Republic of the Philippines ou
HOUSE OF REPRESENTATIVES > RECEIVE
Quezon City © one: 08 AUG
SEVENTEENTH CONGRESS
Second Regular Session
HOUSE BILL NO. 6153

INTRODUCED BY REPRESENTATIVE ALFRED VARGAS

EXPLANATORY NOTE

Cancer is a growing and serious public health concern in the Philippines,
which requires urgent and concerted action. Every day, people are needlessly
dying and suffering; families are robbed of their loved ones; communities lose
productive contributors to a brighter future. A recent report of the Philippine
Statistical Authority (PSA) states that one in every ten registered deaths in the
country is attributable to cancer. In 2013, cancer ranked 3", in the list of top ten
leading causes of adult mortality and morbidity; for child mortality and morbidity,
cancer ranked 4*, As of 2012, the International Agency for Research on Cancer
(IARC) estimates that in the Philippines, there are 269 new adult cancer cases
every day, 11 every hour. Moreover, there are at least 7 Filipinos dying from
cancer every hour. Experts opine that the actual cancer burden and cancer
mortality in the Philippines is in fact very much higher. Many more cases and
deaths from cancer remain uncounted, unrecorded, and unreported.

Cancer affects not just the patient; it has a significant impact on their
families, friends, communities and the country as a whole. The WHO and Harvard
based Global Task Force on Expanded Access to Cancer Care has recognized this
enormous burden, both in years of life lost, human pain and suffering, as well as
in economic terms. The economic impact of cancer is significant and is increasing.
Itis now considered as one of the three leading global economic risks based on its
immense impact on global productivity and economic growth The total annual
‘economic cost of cancer in 2010 was estimated at approximately US$ 1.16 trillion;
this includes the direct and indirect costs of treatment, the income loss by patients
and their families as a result of being unable to work during treatment, and, most
importantly, the lost productivity of the patient and the family from premature
death, disability and the demands of care-giving. Numerous studies have
emphasized that the value of lost productivity from cancer is very much more than
the estimated costs of government support for prevention and treatment. Given
the country’s focus on reducing poverty and accelerating achievement of
development goals, it becomes imperative for the government to address the
cancer challenge.

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Cancer pushes Filipino families deeper into poverty. Cancer treatment
costs are catastrophic and the economic burden is overwhelming. This is because
financial risk protection mechanisms are limited, with patients and their families
often shelling out money from their own pockets to cover not only treatment but
other costs, such as laboratory tests, medicines, medical supplies, nutritional
supplements, food, temporary housing arrangements and transportation.
Evidence shows that in a study of cancer patients, the mean out-of-pocket
expenditure for cancer treatment, far exceeded their mean household income; 117
percent at baseline to 253 percent twelve months after, leading more than 56
percent of households into financial catastrophe.! These huge out of pocket costs
often deter health seeking behavior or leads to discontinuance and abandonment
of treatment (ie. voluntary stoppage by patient, beyond one month, of necessary
treatment). In some areas and with certain types of cancer, abandonment or
discontinuance of treatment can be as high as 75 per cent. These conditions are
most observed among the poor marginalized sectors but occur even among the
middle class.

Current mortality statistics from various types of cancer in the Philippines
are alarming. Survival rates for the most common adult cancers (i.e. lung, breast,
colon, cervical, prostate, liver) are relatively low compared to other countries in
Asia and the world. For females, all-cancer mortality rate, the Philippines ranks
second highest among 15 countries in Asia, with 124 deaths per 100,000
population. Compared to Asian countries, the Philippines has the highest
mortality rate for 2 types of cancer: breast (27 per 100,000 population) and
prostate cancer (13 per 100,000 population). Lung cancer mortality rates are also
high exceeding 40 per 100,000 population. For breast cancer, the Philippines also
has the lowest survival (.58 mortality to incidence ratio.) For childhood cancers,
which now has an average survival rate of 84 percent in high income countries
and a growing number of middle income countries, average survival rate in the
Philippines is at a low 30 percent. These data become doubly distressing when
we consider that: a) most cancers are now curable and b) in high income countries
anda growing number of middle income countries, survival rates for various types
of cancer now range from a high of 60-96 per cent. (WHO 2016)

Cancer poses a substantial challenge to our health care systems. Many of
the preventable and premature deaths from adult and childhood cancers are
attributable to a combination of the following factors: low awareness of signs and
symptoms of cancer; delayed diagnosis or misdiagnosis; poor access to health
facilities; limited health systems infrastructure for cancer treatment and care
(many regions and provinces in the country do not have health facilities with

Ngelangel et al (2016). Philippine Costs in Oncology Study.


necessary equipment, vital technologies and workforce ready to provide cancer-
related services); limited number of trained health professionals for cancer-
related services (e.g. pathology, surgery, radiotherapy, psychosocial support,
palliative care and pain management etc.); weak or absent referral systems,
patient pathways, programs and mechanisms for early detection, accurate
diagnosis, timely and optimal treatment, palliative care and pain management,
survivorship follow up care, detection and management of late effects and
rehabilitation. Global experts have asserted that 50-60% of cancer mortality in
low-resource countries like the Philippines, could be avoided with country-
specific strategies for prevention and treatment.

Given the limitations of the health system in addressing current
requirements for cancer care, the country is ill prepared and is likely to be further
overwhelmed to effectively care for the expected upsurge of new cancer cases.
According to the World Health Organization (WHO), incidence of cancer by 2030
is projected to exponentially increase by as much as 80%, with the greatest impact
being felt in low resource countries, like the Philippines.

Thus, the government must act now to institutionalize an integrated, multi-
disciplinary, multi sectoral, nationwide cancer control and management for all
types of cancer, for all genders and ages. It needs to achieve a progressive and
sustainable increase in its response capacity as well as build for expected future
needs and requirements. It must scale up its investments in the different
components and patient pathways of cancer control, to provide high-quality,
adequately resourced, geographically distributed and connected networks of
patient and family focused integrated cancer care services for the whole cancer
care continuum. Failure to do so shall be costly and can lead to a health system
crisis in cancer care. Moreover, strengthening health systems capacity for cancer
care shall also provide opportunities for timely and effective response to the
burden of other non-communicable diseases.

All these actions are aligned and supportive of Article 2, Section 15 ("The
State shall protect and promote the right to health of the people and instill health
consciousness among them"), and Article 13 Section 11 (The State shall adopt an
integrated and comprehensive approach to health development which shall
endeavor to make essential goods, health and other social services available to all
people at affordable cost.

This bill is also pursuant to national commitments to the United Nations,
that Member States should increase efforts to strengthen health systems at the
national and local levels to ensure early diagnosis, accessible, affordable and high-
quality care for all cancer patients as well as reduce risk factors for cancer through
adequate policies and programs. It is aligned and supportive of the country
commitment to the 2017 70th World Health Assembly Resolution of the World


Health Organization, on Integrated Prevention, Control and Management of
Cancer which calls for strengthening and expanding national level actions and
initiatives. It shall contribute to the country’s attainment of Sustainable
Development Goal 3, which seeks to ensure healthy lives and promote well-being
for all ages as well as to reduce premature mortality from cancer and non-
communicable diseases by at least 1/3 by 2030.

In view of the foregoing, the enactment of this bill is earnestly sought.

‘ALFRED VARGAS


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Philippines

SEVENTEENTH CONGRESS
Second Regular Session

HOUSE BILL NO. 6153

INTRODUCED BY REPRESENTATIVE ALFRED VARGAS

AN ACT
INSTITUTIONALIZING NATIONAL INTEGRATED CANCER CONTROL AND
APPROPRIATING FUNDS THEREFOR

Be it enacted by the Senate and House of Representatives of the Philippines in
Congress assembled:

SECTION 1. Short Title. - This Act shall be known as the “National
Integrated Cancer Control Act’.

SECTION 2. Declaration of Policy. - The State is mandated to adopt an
integrated and comprehensive approach to health development which shall
endeavor to make essential goods, health and other services available to all the
people at affordable cost. Towards this end, and in view of the fact that cancer isa
complex and catastrophic disease which is an urgent public health concern, the
State shall support and expand efforts to strengthen integrative, multi-
disciplinary, patient- and family-centered cancer control policies, programs,
systems, interventions, and services atall levels of the existing health care delivery
system. The State shall likewise improve survivorship from adult and childhood
cancers, by scaling up essential programs and increasing investments for robust
prevention of cancer, better screening, early detection, prompt and accurate
diagnosis, responsive palliative care and pain management, timely and
optimal treatment, effective survivorship care and late effects management and
rehabilitation.

The State shall make cancer treatment and care more equitable and
affordable for all, even as it endeavors to increase support for the most vulnerable
sectors of society, the under-privileged, sick, elderly, women, children, persons
with disabilities, the poor, marginalized, and disadvantaged.

This law shall contribute to the country's attainment of Sustainable
Development Goal 3, which seeks to ensure healthy lives and promote well-being
for all ages as well as to reduce premature mortality from cancer and non-
communicable diseases by at least 1/3 by 2030. It is also pursuant to national


commitments to the United Nations, that Member States should increase efforts to
strengthen health systems at the national and local levels to ensure early
diagnosis, accessible, affordable and high-quality care for all cancer patients as
well as reduce risk factors for cancer through adequate policies and programs.
Furthermore, it is aligned and supportive to the World Health Organization 2017
World Health Assembly resolution on Integrated Cancer Prevention, Control and
Management which calls for strengthening and expanding national level actions
and initiatives.

SECTION 3. Rationale and Objectives. - High mortality, premature,
preventable deaths and related disabilities from cancer in both adults and
children, are oftentimes attributed to late diagnosis, combined with poor access
to care related to inadequate and uneven distribution of facilities, personnel,
equipment and technologies, poor treatment compliance and high abandonment
of treatment, primarily due to high out-of-pocket costs, unaffordable costs of
treatment and medicines and prevalence of myths and misconceptions on cancer.
These underscore the importance of institutionalizing a systematic, well-
organized, well-coordinated, well-funded, patient- and family-centered,
integrated cancer control program in all levels that shall:

(a) Decrease overall mortality and impact of all adult and childhood cancers;

(b) Decrease incidence of preventable cancers in adults;

(©) Prevent cancer relapse or recurrence and secondary cancers among people
living with cancers and survivors;

(d) Reduce inequities in timely access to optimal cancer treatment and care;

(e) Increase support and PhilHealth benefits to make cancer treatment
and care more affordable;

(f) Improve patients and families experience of cancer treatment and care;

(g) Support cancer survivors to recover, effectively reintegrate and thrive; and

(h) Eliminate various forms of burden on patients, people living with cancer,
survivors, and their families.

SECTION 4. Definition of Terms, - As used in this Act:

(a) Cancer is a generic term for a large group of diseases that can affect any
part of the body. Other terms used are malignant tumors and neoplasms.
One defining feature of cancer is the rapid creation of abnormal cells that
grow beyond their usual boundaries, and which can then invade adjoining
parts of the body and spread to other organs, the latter process is referred
to as metastasizing. Metastases are the major cause of death from cancer.
(WHO February 2015)

(b) Cancer Burden - Differences in the burden of cancer between different
countries relates to cancer incidence, cancer mortality and prevalence of


individuals with cancer. Cancer incidence is defined as the number of new
cases in a defined population over a specific time period. Cancer
prevalence represents the disease burden in a population at a specific
time and is related to survival of individuals diagnosed with cancer.

(c) Cancer Control aims to reduce the incidence, morbidity and mortality of
cancer and to improve the quality of life of cancer patients in a defined
population, through the systemic implementation of evidence-based
interventions along the continuum of care from prevention to end of life.

(a) Cancer Diagnosis comprises the various techniques and procedures used
to detect or confirm the presence of cancer. Diagnosis typically involves
evaluation of the patient's history, clinical examinations, review of
laboratory test results and radiological data, and microscopic and
genotypic examination of tissue samples obtained by biopsy or fine-needle
aspiration or blood samples obtained by blood extraction. (WHO Cancer
Control Knowledge Into Action 2008)

(e) Cancer Prevention:

Primary Cancer Prevention refers to measures and interventions that
shall decrease the likelihood or risk of an individual of acquiring cancer;

Secondary Cancer Prevention involves the use of tests to detect a cancer
before the appearance of signs or symptoms (screening) followed by
prompt treatment;

Tertiary Cancer Prevention involves diagnosis and treatment of clinical
apparent disease

(f) Cancer Registry — The cancer registry is a database that contains
information about people diagnosed with various types of cancer. The
registry shall require systematic collection, storage, analysis,
interpretation and reporting of data on subjects with cancer. There are two
main types of cancer registry - population-based and hospital-based cancer
registries:

1, Population-based cancer registries seek to collect data on all new
cases of cancer occurring in a well-defined population. Usually, the
population is that which is resident in a particular geographical
region. As a result, and in contrast to hospital-based registries, the
main objective of this type of cancer registry is to produce statistics
on the occurrence of cancer in a defined population and to provide
a framework for assessing and controlling the impact of cancer in
the community. Thus, the emphasis is on epidemiology and public
health;

2. Hospital-based cancer registries are concerned with the
recording of information on the cancer patients diagnosed and
treated in a particular hospital. The main purpose of such registries
is to contribute to hospital patient care by providing readily
accessible information on the subjects with cancer, the treatment



they received and its result. The data are used mainly for hospital
administrative purposes and for reviewing clinical performance.
These registries cannot provide measures of the occurrence of
cancer in a defined population because it is not possible to define
their catchment populations, that is, the populations from which all
the cases arise.

(g) Cancer Survivorship starts at the time of disease diagnosis and continues
throughout the rest of the patient's life. Family caregivers and friends are
also considered survivors. It has three distinct phases: living through, with
and beyond cancer. (MD Anderson Cancer Center)

(h) Cancer Treatment is the series of interventions, including psychosocial
and nutritional support, surgery, radiotherapy, radio-isotope therapy, and
drug therapy (chemotherapy, hormone therapy, biotherapeutics,
immunotherapy, gene therapy, supportive therapy), that is aimed at curing
the disease or prolonging the patient's life considerably (for several years)
while improving the patient's quality of life. (WHO Cancer Control
Knowledge Into Action 2008) Some people with cancer shall have only one
treatment. But most people have a combination of treatments.

(i) Carer is anyone who provides care for a friend or family member.

(j) Complementary and Alternative Medicine - Alternative medicine is

distinct from complementary medicine which is meant to accompany, not

toreplace, standard medical practices. Alternative —_ medicine
includes dietary supplements, megadose vitamins, _ herbal
preparations, special teas, massage therapy, magnet therapy, and
spiritual healing, _ not generally recognized by the medical community
asstandardor conventional medical approaches.

(k) Comprehensive Cancer Care Center model was initiated in the Unites
States (Cancer Act 1971) and has been adopted across continents as a
base for a networked approach to cancer __care built on the fundamental
premise that an integrated, highly functioning network, with different
categories of cancer centers, equitably distributed geographically for easier
patient access, shall more effectively and quickly address the multi-faceted
challenges of cancer. CCCC has a focused program of work that is
multidisciplinary and integrates cancer research, education, and clinical
care to accelerate the control and cure of cancer.

() Continuum of Care - The continuum of cancer care includes risk
assessment, primary prevention, screening, detection, _ diagnosis,
treatment, survivorship, and end-of-life care. Palliative care and pain
management are considered as an integral, cross cutting part of the

continuum of care. Movement across the span of the cancer care
continuum involves several _ types of needed care, as well as transitions
between the types of care. Type refers to the care _ delivered to accomplish


a specific goal, such as detection, diagnosis, or treatment. Transition

refers to the set of interactions necessary to go from one type of care to
another, such as from detection to diagnosis. Each type and transition in
care is subject to influences at multiple levels that can facilitate or
impede successful achievement.

(m) Hospice care is a type of care and philosophy of care that focuses on the
palliation ofa chronically ill, terminally ill or seriously ill patient's pain and
symptoms, and attending to their emotional and spiritual needs. Hospice
care is part of palliative care particularly atthe latter stage of cancer.
The goal of the care at end of life is to help people die in peace, comfort,
and dignity.

(n) Management of late effects - Long-term and late effects shall vary
depending on the type and stage of cancer as well as the type of treatment
given. But all the common cancer treatments (chemotherapy, radiotherapy,
surgery and hormone therapy) can cause both long-term and late effects;
although not everyone who has cancer treatment shall have long-term or
late effects. Management of these effects is needed.

(0) Multidisciplinary care is an integrated (interdisciplinary) team approach
to cancer care in which medical and allied health care professionals consider
all relevant treatment options and develop collaboratively an individual
treatment plan for each patient. The multidisciplinary team includes
professionals from different disciplines forming a team to implement
multidisciplinary-interdisciplinary process to cancer management. The
multidisciplinary care process involves the bringing of insights from
different disciplines together, contributing to one plan of management for
the patient.

(p) Philippine Cancer Control Program (PCCP) refers to the program of the
national government for the comprehensive and integrated control of
cancer in the Philippines

(q) Optimal treatment and care - quality treatment care adherence to the
standards of treatment and care based on evidence-based guidelines

(x) Out-of-pocket expenditure - any direct outlay by households, including
gratuities and in-kind payments, to health practitioners and suppliers of
pharmaceuticals, therapeutic appliances, and other goods and services
whose primary intent is to contribute to the restoration or enhancement of
the health status of individuals or population groups. It is a part of private
health expenditure

(s) Palliative Care is treatment to relieve, rather than cure, symptoms caused
by cancer. It can help people live more comfortably. Palliative care relieves
suffering and improves quality of life for people of any age and at any stage
in a serious illness, whether that illness is curable, chronic, life limiting or
life-threatening, Relief from physical, psychosocial and spiritual problems


can be achieved in over 90% of advanced cancer patients through palliative
care. (ITHO February 2015)

(t) Patient Navigation refers to individualized assistance offered to patients,
families, and caregivers to help overcome health care system barriers and
facilitate timely access to quality medical and psychosocial care. Cancer
patient navigation works with a patient from pre-diagnosis through all
phases of the cancer experience.

(u) Patient Pathway is the route that a patient shall take from their first
contact with the health worker, through referral, to the completion of their
treatment. It also covers the period from entry into a hospital or a health
care facility, until the patient leaves.

(v) Premature Mortality refers to deaths that occur between the ages of 30
and 70 (WHO).

(w)Secondary Cancer may be used to refer to either a second primary cancer
ortocancer that has spread from one part of the body to another
(metastatic cancer).

(x) Supportive Care - Supportive care in cancer is the prevention and
management of the adverse effects of cancer and its treatment. This
includes management of physical and psychological symptoms and side
effects across the continuum of the cancer experience from diagnosis,
through anticancer treatment, to post-treatment care. Enhancing
rehabilitation, secondary cancer prevention, survivorship and end of life
care are all integral to Supportive Care. [Multinational Association of
Supportive Care in Cancer (MASCC) 2015]

(y) Practical assistance refers to help on non-medical costs such as financial
assistance, transient housing, transportation, food and nutrition, among

others.
(2) Notifiable Disease means a disease that, by legal requirements, must be
reported to the public health authority when the diagnosis is made.

ARTICLE I
Establishing the National Integrated Cancer Control Advisory Board and
Strengthening the Cancer Program in the Disease Prevention and Control
Bureau of the Department of Health

SECTION 5. Composition of the National Integrated Cancer Control
Advisory Board (NICCAB). - The NICCAB shall be composed of the following:

* The Secretary of the Department of Health who shall serve as the
Chairperson or a designated representative, not lower than Assistant
Secretary, as ex officio member. The Vice-Chair shall be elected by the non-


ex officio members, from among themselves, and shall serve for a term of
two (2) years;

The Director General of the Food and Drug Administration or a designated
representative as ex officio member;

* The President and CEO of the Philippine Health Insurance Corporation
(PhilHealth) or a designated representative, as ex officio member;

© The Secretary of the Department of Social Welfare and Development
(DSWD) or a designated representative, as ex officio member;

© The Secretary of the Department of Labor and Employment (DOLE), or a
designated representative as ex officio member;

* The Secretary of the Department of the Interior and Local Government
(DILG), or a designated representative as ex officio member;

* The Secretary of the Department of Finance (DOF), or a designated
representative as ex officio member;

© The Secretary of the Department of Science and Technology (DOST), or a
designated representative as ex officio member;

© The Secretary of National Economic Development Authority (NEDA), or a
designated representative as ex-officio member;

© The Chairperson of the Commission on Higher Education, or a designated
representative as ex officio member;

© Three (3) members, in total, drawn from among the cancer-focused
professional societies as later determined in the Implementing Rules and
Regulations of this law, to be appointed by the President of the Philippines
and shall serve for a term of 3 years, renewable every year, upon
recommendation of the DOH Secretary;

* Two (2) members, in total, drawn from the academe representing key
disciplines of oncology as later determined by the Implementing Rules and
Regulations of this law, to be appointed by the President of the Philippines
and shall serve for a term of 3 years, renewable every year upon
recommendation of the DOH Secretary; and

* Two (2) members, in total, drawn from cancer-focused patient support
organizations and advocacy network, to be appointed by the President of
the Philippines and shall serve for a term of 3 years, renewable every year,
upon recommendation of the DOH Secretary.

The Cancer Program in the Disease Prevention and Control Bureau of the
Department of Health shall act as the secretariat for the NICCAB.

SECTION 6. Roles and Functions. - The State, through the Department of
Health, shall establish a NICCAB to oversee the implementation of this law. The
NICCAB shall recommend policies, programs and reforms that shall enhance
synergies among stakeholders and ensure well-coordinated, effective and
sustainable implementation of the provisions of this law. The NICCAB shall


provide technical guidance, advice and support in planning, policy making,
program development, development of good practice models, standard setting,
stakeholder engagement, program monitoring, evaluation and assessment,
strategic, programmatic and operational review. It shall, as necessary, create
expert groups or technical working groups to assist the DOH to undertake any of
the following key tasks:

(a) Secure from government agencies and other stakeholders concerned,
recommendations and plans on how their respective agencies could
operationalize specific provisions of this Act. The Board shall consider and
integrate sound recommendations in the implementing rules and
regulations for this act;

(b) Develop the National Integrated Cancer Control (NICC) roadmap with
annual targets, priorities and performance benchmarks, for the effective
institutionalization of integrated cancer control strategies, policies,
programs and services in the national and local health care system for
the effective institutionalization of integrated cancer control strategies,
policies, programs and services in the national and local health care
system;

(c) Develop integrated and responsive cancer control policies and programs
tailored to the socio-economic context and epidemiological profiles of the
Philippines and aimed at improving survivorship, making cancer care more
accessible and affordable, expanding and enhancing cancer care to include
the whole continuum of care, promoting integrated, multidisciplinary,
patient- and family-centered care, and enhancing the well-being and
quality of life of cancer patients and their families;

(d) Develop, periodically update and promote, evidence-based treatment
standards and clinical practice guidelines for all adult and childhood
cancers, of all stages, including the management of late effects;

(e) Develop innovative and cost-effective cancer care service models for
effectively delivering integrated cancer care in the most appropriate
settings and improving patient care flow from primary to tertiary care;

(f) Develop clearly defined patient pathways and evidence-based standards of
care for the network of cancer centers; that is, Comprehensive Cancer Care
Centers, Specialty Care Centers, Regional Cancer Centers, Satellites and
others, as deemed essential;

(g) Set quality and accreditation standards for cancer-focused health service
facilities, health care providers, medical professionals, allied health
professionals, as well as, ethical cancer research;

(h) Monitor and assess the implementation of prioritized packages of cancer
services, for all ages and all stages of cancer, ensuring they are provided in
an equitable, affordable and sustainable manner, at all levels of care; that
is, primary to tertiary health care;



(i) Develop mechanisms on improvement of core systems and processes
related to availability and affordability of quality, safe, and effective
medicines, not limited to those in the WHO List of Essential Medicines and
the Philippine National Formulary, and to include vaccines, diagnostics for
cancer, innovative medicines and technologies, and compassionate use
protocols, as necessary;

Establish mechanisms and platforms for multi-sectoral and multi-

stakeholder collaboration, coordination, and cooperation, especially in,

health promotion, disease prevention, capacity development, education,
training and learning, information and communication, social mobilization
and resource mobilization;

() Establish mechanisms and platforms for patient, family, and community
engagement, especially on protection and promotion of the rights of
patients, survivors and their families and their active involvement in multi-
disciplinary patient care, patient navigation, and survivors’ follow-up care;

() Strengthen linkages with local and international organizations for possible
partnerships in treatment and management of challenging and rare cases,
education, training and learning, advocacy, research, resource mobilization
and funding assistance; and

(m) Establish a system for program review, monitoring and evaluation,
inclusive of financial aspects and submit an annual report to the Secretary
of Health on the progress, accomplishments, implementation challenges
encountered and recommendations for way forward.

0

The NICCAB shall meet quarterly or as the need arises.

SECTION 7. Strengthening of the human resource complement for the
cancer program in the Disease Prevention and Control Bureau of the
Department of Health. In order to ensure that this law shall be effectively
operationalized and implemented, the human resource complement of the cancer
unit under the Department of Health shall be strengthened. A Director for Cancer
Control shall be designated to provide operational leadership, undertake
coordination with program stakeholders, and ensure effective and sustainable
implementation of the program.

ARTICLE II
Optimizing Quality Health Care Systems for Cancer Control in All Levels

SECTION 8. Strengthen Cancer Care Infrastructure and Other
Resources. - The State through the Secretary of Health, the Local Government
Units and its instrumentalities, shall strengthen the capacity of public health
systems and facilities, in the provision of services, in the cancer care
continuum, through the following key activities, but not limited to:


(a) Allocate adequate resources for investments in health facility renovation
or upgrade, inclusive of technologies and equipment for use in cancer
treatment and care (from diagnosis to rehabilitation);

(b) Develop robust and effective patient referral pathways across levels of
health service delivery;

(©) Provide reliable supply of cancer drugs and cancer control related vaccines
(HPV, Hepatitis B) to patients by ensuring that health facilities and local
health centers, through coordination with local government units
(LGUs), consistently have sufficient supply of essential medicines and
vaccines;

(d) Enhance and strengthen the oncology related competencies of health
providers in all levels of care;

(e) Establish clear standards and guidelines for patient care, psychosocial
support, palliative care and pain management, and patient navigation;

(f) Establish and strengthen community level of care for cancer patients,
cancer survivors, and people living with cancer, of all gender and ages;

(g) Ensure the proper recording, reporting and monitoring of cancer cases, of
all gender and ages, in all levels of care;

(h) Network and link-up with Comprehensive Cancer Care Centers, specialty
centers, privately managed cancer centers and relevant health facilities
and international institutions, for knowledge and resource sharing;

(i) All other activities and initiatives as may be identified by the NICCAB.

SECTION 9. Establish an integrated, robust, well connected, accredited
network of cancer care centers in strategic areas of the country. The State,
through the Secretary of Health, and with assistance from NICCAB, shall develop
standards to classify cancer centers, accredit and designate Comprehensive
Cancer Centers, Specialty Centers, Regional Cancer Centers and satellites. The
required diagnostic, therapeutic, research capacities and facilities, technical,
operational and personnel standards for these centers shall be defined in the
Implementing Rules and Regulations of this law.

The Regional Cancer Centers shall have the following objectives and functions:

(a) Provide timely and high-quality cancer__ services _—_ such
as screening, diagnosis, optimal treatment and care, supportive care and
palliative care, survivorship follow-up care. and_—re-
integration, rehabilitation, to cancer patients of all gender and ages;

(b) Establish as necessary, networks with both public and private facilities,
to improve access, expand range of services, reduce costs and bring
services closer to patients;

(©) Provide and promote supportive care, palliative care and pain
management, patient navigation, hospice care and other measures to


improve the well-being and quality of life of cancer patients, people living
with cancer, their families and carers;

(a) Ensure there are separate units and facilities for children/adolescents with
cancer and that they are not mixed with the general population;

(e) Design and implement high-impact, innovative, and relevant local
communications campaigns that are context and culture-sensitive, and
aligned with national programs;

(f) Undertake and support the training of physicians, nurses, medical
technicians, pharmacists, health officers, social workers, and other allied
health professionals on evidence-based, good practice models for delivery
of responsive, multi-disciplinary, integrated cancer services;

(g) Address the psychosocial and rehabilitation needs of cancer patients and
survivors;

(h) Adapt and promote evidence based innovations, good practice models,
equitable, sustainable strategies and actions across the continuum of care;

() Engage and collaborate with LGUs, private sector, philanthropic
institutions and civil society organization to make available programs and
services for practical assistance to cancer families and cancer survivors;

G) Promote and/or assist in ethical scientific research on matters related to
cancer; and

(19) Institutionalize and implement the comprehensive and integrated
Philippine Cancer Control Program.

SECTION 10. Strengthen the capacities of the Human Resources for
Health in Cancer Care. - The Department of Health in collaboration with cancer-
focused professional societies, LGU leagues and LGU-based health associations,
academic institutions, human resources units of designated Comprehensive
Cancer Care Centers (Centers of Expertise or Excellence), designated Specialty
Cancer Centers, designated Regional Cancer Centers, civil society organizations,
and the private sector shall create and implement competency-based learning
packages, for all health care workers providing cancer care service and support at
all levels of the healthcare delivery system. This continuing learning program shall
include adoption and institutionalization of cost-effective, learner friendly,
learning platforms and modalities, so as to broaden reach and accelerate
enhancement of key competencies of health providers.

SECTION 11. Strengthen oncology-related academic curricula of higher
educational institutions (HEIs). Integration of cancer care brings with it
increased demand for highly specialized and relevant expertise. Oncology related
health professionals, need to adapt to rapid changes in standards of practice and
further sharpen their expertise, gaining in-depth, disease-specific knowledge and
learning how to collaborate effectively with other specialists in an integrated,
multi-professional setting. The Commission on Higher Education in collaboration
with DOH, PSC, HEls, professional oncology societies, accrediting institutions and


patient support organizations, shall undertake an assessment of current oncology-
related academic curriculum and ensure that it meets local needs and global
practice standards. It shall encourage HEls to offer degree programs for high
priority oncology related specializations as well as continuing education
programs related to oncological treatment and care.

SECTION 12. Establish and implement regulatory and accreditation
standards for cancer centers and cancer facilities, both public and private.
This also covers stand-alone clinics that provide services to cancer patients,
people living with cancers and survivors.

ARTICLE III
Enhancing Public Awareness on Cancer in Schools, Workplaces, and
Communities and Creating a Supportive and Safe Environment in Various
Settings

SECTION 13. National Cancer Consciousness Month. The Department of
Health, in collaboration with partners, shall lead in the celebration of National
Cancer Consciousness Month every February of every year.

SECTION 14. National Cancer Information Service. The State shall
intensify provision of up-to-date, evidence-based information, as well as practical
advice, support, and referral for cancer patients, people living with cancer,
survivors, their families, carers, and caregivers. The service shall be provided
through the existing Department of Health Call Center, website, help line or other
platforms that may be developed, including that of the Department of Information,
Technology and Communications. This shall increase cancer literacy and
understanding of risk factors associated with cancers, help combat myths and
misconceptions, as well as reduce the anxiety, fear, distress and uncertainty
associated with cancer and/or a cancer diagnosis.

SECTION 15. Health Education and Promotion in Schools, Colleges,
Universities, and other Training Institutions. - The Department of Health, in
collaboration with partners, such as the Commission on Higher Education and
Department of Education, shall develop policies and provide technical guidance to
academic institutions and administrators to: a) Promote and facilitate integration
of age-appropriate key messages on cancer risk factors, early warning signs and
symptoms of adult cancers and childhood cancers, cancer prevention and control,
adoption of healthy lifestyles and healthy diets, in their curriculum, health and
wellness programs, and co-curricular activities; b) Undertake mainstreaming of
practical supportive care and psychosocial support programs for people living
with cancer, cancer survivors, and their family members, especially those who act
as carers for cancer patients; and c) Adopt initiatives that shall minimize or


eliminate stigma and discrimination in schools, colleges, and universities. For this
purpose, funds shall be allocated for training of key staff, lead personnel and
counselors.

SECTION 16, Health Education and Promotion in the Workplace. - The
Department of Health, in collaboration with partners, such as the Department of
Labor and Employment (DOLE) and Civil Service Commission (CSC) shall develop
Policies and provide technical guidance to employers, employees associations,
and unions to: a) Promote and facilitate integration of key messages on cancer risk
factors, early warning signs and symptoms of adult cancers and childhood cancers
cancer prevention and control, adoption of healthy lifestyles and healthy diets, in
their communication initiatives, health and wellness programs, and employee
development programs; b) Undertake mainstreaming of practical supportive care
and psychosocial support programs for people living with cancer, cancer
survivors, and their family members; (c) Integrate appropriate cancer services in
their health services and clinics; and d) Develop programs, initiatives or
mechanisms that shall minimize or eliminate stigma and discrimination in the
work place that is experienced by people living with cancer, survivors, and their
families. The Armed Forces of the Philippines (AFP) and the Philippine National
Police shall likewise be engaged and assisted by the Department of Health in
collaboration with appropriate agencies.

SECTION 17. Health Education and Promotion in Communities, The
Department of Health, in collaboration with partners such as the Department of
the Interior and Local Government, League of Provinces, League of Cities and
League of Municipalities, DOH Regional Offices, local cancer-focused patient
support organizations and professional oncology societies, shall implement a
locally based, multi-sectoral community response to cancer. This shall not be
limited to information and cancer focused health education but shall include
assisting cancer patients, people living with cancer, cancer survivors and their
families in accessing community resources for cancer services and support for
effectively coping and living with cancer. Gender and Development Funds and
other appropriate local sources may be utilized for these Purposes,

The Department of the Interior and Local Government, in coordination with the
Regional Offices and the Department of Social Welfare and Development, shall
conduct age-appropriate cancer- focused health education and promotion for out-
of-school youth.

SECTION 18. Health Education and Promotion for. Special Communities
and Vulnerable Groups.
The Department of Health shall collaborate with respective national government
agencies in developing and conducting cancer-related information and education
campaigns as well as providing much-needed services to under-privileged and


marginalized population, such as but not limited to, inmates, indigenous people,
workers in the informal sector, and internally displaced persons.

ARTICLE IV
Making Cancer Care and Treatment More Affordable

SECTION 19. Establishment of Cancer Assistance Fund (CAF). Every
year, the State shall automatically appropriate the initial amount of Php30 billion
to support the medical (diagnostics) and treatment assistance program. Funds for
the CAF shall initially be drawn from the appropriations of the DOH, the DSWD,
PCSO and PAGCOR. The amount may be adjusted according to macroeconomic
variables and projected demand,

SECTION 20. Expansion and Introduction of Innovative PhilHealth
Benefits for Cancers. - The Philippine Health Insurance Corporation (PhilHealth)
shall expand current benefits to include screening, detection, diagnosis, treatment
assistance, palliative and supportive care, survivorship follow up care and
rehabilitation, for all types and stages of cancer, in both adults and children. It shall
also develop innovative benefit packages such as. community-based models of care
to improve cancer treatment journey and reduce costs of care; this may include,
but not limited to, stand-alone chemotherapy infusion centers, ambulatory care,
home-based palliative care and pain management, community based hospice
facility.

SECTION 21. Institutionalizing Social Protection Mechanisms for
cancer patients, persons living with cancer, survivors, their families and
carers. - The DOH, in close coordination with SSS, GSIS, PCSO, PAGCOR, DOLE,
DSWD, and LGUs shall develop appropriate, easily accessible social protection
mechanisms to support the needs of cancer patients, people living with cancer,
survivors, their families and carers and to reduce, if not eliminate catastrophic
costs of cancer, so as to reduce distress and ensure their well-being.

ARTICLE V
Ensuring Essential Medicines are Available, Accessible, Affordable and of
Quality

SECTION 22, Facilitating Access to Cancer and Related Supportive Care
Medicines. - The Department of Health and other agencies (i.e. Food and Drug
Administration, PhilHealth, Philippine Pharma Procurement Inc, Bureau of
Customs, among others) shall implement reforms supporting early access to
essential medicines and health technologies to ensure highest possible fighting
chance of survival among people with cancer. This shall include facilitating quick


access to drugs for compassionate use and developing a more responsive system
for effectively addressing emergency cases.

SECTION 23. Availability and Accessibility of Medicines for Palliative
Care and Pain Management. - The Department of Health shall lead in the
provision and distribution of medicines for palliative care of cancer patients, such
as but not limited to, analgesics, anesthetics, and opioids and shall be available and
accessible in the community.

SECTION 24. Misinformation on Cancer. - False and misleading
advertising and claims in any of the multimedia and/or promotional marketing of
drugs, devices, agents or procedures without prior approval by the FDA and
without the requisite medical and scientific basis, purporting to be a cure for
cancer or a fail-safe prophylaxis against cancer, shall be prohibited.

ARTICLE VI
Creating a Supportive Environment for Persons Living with Cancer and
Cancer Survivors

SECTION 25. Designation of Persons Living with Cancer and Cancer
Survivors as Persons with Disabilities. ~ Persons Living with Cancer and Cancer
Survivors shall be considered as persons with disabilities (PWDs), in accordance
with Republic Act No. 7277, as amended, or the Magna Carta for Disabled Persons.

SECTION 26. Rights and Privileges of Persons with Cancer and Cancer
Survivors. - The appropriate national government agency shall ensure that they
are accorded the same rights and privileges as PWDs, to wit:

(a) The Department of Social Welfare and Development (DSWD) shall provide
assistance to persons with cancer and cancer survivors to ensure that their
social welfare and benefits provided under Republic Act No. 7277, as
amended, or the Magna Carta for Disabled Persons, are granted; and

(b) The Department of Labor and Employment (DOLE) shall adopt programs
that promote the availability of opportunities for work and employment of
able-persons with cancer and cancer survivors.

SECTION 27. Promoting Non-Discrimination. - The State and its
instrumentalities shall ensure that people living with cancer and survivors of
cancer have the right to freedom from discrimination with regards to access to
and continued employment, conditions of employment, access to education, use
of public facilities, and other social services.


ARTICLE VII
Establish National Cancer Registry and Surveillance

SECTION 28. Establish National Cancer Registry and Surveillance
System. - The DOH through its Disease Prevention and Control Bureau (DPCB),
Epidemiology Bureau (EB), Knowledge Management and Information Technology
Service (KMITS), Health Facilities Services and Regulatory Bureau, Philippine
Health Insurance Cooperation, and Philippine Cancer Society Inc, and other
private organizations shall collaborate with other private organizations on the
design and implementation of a national cancer registry and surveillance system
covering all forms of cancer among adults and children to guide policy
development and program decision making. The DOH shall undertake a review of
the current population-based and hospital-based cancer registries towards
establishing a comprehensive and harmonized national cancer registry and
surveillance system compliant with the National Health Data Standards and Data
Privacy Act of 2012 and that allows categorization by type of cancer and
population groups including children.

SECTION 29. Strengthen Population-Based and Hospital-Based Cancer
Registries. - The Department of Health shall allocate resources to support the
institutionalization of hospital-based cancer registry. Moreover, it shall conduct
population-based cancer data collection on a regular basis or as necessary.
Submission of cancer registry shall be a requirement for the renewal of license to
operate of the hospital.

SECTION 30. Notification on Cancer Cases. - Adult and childhood cancer
shall be considered as a notifiable disease in all levels of the health care system.

ARTICLE VIII.
Research and Demonstration Projects

SECTION 31. Research & Demonstration Projects. - The Department of
Health shall, directly or through grants to public or nonprofit private entities,
perform the following activities:

(a) Conduct basic and clinical research based on the health agenda to be
developed by partners in the academe, health professional groups and
other local health partners with possible support from foreign
organizations;

(b) Develop demonstration projects to generate evidence for responsive
policies and to develop regional capabilities for the prevention, screening,
detection, control, and management of cancer; and


() Provide support for model centers to sustain their initiatives under
subparagraphs (a), and (b); and

(d) Collaborate with local and foreign organizations for partnership in various
activities and in providing technical and funding support.

ARTICLE IX
Final Provisions

SECTION 32. Report. - The Secretary of Health shall submit an annual
report to the Committees on Health of the Senate and the House of
Representatives on the activities carried out to comply with the provisions of this
Act on or before June 30 of every year.

SECTION 33. Appropriations. - The amount necessary to implement the
provisions of this Act shall be charged against the current year’s appropriation of
the DOH, PCSO, PAGCOR, and DSWD. Thereafter, ten percent (10%) of the
incremental revenues from the excise tax revenues on alcohol and tobacco
products-collected by the government pursuant to Republic Act No. 10351 shall
be earmarked for the implementation of this Act, among other tax revenues.

SECTION 34. Implementing Rules and Regulations, - The DOH, in
consultation with its attached agencies (FDA, PhilHealth), DSWD, DOLE, DOF,
DepEd, CHED, TESDA, SSS, GSIS, LGUs, private sector, professional cancer-focused
societies, patient support organization and advocacy network representatives,
academe, and other interest groups, shall issue the rules and regulations
implementing the provisions of this Act within ninety (90) days from its
effectivity.

SECTION 35. Penalty Clause. - Any person who violates any of the
provisions of this Act or its Implementing Rules and Regulations shall, upon
conviction by final judgment, be punished by imprisonment of not less than six (6)
months nor more than two (2) years or a fine of not less than Ten Thousand Pesos
(Php10,000) nor more than Two Hundred Thousand Pesos (Php200,000), or both
at the discretion of the court. If the violation is committed by a juridical person,
the officer responsible therefor shall serve the imprisonment when imposed. If
violation is committed by an alien, he or she shall be immediately deported after
service of sentence, without need of further proceedings.

SECTION 36. Separability Clause. - If any provision or part hereof is held
invalid or declared unconstitutional, the other provisions which are not affected
thereby shall continue to be in full force and effect.

SECTION 37. Repealing Clause. - Any law, presidential decree or issuance,
executive order, letter of instruction, administrative order, rule or regulation


contrary to or inconsistent with the provisions of this Act is hereby repealed,
modified or amended accordingly.

SECTION 38. Effectivity. - This Act shall take effect fifteen (15) days after
its publication in the Official Gazette or in a newspaper of general circulation