Two-dimensional graphs and figures filled the Powerpoint presentation of medical oncologist Dr. Dennis Sacdalan on cancer. In between the slides of shapes and numbers and little text, a picture stood out. It was one of a fictional, motley crew of galactic heroes.
Sacdalan was speaking a t the launch of Medical Center Manila’s (ManilaMed) new Center for Cancer Care, a department which he heads, when a movie poster of Marvel’s Guardians of the Galaxy flashed onscreen. The image showed the comic-book team of space mercenary Starlord, green-skinned assassin Gamora, vengeful brute Drax, sly raccoon Rocket and talking tree Groot.
“This is how we are supposed to practice cancer treatment. It’s gathering people from all over, specialists in their respective fields,” Sacdalan said. “Also, it’s about making them work together for a common goal, and that is to serve our patients better.”
Sacdalan proceeded to the present data on cancer, which remains anything but comical.
The illness is a perennial leading cause of death locally and globally. According to a World Health Oganization (WHO) study, cancer accounted for 8.2 million deaths in 2012—a figure that topped the number of deaths due to AIDS, tubercolosis and malaria combined.
That year, Globocan, a project of the WHO International Agency for Research on Cancer, said that the most prevalent forms of cancer were breast, lung, prostate, cervical and colarectal, in that order. The study identified lung and liver cancers as the type with the highest mortality rates.
These growing figures strengthen Sacdalan’s call to improve cancer treatment in the country, especially when common wrong practices and logistical limitations still exist. One of which is what medical oncologist Dr. Lou Jorel Tia, also a speaker at the event, calls the “specialist approach”.
This process involves patients consulting with autonomous specialists, neither of whom coordinate nor consult with each other. He said this disjointed approach is still widespread among Philippine hospitals today. Another case was cited by Dr. Jimmy Catapia, a general surgeon with a subspecialization in surgical oncology who practices in Bulacan. While initial checkups and some basic tests of cancer patients can be done in the province, he said there still are examinations and treatments available only in Manila.
“Kung kailangan ng pasyente ng MRI para malaman ’yung location ng bukol, wala sa Bulacan n’un so ipapaluwas ko sila sa Maynila. Kung nasa look ng katawan, kailangan ng CT-guided biopsy; wala rin gagawa, so dadalhin ulit sa Maynila. The result? Delay in diagnosis,” he said.
These shortcomings initiated the launch of ManilaMed’s Cancer Care Center (CCC), a one-stop shop that covers medical, surgical, radiotherapy and palliative care for cancer patients.
The CCC is established in partnership with the Philippine Oncology Center Corp. (POCC), which operates cancer centers in five locations in Luzon. Targeting an opening next month, ManilaMed’s CCC will be the first cancer center in Manila.
The CCC has two key components: its state-of-the-art Linear Acceletor (Linac) radiation therapy machine and its multidisciplinary teams (MDTs).
The Linac machine utilizes radiation to kill cancer cells. The one ManilaMed has is the most advanced in the country, as it will be the first functioning Volumetric Modulated Arc Therapy (VMAT) variety.
“With the VMAT-capable Linac, accuracies in terms of hitting the tumor is now reckoned in millimeters,” ManilaMed Chief of Radiation Oncology Dr. Vicente Francisco R. Hizon said.
He adds that during treatment, it’s not only the machine that moves, but the resting patient as well. This dynamic treatment saves normal structures from being targeted.
Another anchor of ManilaMed’s CCC is the concept of a MDT. It’s a group of health professionals from different disciplines that are each capable of contributing independently to the diagnostic and treatment decisions of a patient.
“We all have our own expertise, and we all have to work together,” Sacdalan said. “It’s the way to go. It’s the proper way of managing cancer patients.”
The benefit of having an MDT cuts two ways. For patients, it increases survival by shortening the time from diagnosis to treatment. It also minimizes logistics and the costs of consultation and cure. For health professionals, MDT streamlines treatment pathways, reduces duplication of services and presents educational opportunities.
The process is also simplified with a designed algorithm to help patients get treatment in an organized fashion.
Sacdalan explained that when a patient is diagnosed and admitted with cancer, there will be an automatic referal to the CCC. The center’s coordinator will then review the referral and assign the patient to a predefined MDT. Sacdalan said these teams are divided according to the disease for better courses of action. There’s a hepatomic team for liver-cancer cases, a colorectal team for colorectal cancer cases, and so on.
The MDTs will then plot a treatment plan, from scheduling of diagnostics, hospitalization (if needed), treatment and follow-ups. Patients will be guided by the coordinator, acting as navigator, throughout the process.
If the patient is a case of curative cancer, surveillance will be done regularly to make sure that the cancer does not recur, and if it does, an early intervention can be done. If, however, the patient is a case of advanced disease, there will be a referral to the palliative care services.
Palliative care is defined as specialzed medical care for people with terminal disease, focused on providing relief from the symptoms and stress of the serious illness. “Cancer does not just affect one person. It affects everyone, including the patient’s family,” said Dr. Manuel Medina, an oncologist specializing in palliative care.
He said patients react differently to learning that their cancer has worsened. “Some patients will get depressed. Others will ask, ’Bakit ako nagka-cancer? Mabuti naman akong tao.’ Some will have financial issues.”
This is where specialists like Medina come in with the message that patients “won’t get left behind”, adding “the doctors and hospital personnel are your family, and they’re going to take care of you.
“We’re dealing with people faced with very tough problems, they’re in a tough situation,” Medina continued. “The thing that will make you want to go back to a cancer center is the feeling that this is your home. Everyone here wants to take care of you. Even if it’s just a simple blood transfusion, you’d rather just have it in a cancer center where people really look out for you.”
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