EDITORIAL PREFACE

Esteemed readers, welcome to this issue of our journal! Within these pages, you’ll find a wealth of insights and advancements in cancer care interwoven with threads of hope and innovation. As you embark on this journey through the pages, we acknowledge the challenges in cancer care and the resilience it demands. Prepare to be captivated by the spectrum of cancer care – from the intricacies of research to the poignant expressions of human resilience. Together, we can overcome these challenges and inspire hope for a brighter future.

One crucial piece of this spectrum is the power of data and research. The visionary Perspective Piece “Cancer Research, The Philippine Population-Based Cancer Registry, and The Quest for Philippine Cancer Survival Information” perfectly exemplifies this. Imagine the Philippines, where cancer control soars, guided by the sharpest data! Thanks to our dedicated population-based cancer registries (PBCRs), this is closer than ever. These heroes meticulously gather and analyze vital cancer trends. Let’s leverage this data to make informed decisions, empowering us to pave the way for a healthier future for all Filipinos! This is a testament to the power of collaboration, inspiring us to work together towards a common goal.

Building on this foundation of data-driven insights, we’re excited to introduce a new feature in this issue: “Cancer Stats on the Spot: Breast Cancer” from the Philippine Cancer Society. This article showcases the invaluable work of the Philippine Cancer Society-Manila Cancer Registry (PCS-MCR), a population-based cancer registry covering the Metro Manila cities of Caloocan, Quezon, Manila, and Pasay. Since 1992, PCS-MCR has been contributing to the WHO IARC Cancer in 5 Continents, providing crucial data on breast cancer trends and patterns in the Philippine context. This spotlight on breast cancer statistics not only complements our broader discussions on cancer care but also underscores the importance of long-term, consistent data collection in shaping our understanding and strategies in the fight against cancer.

Following this emphasis on data, we delve deeper with a Population-Based 5-year Cancer Survival Study (2006-2017) among Filipino Pediatric Cancer Patients. This study paints a vital picture of survival in a particularly vulnerable population. Together, we can turn the tide. We can significantly improve pediatric cancer outcomes in the Philippines by implementing comprehensive cancer control strategies and upgrading children’s services in cancer centers nationwide. Let’s join hands and create a future where every child has the best chance to fight cancer and win.

The battlefield against cancer, however, is far broader than just data collection. It is multifaceted and demands expertise from various disciplines. We witness this through Multidisciplinary Management of Advanced Thymoma: A Case Study of a 47-Year-Old Female and Implications for Future Research. This case study from one of the ONCOLLABORATE sessions unveils the collaborative spirit that fuels advancements in treatment strategies for complex cancer cases and inspires hope for the future, suggesting future investigations.

Two compelling studies further explore treatment options. Hypo-fractionated Radiotherapy versus Conventional Radiotherapy in Post-Mastectomy Breast Cancer Patients: A Single Institution Trohoc Study provides valuable data on the efficacy and safety of different radiotherapy regimens, offering useful insights for oncologists. Innovation isn’t confined to technical advancements. Enhancing Sentinel Lymph Node Localization in Early-stage Breast Cancer: A Comparative Study of Blue Dye and Combined Blue Dye-Lymphoscintigraphy explores an improved method for early detection, a way to improve clinical outcomes for breast cancer patients.

We now shift our focus to the organizational machinery behind patient care. The Operational Effectiveness of the Multidisciplinary Tumor Board of Jose R Reyes Memorial Medical Center, 2021 – 2022, sheds light on the crucial role of collaboration, which is critical to conquering cancer! The MDTB embodies this spirit, meticulously evaluating cases and fostering communication among specialists. Their dedication translates to standardized procedures, informed treatment plans, and a path toward patient symptom relief. By harnessing the power of collaboration, we can create a brighter future for those battling cancer.

While the organizational aspects of cancer care are essential, it’s equally important to understand the disease on a physical level. Primary Breast Cancer with Orbital and Rectal Metastasis: A Case Report highlights the diverse ways cancer can manifest. We also explore the unique diagnostic challenges presented in Retroperitoneal Soft Tissue Sarcoma with Ectopic Beta-human chorionic gonadotropin (ß-hCG) production mimicking a Nonseminomatous Germ Cell Tumor in a 33-year-old male: A Case Report. How about admiring the case report of a minimally invasive Topical Imiquimod as an Adjunct to Conventional Chemotherapy, an Effective Treatment for Cutaneous Invasive Breast Carcinoma Metastasis, showcasing a potential advancement in treatment strategies and encouraging us to look forward with optimism? These potential advancements in cancer care should fill us with hope and optimism for the future.

Beyond the physical realm, we explore the profound impact of Maya Angelou’s poem “Still I Rise” on a cancer survivor’s life. “More Than Words: A Multifaceted Analysis of ‘Still I Rise’” invites you on a close reading journey, examining the poem’s depth and adaptability. This analysis paves the way for its potential use as a powerful tool in clinical settings.

Complementing this analysis is “The EFECT of Poetry: Enhancing Engagement and Emotional Exploration in Cancer Survivors through Independent Reading and Expression.” This article explores the EFECT framework (Engage, Feel, Explore, Connect, and Transfer). This framework sheds light on the therapeutic tasks involved in experiencing poetry, like “Still I Rise,” on a personal level. Imagine empowering cancer survivors to process emotions and find healing through independent exploration of this poem!

Beyond the physical and emotional, there’s a deeper existential dimension to consider. A Psalm of Hope: Biblical Verses for Cancer Patients reflects on the timeless wisdom of scripture, particularly for those facing the relentless fight against cancer. Verses like Psalm 103:3, “He heals all your diseases,” and Psalm 34:18, “Yahweh is near to the broken-hearted,” are potent reminders of God’s enduring presence and support. For patients, these verses provide comfort and a sense of divine companionship in their most vulnerable moments. The article also highlights the importance of community, as taught by Pope Francis, and the shared suffering of Christ in Isaiah 53, offering patients a profound sense of connection and hope amidst their trials.

This journal issue is a testament to the tireless efforts of researchers, clinicians, and healthcare professionals who dedicate themselves to the fight against cancer. We invite you, our esteemed readers, to delve into these pages and discover the spirit of innovation, empathy, and unwavering hope that fuels this ongoing battle. Your active participation and dedication are crucial in this fight.

PERSPECTIVE PIECE

Cancer Research, The Philippine Population-Based Cancer Registry and The Quest for Philippine Cancer Survival Information

Corazon A Ngelangel and Rachel Marie B Rosario

In most cancer research proposals and publications, the cancer burden is emphasized at the beginning and the end—the very reason for their existence. Inside the proposals and publications are “explorations of the complexity and many facets of oncology care and cancer control from diverse perspectives.”

SEER² has defined a cancer registry as an information system specifically designed for the collection, storage, and management of data on individuals with cancer. These registries, whether population-based or hospital-based, play a pivotal role in cancer surveillance, providing crucial insights into our progress in reducing the cancer burden.

WHO-IARC³ indicated that population-based cancer registries (PBCR) “describe the extent and nature of the cancer burden in the community and assist in the establishment of public health priorities, are used as a source of material for etiological studies, and help in monitoring and assessing the effectiveness of cancer control activities.” PBCRs record all new cases in a defined population (most frequently a geographical area such as Metro Manila), emphasizing epidemiology. PBCRs are designed to determine cancer patterns among various populations or sub-populations, monitor cancer trends over time, guide the planning and evaluation of cancer control efforts, help prioritize health resource allocations, and advance clinical, epidemiological, and health services research.⁴ Analysis of the routine data on cancers in a PBCR remains an essential component in understanding the epidemiology of cancers in a limited resource setting, and routine data of the cancer registry can be used for retrospective research (inferred from incidence, mortality, and survival rates) and exciting cases to report. New trends or findings from cancer registries would incite prospective research.

Currently, the Philippines boasts two high-quality PBCRs – the Department of Health Rizal Cancer Registry (DOH-RCR) and the Philippine Cancer Society Manila Cancer Registry (PCS-MCR), both launched in 1974 and 1983, respectively. These registries, established through the Department Circular No. 200 s. 1974 and Ministry Circular No. 126-A s.1983, play a crucial role in providing essential public health information such as cancer incidence and prevalence. They are a testament to the Philippines’ commitment to cancer research and control, and their importance cannot be overstated.

Philippine PBCRs gather cancer-related data from hospitals and local civil registries through both passive and active methods. This involves visiting various hospital departments and the tumor registry for cancer-related data. However, the implementation of the Data Privacy Act in 2012 posed a challenge to this data collection process. The Act classifies health information as sensitive personal data and prohibits its processing. The National Integrated Cancer Control Act (NICCA)

and its Implementing Rules and Regulations (IRR) provide a solution by establishing a national cancer registry and monitoring system through PBCRs, thereby superseding the DPA.

Population-based survival data requires the entry of the last known status of the patient if alive, dead, lost to follow-up, or vital status unknown. The vital status information can be obtained through active or passive procedures. Active follow-up consists of regular checking of the vital status of each cancer patient by the physician, hospital, or through home visits. Passive follow-up refers to regularly checking the vital status of all registered patients from information provided by registries, herewith the Local Civil Registry (LCR) and the Philippine Statistics Authority (PSA) national registry.

The LCR is a data source with a death registry containing the certificates of those who died in the locality. DOH-RCR and PCS-MCR PBCRs utilize data collection forms for hospital case-finding and death certificates in LCRs. Cancer registry clerks collect all data and bring them back to the PBCR office for cross-checking, abstracting, coding, and encoding.

Each city and municipality in the Rizal and Manila region has its own LCR. The LCR office receives the accomplished death certificates of people who died there. Physicians in charge file death certificates and include the full name, age, sex, place of death, date of death, and probable cause. The LCR processes, files, and endorses the Certificates of Death to the PSA for certification and printing. The PBCR’s official link with the PSA is essential for collecting survival status information. In the case of local migration, the death of index patients outside Manila and Rizal will not be reflected in the LCRs.

The PSA is the central statistical authority of the government, established in 2013 pursuant to Republic Act 10625, which reorganized and strengthened the Philippine statistical system. It is the national depository for the birth, marriage, and death certificates of the Philippine citizenry.

There has been no official collaboration between the PSA and the DOH-RCR and PCS-MCR PBCRs. These PBCRs’ previous population-based survival analysis utilized a combination of expensive and labor-intensive active and passive follow-up procedures. In contrast, obtaining death certificates from the PSA will reliably identify all registered cancer patients’ deaths. All patients not identified as deceased would be alive.

Just last 29 November 2023, DOH Cancer Control Division, Epidemiology Bureau, Knowledge Management & Information Systems, PSA, National Data Privacy Commission, Philippine Cancer Center, DOH-RCR, PCS-MCR, and WHO came together to resolve this obstacle to the PBCRs in the country. An official process was found to already exist for requests on PSA data through a formal Data Sharing Agreement (DSA), exemplified by linkages with PhilHealth, the Philippine National Police, and other government agencies at no cost. A supporting mandate of the requesting agency is a prerequisite for the collaboration. NICCA Section 28 mandates the establishment of a National Cancer Registry and Monitoring System, which includes the PBCR. Thus, collecting relevant health information is allowed, provided it is to establish the required National Cancer Registry and complies with the NICCA and its IRR. With official data linkage to the PSA, the PBCRs would easily access target population survival data in the country.

Hospital-based cancer registries (HBCR) maintain data on all patients diagnosed and treated for cancer at a particular health facility, focusing on clinical care and hospital administration.³ More in-depth information on the clinical profile of the cancer cases, like the extent of cancer disease and initial treatment, are mainly within the purview of an HBCR rather than a PBCR; the clinical outcome of the patient, such as survival, is significantly related to the extent of cancer disease and the initial treatment. The HBCR complements the PBCR. Such HBCRs can be culled out of the hospital’s medical records, capturing only those with a cancer diagnosis more quickly if the hospital has electronic medical records. It would be best if hospitals (wherein the population-based registry data are being collected) had hospital-based cancer registries to feed complete pertinent data to the population-based cancer registry.

Cancer registries are research gold mines. The re-launch of the Philippine Journal of Oncology by the Philippine Society of Oncologists in 2024 is laudable. We were much awaited to worthwhile share for a lifetime through publications our many thoughts, experiences, knowledge, practices, and processes on cancer management and control in the hospitals and the community, which indeed would “center on several viewpoints that illuminate essential facets of patient welfare, therapeutic approaches, and healthcare infrastructures, and provide distinctive perspectives on the intricacies encountered by medical professionals, patients, caregivers, and policymakers in diverse facets of cancer treatment and control”¹.

REFERENCES

1. Dr. Susano Tanael, Editor-In-Chief of PJO, on Themed issue of PJO, Sept 2024.
2. A cancer registry is an information system designed for the collection, storage, management, and analysis of data on persons with cancer [Internet]. National Cancer Institute Surveillance, Epidemiology, and End Results Program. [cited 2023 Dec 1]. Available from: https://seer.cancer.gov/registries/cancer_registry/
3. Cancer registry [Internet]. International Agency for Research on Cancer. [cited 2023 Dec 1]. Available from: https://publications.iarc.fr/Advanced-Search?q=cancer+registry
4. Hospital-based registries [Internet]. National Cancer Institute Surveillance, Epidemiology, and End Results Program. [cited 2023 Dec 1]. Available from: https://training.seer.cancer.gov/registration/types/hospital.html
5. Krishnatreva M. Epidemiological research on cancers by cancer registries: A viewpoint. South Asian J Cancer. 2015 Jan-Mar;4(1):50.