By KIMBERLIE QUITASOL
Northern Dispatch
BAGUIO CITY— Cyrene Reyes, editor of the North Star Magazine, was diagnosed with Breast Cancer Stage 2-B in February 2021, at a time when the country’s healthcare system was overwhelmed by the Coronavirus disease (COVID-19) pandemic.
Cye, as her friends fondly call her, said getting diagnosed and undergoing treatment for breast cancer at the height of lockdowns, restrictions, and an overburdened healthcare system was no easy feat.
In February 2021, her treatment journey started just as the hospitals in the country were battling the Omicron variant. Her doctor immediately scheduled her for a unilateral modified radical mastectomy after a frozen biopsy. She was able to access treatment at the Ilocos Training Regional and Medical Center (ITRMC).
“What they did was make me sign a consent that if the lump is malignant, they will proceed with mastectomy, so when I woke up, the first thing I did was touch my breast, when I could not feel my left breast, I already knew, I have cancer,” she shared.
After the surgery, she had to go through eight cycles of chemotherapy and 18 cycles of targeted therapy that lasted from February 2021 to September 2022.
“Remember this was during the CoVid lockdown when travel restrictions were imposed that public transport was down, and many protocols must be observed which made it more difficult,” she said.
She said they had to travel one and a half hours to the hospital every treatment session. She added that they also had to rent overnight accommodation near the hospital because there were laboratory tests required before the actual chemotherapy and the mandatory COVID tests.
“We also have to be early for the queuing, and after the therapy, I would be so weak that I need to rest before travelling back home,” she explained.
According to her, only one day was allotted every week for surgery and two days for chemotherapy due to the pandemic, with 60 to 80 patients regularly lining up for chemotherapy at the time. She recalled that her treatment was delayed for two weeks in February 2022 because she got infected with COVID-19.
Right information is key
According to Cye, breast cancer is not new to her. After having a benign lump found on her right breast in 1990, she closely monitored her breasts and had yearly mammograms. “But still, I needed to know what are the available treatment options for me, where and how to avail of these,” she added.
She turned to the internet to look for relevant information. But only after talking to an oncologist that she got a more concrete treatment option. She said the lockdown and the pandemic made it more difficult to seek professional and expert advice.
Breast cancer survivors, who started undergoing treatment earlier, guided her through the hospital processes. They also gave tips on where to access assistance and practical advice on what to do and what not.
“This practice of old patients guiding new patients has become a tradition among us. It would have been better if health care facilities and institutions could also take on this task of providing patients guidance, especially through the rigorous processes and stringent requirements in availing assistance and services, to make their treatment journey better,” she said.
While the internet is filled with information about breast cancer, Dr. Jennifer Joyce Pira, Medical Officer IV of the Department of Health (DOH)-Cordillera Administrative Region (CAR), said that every patient has specific treatment needs that their oncologist can best determine.
“Treatment options vary for every patient, depending on the diagnosis and the patient, some treatments work on some patients but does not for some. The best way really is to consult your doctor,” she reiterated.
Nikoy De Guzman, president of the ICanServe Foundation, who survived breast cancer twice, said that even before the pandemic, patients already had difficulty accessing the correct information for their treatment. “I was diagnosed in 2002 and 2015, my mother who was a survivor herself was my guide in my treatment journey,” she said.
Nikoy was in Baguio on September 26 when they launched the You Can Do This: A Breast Cancer Patient’s Manual. She described the manual, which can be downloaded online for free, as “a manual by survivors for survivors.”
“Having access to the right information when facing cancer is like a compass in a storm. It guides us towards informed decisions, empowers us with knowledge, and ignites a spark of hope in our hearts,” said Abbygale Arenas-De Leon.
Abbygale, a former beauty queen and professional image consultant, is featured on the cover of the said manual. She was diagnosed with Stage 3 HER 2 positive breast cancer in June 2020.
According to ICanServe Foundation, breast cancer remains the most common cancer in the Philippines, citing World Health Organization (WHO) data that in 2020 alone, there were 27,163 diagnosed with the illness in the country.
DOH-CAR data showed 16 breast cancer patients from 2020 to 2022 in the region: one male and 14 females. In 2021 alone, 65 died of the illness based on the same record: 61 females and four males.
According to Dr. Pira, the patients who died in 2021 may have been diagnosed earlier. She added that they are still improving their data aggregation for breast cancer patients, noting that most are just logged as cancer in general.
“We still need to really disaggregate our cancer data, but so far these are the numbers logged as particularly breast cancer patients,” she said.
Costly treatment, limited assistance
The cost of the treatment is another story.
Cye was told that one chemotherapy cycle alone costs around P40,000 to P50,000. She added that one cycle of the targeted therapy ranges from P22,000 to P100,000. On top of these are the miscellaneous expenses like transportation, food, and accommodation, among others.
“I was lucky to have been able to avail of assistance from various government agencies and programs,” Cye shared.
The Philhealth package for catastrophic illnesses paid for her chemotherapy, and was able to avail herself of free oral medicines from the Malasakit center. Her targeted therapy was sourced from the DOH’s free cancer medicines as part of the implementation of the National Integrated Cancer Control Act. She was also able to access financial assistance from the local government units and the Department of Social Welfare and Development (DSWD).
“But I was able to access all these government assistances because I was able to get a certificate of indigency and went to ITRMC (Ilocos Training and Regional Medical Center), one of the hospitals with Cancer Assistance Funds (CAF). I lost my job during the pandemic,” she stressed.
As of 2002, hospitals all over the country were allotted CAF. Aside from ITRMC, hospitals in Northern Luzon with CAF are the Baguio General Hospital Medical Center (BGHMC), Region I Medical Center, Mariano Marcos Memorial Hospital and Medical Center, and Cagayan Valley Medical Center.
She shared that there were patients she met who started their treatment in private medical institutions. The high cost of treatment forced them to transfer to a public hospital. However, they could not avail of government financial assistance given to indigent patients.
Moreover, Cye shared that apart from the certificate of indigency, there were many other documents that government agencies and institutions require. “You will need a lot of patience to go through the stringent processes of acquiring the needed documents and the long queues, not to mention the added difficulties the pandemic brought at the time,” she said.
She further pointed out the need for more information on how to access the various government assistance. “In fairness, there is a one stop shop for the processing of these various government assistance at the ITRMC but I learned about these from other patients who were also able to avail of them,” she said.
Rodora Humiwat-Abluyen, diagnosed with Stage 4 Breast Cancer with Bone Metastasis, said financial assistance for stage 4 cancer patients is limited.
The Philhealth package does not cover Stage 4 cases, but the Malasakit Center paid for her chemotherapy. The assistance from the office of the Baguio congress representative helped foot the bills for some of her laboratory tests. ICanServe took care of her first mammogram.
Rodora, who sells wood carvings, just finished her eighth chemotherapy session this July. She is currently undergoing bone and hormonal therapy, which costs P7,000/month, but has been free so far at the BGHMC.
“The hospital told me I can avail of the free bone therapy until the end of the year,” she said.
However, she pays for the required blood test every time she undergoes the therapy, which costs around P1,800. She also buys the medicine for her hormonal therapy. She used to buy it at the BGHMC at P50 pesos per tablet, but this September, the hospital ran out of supply. She had to buy her medicine from a private drugstore for P150 a tablet.
According to Rodora, there is no definite timetable for her bone and hormone therapy. “I guess I have to continue until my doctor tells me to stop,” she said.
Mental health care a must
The mental health aspect is equally important, said journalist Alya Honasan, who is in her 10th year as a cancer survivor.
“You do not give up on stage 4 people,” said the editor of the ICanServe Foundation breast cancer manual, adding that such is not a hopeless case.
She highlighted the importance of keeping the mind healthy during the treatment journey, both for patients and their caregivers. She said that a section of the manual also provides input from experts in psychiatry written in layperson’s terms to make it easier to understand.
Cye also mentioned the absence of mental health care in cancer treatment, pointing out that keeping a healthy mind and positive disposition is a must in going through treatment.
“I was able to go through my treatment because I did not lose my mind and sustained my will to fight, because once you give up, you lose,” she stressed.
In the absence of mental health care services, Cye said that conversations and sharing of experiences during the long queues and when they meet in the hospital helped patients and caregivers keep their sanity as they battle cancer.
“We encourage and cheer each other, we laugh and cry, we listen to each other’s problems and learn from each other’s experience,” she shared.
Rodora, on the other hand, said survivor-volunteers of the ICanServe Foundation guided and supported her through her treatment journey. The experiences of survivors inspire and encourage her to continue to face the challenges in the fight against cancer.
Despite the passage of the Philippine Mental Health Law in 2018, access to treatment remains a challenge, especially in the provinces. The scarcity of mental health care professionals, services and facilities, and the costly medicines have become an added burden for cancer patients needing psychiatric support.
According to Dr. Pira, DOH continues to capacitate health workers in the Rural Health Units (RHU) on how to handle cancer cases, including basic counseling in recognition of the need for mental health wellness. # nordis.net
