Philippine Costs in Oncology (PESO): Describing the economic impact of cancer on Filipino cancer patients using the ASEAN costs in oncology study dataset

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Cancers are among the top causes of mortality in the Philippines. The treatment regimens are also costly and put Filipinos at risk of financial catastrophe. The economic impact, however, has not been documented.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This analysis aimed to describe the economic impact of cancer in the Philippines and analyze predictors of financial catastrophe among Filipino cancer patients.</p><p style="text-align: justify;"><strong>METHOD:</strong> The analysis used the dataset from the ASEAN costs in oncology study, a prospective study of adult cancer patients in Southeast Asia. Cancer patients were recruited at time of diagnosis and were monitored in terms of health outcomes, costs, and quality of life. Multinomial regression models were generated to assess predictors of death and financial catastrophe.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Information from 909 respondents in the Philippines was included in the analysis. Overall, 240 (26.4%) of the cohort were dead at the end of the study while 40.6% were still alive at Month 12 but had experienced financial catastrophe. Mean combined Month 3 and Month 12 out-of-pocket expenditure was PhP181,789.00 (n = 458, sd = 348,717.47). Belonging to higher income groups (vs. belonging to the lowest two) was significantly associated with lower risk of financial catastrophe. Insurance did not confer significant change in risk of death or financial catastrophe.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Cancer can be a significant economic burden for Filipinos leading to financial catastrophe. Insurance mechanisms at the time of study failed to protect against catastrophe.</p>

The role of prophylactic renin-angiotensin system inhibitors for the prevention of anthracycline-induced cardiotoxicity among adult cancer patients: A meta-analysis

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Anthracycline is a cornerstone in the treatment of various cancers. One major limitation to its use is cardiotoxicity. Renin angiotensin system (RAS) inhibitors have been shown to attenuate myocardial injury, initial data is promising in its use as prophylaxis for anthracyclineinduced cardiotoxicity. The aim of the study is to determine effectiveness of prophylactic RAS inhibitors in preventing anthracycline-induced cardiotoxicity and adverse cardiac events among adult cancer patients</p><p style="text-align: justify;"><strong>METHODS:</strong> Systematic search of databases PUBMED, MEDLINE, EMBASE, and CENTRAL was done. Selection criteria were: 1) randomized controlled trials (RCT) 2) adult cancer patients with normal ejection fraction and without heart failure symptoms 3) RAS inhibitors as prophylaxis versus placebo 4) development of cardiac events, all-cause mortality and left ventricular ejection fraction (LVEF) reduction as outcomes. Two reviewers independently assessed the trials. Disagreements were resolved with a third reviewer. Test for effect of intervention, heterogeneity, trial quality and risk of bias were assessed using the Cochrane Review Manager Software version 5.3.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Five RCTs involving 530 adult patients, with average age of 50± two years old, and average follow-up from six months to three years were included. Combined clinical outcomes of heart failure, cardiac events and all-cause mortality showed an RR of 0.27[95%CI 0.18, 0.40],p<0.00001, in favor of RAS inhibitors. There is same benefit in LVEF preservation with mean difference of 4.37%[95%CI 1.20, 7.55;p=0.007]. Exploratory subgroup analysis showed significant benefit in LVEF preservation with combined RAS inhibitor and beta-blocker, with mean difference of 2.45%[95%CI 1.27, 3.63]. There is overall significant heterogeneity (I2=95%). Excluding one article with high-risk population, after sensitivity analysis, showed same benefit but reduced heterogeneity.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Renin angiotensin system (RAS) inhibitors may be used as prophylaxis for cardiotoxicity. As prophylaxis, it reduced the clinical outcome of cardiac events, heart failure, and all-cause mortality among cancer patients needing anthracycline. Combined RAS inhibitor and betablocker limits LVEF reduction.</p>

The role of prophylactic renin-angiotensin system inhibitors for the prevention of anthracycline-induced cardiotoxicity among adult cancer patients: A meta-analysis

INTRODUCTION: Anthracycline is a cornerstone in the treatment of various cancers. One major limitation to its use is cardiotoxicity. Renin angiotensin system (RAS) inhibitors have been shown to attenuate myocardial injury, initial data is promising in its use as prophylaxis for anthracyclineinduced cardiotoxicity. The aim of the study is to determine effectiveness of prophylactic RAS inhibitors in preventing anthracycline-induced cardiotoxicity and adverse cardiac events among adult cancer patientsMETHODS: Systematic search of databases PUBMED, MEDLINE, EMBASE, and CENTRAL was done. Selection criteria were: 1) randomized controlled trials (RCT) 2) adult cancer patients with normal ejection fraction and without heart failure symptoms 3) RAS inhibitors as prophylaxis versus placebo 4) development of cardiac events, all-cause mortality and left ventricular ejection fraction (LVEF) reduction as outcomes. Two reviewers independently assessed the trials. Disagreements were resolved with a third reviewer. Test for effect of intervention, heterogeneity, trial quality and risk of bias were assessed using the Cochrane Review Manager Software version 5.3.RESULTS: Five RCTs involving 530 adult patients, with average age of 50± two years old, and average follow-up from six months to three years were included. Combined clinical outcomes of heart failure, cardiac events and all-cause mortality showed an RR of 0.27[95%CI 0.18, 0.40],pCONCLUSION: Renin angiotensin system (RAS) inhibitors may be used as prophylaxis for cardiotoxicity. As prophylaxis, it reduced the clinical outcome of cardiac events, heart failure, and all-cause mortality among cancer patients needing anthracycline. Combined RAS inhibitor and betablocker limits LVEF reduction.

Quality of life changes in Filipino cancer patients from baseline to one year after diagnosis: A country-specific analysis of the ACTION Study

BACKGROUND: Health-related quality of life is an important aspect of cancer research. Studies in the Philippines documenting this among survivors are limited in scope and number.OBJECTIVE: To document quality of life indicators of Filipino cancer survivors starting at 12 months from diagnosis and identify predictors of these changes.METHODS: The ACTION study is a prospective longitudinal study examining the economic and health impact of cancer in the Southeast Asian Region. A country-specific analysis for Filipino patients was conducted.RESULTS: Of the 909 Filipinos included in the study, 462 survived month 12 and had health-related quality of life (HRQoL) data. HRQoL data showed significant improvement from baseline (0.73, SD: 0.15) to month 12 (0.79, SD: 0.24) as measured by the EQ-5D weight score. Similar trends were seen in the EQ5D VAS Scores and the QLQ30 Global function scores. There was, however, an increase in the proportion of respondents experiencing significant problems related to EQ5D domains by month 12. Data disaggregated according to cancer type showed a decrease in QLQ30 GF scores from baseline to month 12 for all types except breast cancer. Individuals at risk of anxiety and depression increased from 15.37% to 25.54% and 18.83% to 32.25%, respectively. Predictors of worsening HRQOL include experiencing economic hardship, progression of disease, and higher stage at baseline.CONCLUSION: HRQOL scores were found to increase despite experiencing more difficulties in function among Filipino cancer survivors one year after diagnosis.