Lymphoma - A debilitating hematological disorder - Q&A session with an Expert
(Focus - Philippines)
Dr. Jay Ty Datukan - A proficient doctor with a dynamic persona agreed for a short discussion on lymphoma disease, and shared his thoughts and insights regarding the disease based on his experience and analysis. We hope that our readers will get to know this disease better.
Dr. Jay Ty Datukan has been working in Hematology and Medical Oncology Department, serving currently in St. Luke's Medical Center Quezon City and Global City.
The most important part was played by the infection control team during the COVID-19 pandemic because they were updating guidelines, frequently, so that we were guided. I think that was very helpful in controlling the situation inside the hospital, and we have also limited the entry of people.
First of all we would Thank You for participating in our small discussion.
So, let's start the interview Doctor, kindly let us know, how was the lymphoma care affected during COVID times?
Dr. Jay: During the onset of the pandemic, it was really a challenge to go to the hospital, to come back, and of course, to convince patients to continue with the treatment.
I remember, during the initial weeks, the chemo unit of the hospital had to stop the operations for a few days because we didn't know how to handle the situation and continue the operations safely. So, definitely, there were some delays, especially in the cancer treatment. But we were very lucky, especially me, as I am working in a hospital that is very innovative.
The hospital infection control team was very diligent and prompt in providing the guidelines on how to operate each center. So, we were able to do so in a few days. We started screening all the patients entering the hospital and limited the number of people coming inside the hospital. The companions were also screened, and there were safety officers assigned and obviously, the necessary PPEs were enforced. We have also educated our patients on how to avoid the COVID infection, especially when they go back to their homes. And during that time also, we tried to limit our exposure. So, the whole of the medical oncology team went into group practice so that one doctor can go to the hospital and look after all the patients in the hospital. So, I think that was somehow successful. And we were able to bring back the operations again.
So, doctor are there any other measures that you or your hospital has taken in order to overcome these challenges during the COVID epidemic?
So, all the patients and their companions were required to get the COVID test done, and only one companion was allowed with the patient. We were very vigilant in screening the patients. So, whenever our patient has some symptoms, we would report them to the infection control committee. And also, the most important part was played by the infection control team because they were updating guidelines, frequently, so that we were guided. I think that was very helpful in controlling the situation inside the hospital, and we have also limited the entry of people.
Could you discuss the delay of cancer care during the COVID 19 pandemic?
Dr. Jay: So, during the start of the pandemic, we were wondering what effect it will have on the patients, because there were a lot of treatment delays, even though we were provided with the guidelines on how to operate safely. There were still a lot of patients who would not go back to the hospital because of the fear of getting an infection. So, we wanted to find out if there is an impact on the outcomes of those patients who had treatment delays, like the anti-cancer treatment delays. We did a cross-sectional study with this objective in mind. The major finding in this analysis was that the cancer treatment delays were associated with inferior outcomes in terms of disease progression. There were more patients who had treatment delays and showed rapid disease progression as compared to those patients who continued with their treatment.
Another finding was that there was no association between treatment continuation or treatment delays with the risk of the COVID 19 infection. So, we had very few incidents of the COVID-19 infection in the chemo unit as well as those patients who were admitted for cancer treatment. We have a local society: the Philippine Society of Medical Oncology whose recommendation was to avoid treatment delays, which was in accordance with the American Society of Clinical Oncology (ASCO), and the European Society of Medical Oncology (ESMO). So, this study further strengthened the recommendation of our local society to avoid treatment delays, especially for those patients whose treatment intent is for a cure, and the lymphomas are included in this category.
Kindly let us know if there are any specific factors that can be applied to lymphoma care?
Dr. Jay: Well, the inclusion criteria were all patients who had a malignancy and were undergoing treatment. So, basically, most of the patients included in this study were lung cancer patients, and there were some lymphoma patients. In terms of lymphoma treatment, we could safely say that the treatment should not be delayed even during the pandemic, because the major finding in this study is that treatment delays are associated with disease progression.
In terms of treatment, we do have novel agents and the newer anti-CD 20 antibodies. We also have the BTK inhibitors and immunotherapy although we don't have the CART cell yet, we do have more bone marrow transplant centers now, as compared to three or five years ago.
Are the advancements in the diagnostic space and a general increase in health awareness, helping the healthcare providers in diagnosing lymphoma at an early stage?
Dr. Jay: In terms of the diagnosis, I don't think there has been a lot of advancements. We had the PET-CT scan years before when I was under training, and we also had hemato-pathologists in the Philippines. They're doing really a good job. But I think it's more about the awareness because when I was under training and started my practice, I noticed that most of the lymphoma patients that we receive from other hospitals, would have a general diagnosis of the B cell non-Hodgkin's lymphoma, and specific type of lymphoma was not included.
Because of this observation, we started creating focus groups and roundtable discussions on the different types of lymphomas and how the diagnosis can impact the outcome and we included medical oncologists, hematologists, pathologists, medical residents, surgical residents, ENT residents, and pathology residents in the discussion. So, there are more patients now who are being diagnosed with a specific type of lymphoma, and therefore receiving appropriate treatment. We are far from the standards in the terms of diagnosis, but eventually, we will get there.
Kindly let us know your views on the lymphoma patient profile has it changed or remained the same when compared to the last 5 to 10 years in general?
Dr. Jay: In general, it's mostly the same in terms of the stage. But I think the difference is in the type of lymphoma because we are now seeing specific types of lymphoma and we are now able to give the most appropriate treatment.
Singapore, an ASEAN country is lauded globally for its focus on the adoption of new technologies in healthcare delivery. On this front, where do you think the Philippines healthcare delivery stands?
Dr. Jay: In terms of diagnosis, I think we are not far behind. We do have some molecular laboratories. I mean, in my hospital at St. Luke's Medical Center, we are developing a molecular laboratory for prognostication, and also for the diagnosis. In terms of treatment, we do have novel agents and the newer anti-CD 20 antibodies. We also have the BTK inhibitors and immunotherapy although we don't have the CART cell yet, we do have more bone marrow transplant centers now, as compared to three or five years ago.
Unfortunately, most of the patients in the Philippines are paying out of their pockets so, it is challenging for many Filipinos to receive the standard of care because of the cost of the treatment. So, I think that's the major difference between Singapore and the Philippines in delivering health care.
Are there any emerging healthcare delivery models in the Philippines for lymphoma care, or in general cancer care?
Dr. Jay: Specifically for lymphoma, I'm not aware of any models. But I do know that in our healthcare system, the Department of Health is coming up with programs to help the patients to overcome the cost of cancer treatment. And the government should recognize that we need to address this glitch in cancer care delivery.
What message would you want to convey to the lymphoma patients and their caregivers?
Dr. Jay: As a physician, hematologist, and a medical oncologist, I think the most important message that I want to give to cancer patients or lymphoma patients is that the voices of our patients and their families should be heard, especially in the developing countries and the government would need to know what these patients are going through. In fact, the government may not listen to us as they may think that our views are biased. But they will definitely hear the patients and their relatives talking about cancer care delivery.
And among all the malignancies, in my opinion, patients with lymphomas can achieve better outcomes, though at a certain cost as cancer care treatment for lymphoma is quite costly. The lymphoma patients, their relatives, and their friends, if they collectively put their efforts in convincing the government agencies, the cancer care delivery in the world can definitely improve.
Doctor, Thank you so much for your time and your viewpoints on lymphoma care.