Introduction
In response to the challenges of cancer care in the Philippines, the Philippine National Integrated Cancer Control Act, Republic Act No. 11215, was signed into law in February 2019.1,2 This law aims to strengthen cancer control in the country, increase cancer survivorship, and reduce the burden on families and patients with cancer. Furthermore, this law created the Philippine Cancer Center (PCC), serving as the center of excellence in providing cancer care, research and development, and capacity building for medical and allied professionals involved in the care of patients with cancer.
The PCC is situated in Diliman, Quezon City, and is currently building its 20-storey hospital that will feature state-of-the-art facilities in cancer care. The PCC will serve as the apex cancer care facility of the Department of Health in the provision of subspecialty oncologic care to Filipinos, guidance and technical services, and research leadership among all the Cancer Centers around the country. PCC also continues redevelopment of a facility housing the PCC Data Center and core laboratory facilities.
The PCC is mandated to take the lead in advancing and supporting cancer research in the Philippines. The PCC must play a leading role in guiding the National Cancer Research Agenda (NCRA) in a manner that is responsive to the current needs of patients and other key stakeholders. The formulation of the NCRA by the PCC will also ensure that cancer-related research efforts will have an effect on the health of Filipinos by informing government support priorities and guiding health care practitioners and policymakers. This endeavor is aligned with the Philippine Department of Health's mandate to provide direction of national policies and develop national plans, technical standards, and guidelines on health.
Creating the PCC NCRA 2024-2028
In June 2024, the PCC facilitated a 4-day intensive workshop to set the PCC NCRA. Various multisectoral and multidisciplinary stakeholders composed of key experts in the field of health, cancer care, and research representing various agencies were involved (Appendix Table A1).
The development of the PCC NCRA went through a multistep process that started from the identification of key stakeholders in cancer research in the Philippines including representatives of national government agencies, specialty cancer centers and training institutions, academe and research institutions, civic society and professional organizations, and development partners. The first step used the following criteria for stakeholder mapping: (1) institutions with a mandate to do cancer-related research whether biological, medical, service, or policy; (2) institutions with resources to do or support cancer-related research; (3) institutions or groups that represent vulnerable groups; and (4) direct beneficiaries of cancer research.
The second step involved data gathering through small group discussions and consultative meetings where contextual factors such as regional disparities, economic constraints, human resource shortage, patient experiences, cancer registry concerns, and institutional challenges were discussed. There were five main questions used during the focus group discussions and key informant interviews which focused on the mandate of the organization about cancer research, the major relevant cancer research of the organization in the last 5 years, successes in cancer research, the failures or setbacks and areas for improvement in cancer research, and cancer research topics they think should be prioritized.
The third step was data analysis involving evidence synthesis of current literature, together with the pressing concerns affecting the frontliners, and thematic analysis where recurring patterns and themes of cancer research were identified. The following frameworks were used to guide the development of the PCC NCRA 2024-2028: (1) national cancer research system, (2) Council on Health Research and Development (COHRED) manual on building and strengthening national health research systems (COHRED, 2008), and (3) WHO six building blocks framework (WHO, 2007).
The fourth step involved a plenary workshop where all key stakeholders agreed on the number of criteria to be used and the weight of each criterion. Participants selected prioritization criteria lifted from the National Unified Health Research Agenda 2023-2028 of the Philippine National Health Research System which is the country's main government arm dedicated to boost health through research.3 The final criteria agreed upon by the stakeholders included (1) impact on disease burden, (2) potential for policy impact, (3) systems framework (multilevel and community focus), (4) financial sustainability, (5) equity and diversity, (6) interdisciplinary collaboration, (7) innovation, and (8) capacity-building potential. The stakeholders then prioritized and ranked the health research topics. Through a QR code linked to a Google Form, the participants independently, individually, and anonymously assigned a score of 0-100 to each cancer research theme per criterion. The score of each research theme was then computed using a single weighted-sum approach4 that led to the final top 12 themes that will be part of the PCC Research Agenda for 2024-2028.
The last step involved activity for consensus building and commitment setting whereby key officials and representatives of institutional stakeholders belonging to the cancer research network expressed their commitment and support to the implementation of the research agenda.
Some challenges faced during the stakeholder consultations mainly included issues on funding and capacity development, and the wide variety of research topics that were being explored. These will be strategically addressed by commitments from the National Government Agencies involved to enhance funding mechanisms and resource allocation tracking and improve coordination among stakeholders and build regional capacities. Furthermore, almost all research topics that were identified in the stakeholder consultative meetings and plenary were included in the 12 themes identified as discussed below.
Themes of the PCC Research Agenda
The 2-day plenary among the different stakeholders resulted in the finalization of the 12 final themes of the PCC Research Agenda (PCC, 2024). These themes are summarized in Figure 1.
-
Cancer Treatment Outcomes
Studies will investigate the effectiveness, safety, and cost-effectiveness of cancer treatments for various cancer types and stages. This theme underscores the need to optimize treatment outcomes and implementation of cancer-related policies specifically in the context of Filipino patients.5-8 Subthemes include (1) cancer treatment outcomes for both common and rare cancers across all stages, (2) nutritional support and upbuilding in improving treatment outcomes, (3) impact of multimodal cancer treatment approaches in patient outcomes, and (4) patient-reported outcomes and satisfaction with cancer treatment services.
-
Health Systems Strengthening
This includes research on strategies to enhance governance, financing, technology, human resources, and service delivery for equitable access, including assessment of direct and indirect costs to improve understanding of financial aspects of cancer care.6,9-12 Subthemes include (1) effectiveness of cancer policies and strategies including support mechanisms, (2) evaluation of the National Integrated Cancer Control Program Strategic Framework,13 (3) patient navigation and cancer referral systems, (4) economic evaluation and costing studies across all levels of care, (5) policy analyses of national cancer control strategies and its adoption at the level of the local government units,14 (6) time toxicity, (7) utilization of fund assistance mechanisms, and (8) service-level allocations in the national health care provider network system.
-
Health Promotion, Prevention, and Early Detection
This theme investigates strategies for promoting healthy behaviors, preventing cancer occurrence, and enhancing early detection methods such as screening programs15,16 and biomarker development. Subthemes include (1) cancer screening methods including artificial intelligence, (2) early detection strategies including alternative procedures for screening, (3) effective referral systems facilitating early detection, (4) effective capacity -building activities for community health care workers, (5) development of promotional materials for healthy lifestyles for the general public, (6) biomarkers for early detection of cancer, (7) evaluation of health literacy on cancer, (8) effectiveness of cancer prevention and early detection strategies, (9) assessment of community-based engagements and interventions on cancer control, (10) qualitative studies on barriers and drivers for cancer screening among Filipinos, and (11) assessment of school-based cancer screening and health education and promotion programs.
-
Data Management and Sharing
This theme aims to enhance national and hospital-based cancer registries and data systems to facilitate collaboration, research reproducibility, and accelerated discoveries.8,17,18 Subthemes include (1) development of a big data platform for cancer care; (2) open access data registries; (3) readiness assessment on cancer registration; (4) feasibility studies on mobile technologies to collect data on cancer in the community especially in geographically isolated and disadvantaged areas as identified by the Department of Social Welfare and Development; (5) quality assurance and alignment studies of existing cancer registries; (6) studies on the implementation and operation of cancer registries; and (7) expansion of population-based cancer registries nationally.
-
Epidemiological Research on Cancer Burden
Research on cancer prevalence, incidence, distribution, and determinants within population is needed to inform public health policies and interventions.19,20 Subthemes include (1) studies on disability and quality-adjusted life years in the Philippine context; (2) cancer care disparities among the different social, regional, and ethnic groups; (3) risk factors of common cancers including unique environmental21 and occupational exposures among Filipinos; and (4) relationship between nutrition and cancer.
-
Multidisciplinary and Holistic Care
Research integrating the importance of collaboration among medical, psychosocial, nutritional, supportive care, and paramedical services to address the diverse needs of patients with cancer throughout the care continuum is essential.22,23 Subthemes include (1) patient navigation and integrated care pathways, (2) cancer caregiver experience and support needs, and (3) effectiveness of caregiver support programs.
-
Palliative and Survivorship Care
Research on improvement of quality of life including symptom management, psychosocial support, and end-of-life care is essential.24,25 Subthemes include (1) effectiveness of compassionate community linkages, (2) quality of life of caregivers and families with a special focus on caregiver strain, (3) long-term effects of cancer care and treatment on patents using the biopsychosocial model, (4) artificial intelligence technologies to facilitate survivorship tracking, (5) barriers and drivers for accessing palliative and hospice care, and (6) the effectiveness of palliative care.
-
Human Resources for Health
Research that assesses access to health care professionals with training in cancer care including distribution, competency, wellbeing, and retention is crucial.26 Subthemes include (1) evaluation of staffing standards for health professionals and nonprofessionals in hospital settings, (2) mapping the distribution of medical and paramedical professionals trained in cancer care around the country, (3) role of community health workers in cancer prevention and control, (4) cancer competencies of human resources for health, (5) evaluation of fair compensation and right sizing of health institutions, and (6) training needs and skills development assessment.
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Technological Innovations and Interventions
This theme includes research on innovative technologies, devices, and treatment modalities, including novel imaging, surgical, radiotherapeutic, and system developments.18,27 Subthemes include (1) telemedicine, (2) artificial intelligence–powered imaging and diagnostics, (3) remote monitoring devices, (4) development of diagnostic tools based on novel biomarkers, (5) development of assistive devices for patients with cancer, and (6) effectiveness of novel treatments and diagnostics including preclinical discovery, clinical trial, and validation of imported cancer diagnostics among Filipinos.
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Traditional, Complementary, and Integrative Medicine
Research under this category studies the efficacy and safety of traditional and complementary therapies in cancer prevention, treatment, and symptom management and how they can be integrated into conventional cancer care.28 Subthemes include (1) safety and efficacy of herbal plants against cancer, (2) role of complementary medicine in Universal Health Care for cancer, (3) cultural acceptability of integrating traditional medicine for cancer, (4) role of food and nutritional as medicine, and (5) knowledge, attitudes, and practices on traditional and complementary medicine on cancer.29
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Personalized Medicine and Multiomics Research
These studies investigate treatments tailored to individual patients on the basis of genetic and biological factors, using genomics, proteomics, metabolomics, and other omics technologies. Subthemes include (1) cancer biobanking, (2) molecular profiling of cancer among Filipinos, and (3) precision oncology. Cognizant that the majority of personalized medicine research has been conducted in more resourced settings, such studies must be tailored to the needs of Filipino patients.
-
Cancer Biology
Research under this theme involves the study of (1) molecular mechanisms underlying cancer development, progression, metastasis, and (2) drug resistance to identify therapeutic targets and biomarkers for personalized treatment approaches, including (3) preclinical models of cancer care.
FIG 1.
The 12 final themes of the Philippine Cancer Center Research Agenda (2024).
Recommendations and Future Directions
As this research agenda has just recently been approved by the national government and was launched on November 27, 2024, dedicated funding should be made available to support research aligned with the agenda. Grant application should be inclusive and logistically streamlined. Efforts to mitigate red tape should be pursued, including dedication of financial resources to research support staff, laboratory space, and computational infrastructure.
Additionally, capacity-building activities and trainings for research methods should be in place at all levels of training to ensure that high integrity and quality of research output are maintained.
Interagency and multi-institutional collaborations within the country should be established to facilitate a holistic approach to cancer research integrating concepts such as health economics and medical anthropology, among others. Regional and global collaborations are essential to learn from different perspectives.8,14,30 Finally, a central repository of research in oncology in the country is essential to streamline research efforts.
Through the leadership of the PCC, all of these can be achieved with the help of the different multisectoral stakeholders including the different government agencies, private partners, scientists, and different medical and paramedical clinician-researchers. By streamlining the cancer research efforts in the Philippines, the country can be one step ahead in achieving the goal of health for all Filipinos.
APPENDIX
TABLE A1.
Composition of the Agencies Involved in the Crafting of the PCC Research Agenda 2024-2028
| PCC |
|---|
| Philippine Department of Health Central Office |
| UHC Services Cluster—Technical Office |
| Disease Prevention and Control Bureau |
| Health Policy Development and Planning Bureau |
| Epidemiology Bureau—Monitoring and Evaluation Division |
| Center for Health Development—MIMAROPA |
| Center for Health Development—Northern Mindanao |
| Department of Health Hospitals |
| Amang Rodriguez Memorial Medical Center |
| Baguio General Hospital and Medical Center |
| Bicol Medical Center |
| Cagayan Valley Medical Center |
| Corazon Locsin Montelibano Memorial Regional Hospital |
| Cotabato Regional and Medical Center |
| National Children's Hospital—Section of Pediatric Hematology and Oncology |
| Jose R. Reyes Memorial Medical Center |
| Lung Center of the Philippines |
| Philippine Children's Medical Center |
| Rizal Medical Center |
| Southern Philippines Medical Center |
| Western Visayas Medical Center |
| Zamboanga City Medical Center |
| National Government Agencies |
| Department of Science and Technology—Food and Nutrition Research Institute |
| Department of Science and Technology—Health Technology Assessment Division |
| Department of Science and Technology—Philippine Council for Health Research and Development |
| Department of Social Welfare and Development—Policy and Research Division—Policy Development and Planning Bureau |
| Philippine Health Insurance Corporation |
| Philippine Institute of Traditional and Alternative Health Care |
| National Economic and Development Authority—Health, Nutrition, and Population Division |
| Civic and Professional Organizations and Consortia |
| CARE Ph |
| CerviQ |
| Pharmaceutical and Healthcare Association of the Philippines |
| Philippine Cancer Society |
| Philippine Radiation Oncology Society |
| Philippine Society of Hospice and Palliative Medicine |
| Philippine Society of Medical Oncology |
| Philippine Society of Pediatric Oncology |
| Northern Mindanao Consortium for Health Research and Development |
| Development Partners |
| JHPIEGO |
| WHO—Philippines |
| Academe |
| University of the Philippines—National Institute of Molecular Biology and Biotechnology |
| University of the Philippines—Philippine Genome Center |
Abbreviations: PCC, Philippine Cancer Center; UHC, Universal Health Care.
SUPPORT
Supported in part through the Cancer Center Support Grant from the National Cancer Institute (P30 CA008748) and through the Prostate Cancer Foundation Young Investigator Award outside the submitted work (E.C.D.).
AUTHOR CONTRIBUTIONS
Conception and design: Frederic Ivan L. Ting, Edward Christopher Dee, Ma. Katrina Domenica R. Ting, Erin Jay G. Feliciano, Carol V. Narra
Administrative support: Frederic Ivan L Ting, Edward Christopher Dee, Carol V. Narra
Collection and assembly of data: Frederic Ivan L. Ting, Abigail R. Tud, Erika P. Ong
Data analysis and interpretation: Frederic Ivan L. Ting, Edward Christopher Dee, Abigail R. Tud, Erika P. Ong
Manuscript writing: All authors
Final approval of manuscript: All authors
Accountable for all aspects of the work: All authors
AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/go/authors/author-center.
Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).
Frederic Ivan L. Ting
Consulting or Advisory Role: Roche
Research Funding: Pfizer
Edward Christopher Dee
Other Relationship: NIH/NCI
Abigail R. Tud
Honoraria: Amgen
No other potential conflicts of interest were reported.
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