Cancer Service Delivery in the Philippines during the COVID-19 Pandemic

Dear Editor,

In a recent article published in this journal, the author interestingly shared several innovations in human immunodeficiency virus (HIV) service delivery during the coronavirus disease 2019 (COVID-19) pandemic in the Philippines. It is indeed delightful to know that these innovations were done such as the offering of blended services of community centers, including online and on-site counseling and services for HIV testing, treatment, and care [1]. In relation to this, I would like to share in the same way the innovations done in the country with regards to cancer service delivery during the said pandemic.

The immunocompromised, such as cancer patients, are at higher risk of infection from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-and have a higher risk of developing severe complications [2]. During the pandemic, the major risk for patients with cancer is the inability to receive necessary medical services (both in terms of getting to hospital and provision of normal medical care once there) because of the outbreak. Patients with cancer need online medical counselling and appropriate identification and treatment of critical cases because delays could lead to tumour progression and ultimately poorer outcomes [3].

In the Philippines, the initial recommendations for cancer treatment during the pandemic is proposed by the Philippine Society of Medical Oncology (PSMO) in May 2020. It centered on the prioritization of cancer care, ensuring a safe work environment, organizing transition of cancer care and maintaining cohesion in a time of isolation. However, these guiding principles in a real-world setting has remained unclear for medical oncologists who are faced with dilemmas on testing for COVID-19 among patients and healthcare workers [4]. To address this, PSMO prioritized cancer patients who need testing by providing a triage/screening area manned by personnel with appropriate personal protective equipment (PPE) that is placed in all cancer institutions. The order of screening is categorized as follows (Table 1) [4]:

Table 1. Prioritization of cancer patients who need COVID-19 testing.

1st Priority	Hospitalized cancer patients with COVID-19 symptoms including, but not limited to, cough, shortness of breath, fever, chills, myalgias, sore throat, new loss of taste or smell, loose bowel movement or other flu-like symptoms.
2nd Priority	Cancer patients seen in the outpatient clinics with COVID-19 symptoms.
3rd Priority	Cancer patients who are asymptomatic but are scheduled to receive active therapy that can suppress the immune system (e.g., cytotoxic chemotherapy, biologic therapy, immunotherapy, high-dose corticosteroids, extensive radiotherapy or stem cell transplantation).
	Cancer patients who are asymptomatic, but have exposure to a confirmed case of COVID-19.

COVID-19, coronavirus disease 2019.

To maintain a safe work environment, patients can be screened remotely (over the phone for symptoms of COVID-19 infection prior to their scheduled visit); strictly enforcing physical distancing; wearing of the appropriate PPE, and proper and frequent handwashing. There was an isolation and quarantine for patients who are suspected of having signs or symptoms of COVID-19. About organizing transition of care, many oncologists maintained communication with their cancer patients through telemedicine, short message/messaging service, or other online communication platforms, such as email or social media, to discuss their medical concerns and treatment options. This is also where maintaining cohesion in a time of isolation is done. Technology platforms that allow webinars, teleconferencing, and recorded messages are practiced for the various organizations that cater to the cancer patients.

One of the most common cause of treatment delay among Filipino cancer patients concerns logistical support. Both the public and private sectors must help and cooperatively work hand in hand to organize and promote more programs for the continuity and improvement of cancer care services in the country.