Country context

The Philippines, one of the fastest growing economies in the Asia Pacific region, is a lower middle-income country with a young population. It has met its SDG target of reducing deaths due to chronic respiratory diseases but has seen limited progress in achieving other non-communicable diseases (NCDs)-related SDG indicators as of 2022. Data from the Philippines shows lower lung cancer incidence and mortality rates than the Asia Pacific regional average. Nevertheless, lung cancer is the second leading cause of cancer deaths in the country, following breast cancer. While Figure 1 shows a notable decline in incidence and death rates since the mid-1990s, there has been an upward trend since 2018, indicating that the country has stalled its progress in combating lung cancer.

Smoking is a primary risk factor for lung cancer, but other contributing factors emerge when analyzing the Philippines’ data by gender. A 2019 study found that, in the Philippines, 82 percent of lung cancer cases were linked to smoking for men, and 47 percent for women. This reflects a gender disparity in smoking rates: roughly one fifth of Filipinos smoke (20.4 percent), with a large gap seen between men (36.2 percent) and women (4.5 percent), indicating that other environmental and hereditary risk factors contribute to lung cancer incidence, especially among women and non-smokers. Fifty-two percent of the Philippines’ population relies on kerosene, biomass, coal, and other polluting fuels for cooking, which are strongly correlated with respiratory illness, while the Philippines’ air pollution level is five times higher than the WHO threshold.

The Philippines faces a heavy social and economic burden due to cancer, which collectively cost the national economy estimated annual losses of PHP 110 billion. Of this amount, PHP 70 billion results from patients’ inability to work and caregiving costs. To put this estimate in perspective, the cost of cancer is equivalent to more than a third of the country’s FY 2023 budget for the health sector (PHP 296.3 billion). In public hospitals, around 15 percent of the inpatient costs for cancer are out-of-pocket, whereas in private hospitals, this share rises to 41 percent. The Philippine Health Insurance Corporation (PhilHealth), which administers the country’s health insurance program, shoulders around half of the inpatient cancer bill. However, lung cancer is not yet covered by PhilHealth’s Z benefits package that provides financial assistance for “medically and economically catastrophic” diseases, which means that the costs borne by patients may be higher for lung cancer. Plans are underway to extend the Z benefits to include lung cancer and other diseases.

Assessing policies and programs

In 2019, the Philippines signed the landmark National Cancer Control Act (NICCA) into law, which mandates a comprehensive approach to controlling cancer, outlining policy objectives related to all stages of a patient’s journey, as well as prevention and awareness campaigns, a national cancer registry, cancer research, and survivor care. The NICCA requires the creation of a cancer assistance fund and the expansion of PhilHealth coverage for cancer patients, and it accords cancer patients the same benefits as persons with disabilities (PWDs), for example, a 20 percent discount on costs for medical services and medicines. The Department of Health oversees the implementation of NICCA and heads the National Integrated Cancer Control Council, composed of government departments, representatives from cancer-focused nongovernmental organizations (NGOs), and two medical doctors.

At present, the country has no specific control plan for lung cancer, and there is no nationwide screening program in place. While the Lung Center of the Philippines offers free cancer screening for high-risk individuals, its location in Metro Manila limits accessibility for those residing outside the national capital region. Recognizing cancer care gaps and in an effort to provide guidance to physicians handling lung cancer cases, the Department of Health, in cooperation with NGOs, released the Philippine Clinical Practice Guidelines for Diagnosis, Staging, and Management of Lung Carcinoma in 2021. These guidelines provide recommendations on lung cancer diagnosis and management based on best available evidence, existing health care resources and facilities, and cultural and socioeconomic factors. Nevertheless, a 2020 study showed that Philippine oncologists’ use of biomarker testing for precision treatment of cancers is dependent upon patients’ ability to pay for associated costs and the availability of these biomarker tests in the doctors’ practice locations, among other factors. Currently, biomarker testing for lung cancer is only available in six locations, all of which are in Metro Manila, the country’s capital region, requiring patients from across the country to travel. 

On prevention-related policies, smoking bans exist in certain public places in the country, as do health warnings on tobacco packages and anti-tobacco media campaigns. The country collects excise taxes on tobacco products, earmarked for the implementation of the Universal Health Care Act (UHC) and other health programs. The UHC mandates the allocation of at least 1 percent of the Department of Health’s budget to health promotion programs. In 2022, the government passed a law regulating vaping products in the country. Moreover, the Philippines enacted the Clean Air Act in 1999 to control air pollution; however, almost 20 years later, air pollution was linked to 32 percent of deaths from stroke and ischemic heart disease.  

Collaboration with the private sector and NGOs—employing whole-of-society approaches—is a key aspect of the government’s strategy to meet its cancer-related objectives. In 2023, the government approved the construction of the first Philippine Cancer Center, which is a public-private partnership (PPP) project to be built through a build-operate-transfer arrangement with a private partner. The development of NICCA drew from extensive consultations with NGOs and other stakeholders. The NGOs themselves are forming alliances with health care companies and business groups to expand access to early lung cancer screening in the country. CARE Philippines, an NGO with over 40 member hospitals, maintains a hospital-based cancer registry system. Moreover, public hospitals in the country are exploring partnerships with foreign government counterparts. Dr. Marcelo Severino Imasa of the Lung Center of the Philippines mentioned in a 2023 interview that the Philippines has a two-year genome-profiling program with the National Cancer Center Hospital in Japan to conduct molecular testing of specimens from Filipinos with rare cancers. The research partnership will inform the development of treatments for rare cancers. In addition to securing financing through tax revenues and partnerships with the private sector, the government has implemented a crowdfunding model in which the earnings from lotteries, sweepstakes, and horse races are used to provide medical assistance for diseases, including lung cancer.

GRIP: Gains, Risks, Innovations, Prospects in Policies and Programs

Opportunities ahead

The Philippines, particularly through the passage of the NICCA and the UHC, has made considerable progress in its fight against cancer. However, these policy advancements have yet to make substantial impacts on the lung cancer burden for patients and their families, or on epidemiological trends. The country can continue to make strides by building on its policy advancements, addressing gaps such as regional disparities, defining a concrete control plan encompassing prevention, treatment, and management strategies for lung cancer, and investing in prevention and early detection. Developing nationwide lung cancer screening guidelines that are informed by the local context and relevant data, particularly the prevailing risk factors, will be critical to improving patient outcomes and alleviating the lung cancer burden.

Addressing regional disparities in health care resources is essential for the Philippines’ effective implementation of NICCA. A 2022 study indicated that 54 percent of cancer care providers are located in the national capital region. The same study reported that the total number of cancer care providers in the country is below WHO standards, at 32 medical oncologists for every 10 million Filipinos. More investments and capacity-building initiatives are needed to expand the pipeline of oncologists and to increase patient accessibility to specialist care. Investments also need to be aimed at strengthening the overall health care system while targeting lung cancer specifically. Leveraging innovative financing mechanisms to support the expansion of health care services is needed to enhance access to, and the quality of, cancer care while effectively utilizing limited public resources. The government’s collaboration with the private sector, NGOs, foreign governments, multilateral institutions, and other stakeholders are promising avenues to address lung cancer urgently and effectively.