity for family members and caregivers. Psychooncology 2023; 32:155-159. [PMID: 36383435 DOI: 10.1002/pon.6067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Janine Patricia G Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines.,Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines.,Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, USA
| | - Patricia N Suanes
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Arevalo MVPN, Robredo JPG, Valenzuela S, Ho FDV, Alberto NRI, Alberto IRI, Bernardo MNG, Manlongat KD, Garcia AMU, Galvez Tan JZ, Dee EC, Eala MAB. The role of traditional, complementary, and alternative medicine in cancer care in the Philippines. Chin Clin Oncol 2022; 11:49. [PMID: 36632981 DOI: 10.21037/cco-22-91] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Sary Valenzuela
- University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
| | | | | | | | | | | | - Ann Meredith U Garcia
- Section of Medical Oncology, Dagupan Doctors Villaflor Memorial Hospital, Dagupan City, Philippines
| | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
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7
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Robredo JPG, Cembrano DLD. Out on a limb: living with diabetes in the Philippines during the pandemic. Lancet Diabetes Endocrinol 2022; 10:771-772. [PMID: 36306812 PMCID: PMC9597553 DOI: 10.1016/s2213-8587(22)00275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022]
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8
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Guarin GE, Dee EC, Robredo JPG, Eala MAB, Medina MF, Tanco KC. End-of-life care for Filipino patients with cancer. Palliat Support Care 2022; 21:1-5. [PMID: 36168286 DOI: 10.1017/s1478951522001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Providing end-of-life care within the cultural context of a Filipino patient in the United States is a complex process for clinicians, patients, and their families. An inclusive approach is crucial, especially because a significant proportion of patients belong to minority groups such as Filipinos, who represent the fourth largest group of immigrants in the United States as of data available in 2019. The case provided in this paper highlights the importance of family, religion, and finances in guiding the best possible way of providing end-of-life care for Filipino patients with cancer. At the end of this review, we discuss concrete action points that may give a non-Filipino physician a deeper understanding of end-of-life care for Filipinos.
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Affiliation(s)
- Geneva E Guarin
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Manuel F Medina
- Supportive, Hospice and Palliative Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Kimberson C Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Eala MAB, Robredo JPG, Dee EC, Lagmay AMFA. Public Health Impact of Disasters: A Philippine Perspective. Disaster Med Public Health Prep 2022; 16:1-2. [PMID: 35844101 DOI: 10.1017/dmp.2022.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alfredo Mahar Francisco A Lagmay
- University of the Philippines National Institute of Geological Sciences, Quezon City, Philippines
- University of the Philippines Resilience Institute and NOAH Center, Quezon City, Philippines
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10
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Valdez IKM, Arevalo MPN, Robredo JPG, Gacad SLS, Villaceran MAJ, Libang GR, Dela Paz EP, Rubin KSTA, Eala MAB. Violence against women in the Philippines: barriers to seeking support. The Lancet Regional Health - Western Pacific 2022; 23:100471. [PMID: 35542896 PMCID: PMC9079295 DOI: 10.1016/j.lanwpc.2022.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Sabrina Laya S. Gacad
- Center for Women's and Gender Studies, University of the Philippines, Diliman, Quezon City, Philippines
| | | | - Gertrudes R. Libang
- General Assembly Binding Women for Reforms, Integrity, Equality, Leadership, and Action (GABRIELA), Quezon City, Philippines
| | - Edelina P. Dela Paz
- Social Medicine Unit, College of Medicine, University of the Philippines, Manila, Philippines
| | | | - Michelle Ann B. Eala
- College of Medicine, University of the Philippines, Manila, Philippines, 547 Pedro Gil Street, Manila, 1000, Philippines
- Corresponding author.
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11
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Eala MAB, Maslog EAS, Robredo JPG, Pedro RJLS, Medina PVN, De la Paz EP, Lasco G. Violence against health-care workers in the Philippines. Lancet 2022; 399:2012-2013. [PMID: 35644150 PMCID: PMC9135372 DOI: 10.1016/s0140-6736(22)00785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Michelle Ann B Eala
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines.
| | | | | | | | - Paolo Victor N Medina
- Department of Family and Community Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Edelina P De la Paz
- Department of Family and Community Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Gideon Lasco
- Social Medicine Unit, University of the Philippines Manila, Manila 1000, Philippines; Development Studies Program, Ateneo de Manila University, Quezon City, Philippines; Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
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12
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Robredo JPG, Eala MAB, Marquez NDE, Camiling-Alfonso R. The costs of inadequate toilet coverage in the Philippines. Lancet Gastroenterol Hepatol 2022; 7:387. [PMID: 35397239 DOI: 10.1016/s2468-1253(22)00046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | | | - Norman Dennis E Marquez
- Health Sciences Program, School of Science and Engineering, Ateneo de Manila University, Quezon City, Philippines
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13
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Eala MAB, Robredo JPG, Dee EC, Lin V, Lagmay AMFA. Climate crisis and cancer: perspectives from the hardest hit. Lancet Oncol 2022; 23:e92. [DOI: 10.1016/s1470-2045(21)00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
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