Philippine Children's Medical Center

With sophisticated laboratory, imaging and nuclear medicine and well-trained medical and supporting staff, PCMC offers the best pediatric medical care in the country.

The Philippine Children's Medical Center (PCMC) in Quezon City is the country's premier pediatric tertiary care facility. It was created by Presidential Decree in 1979, and is now administratively attached to the Department of Health as its flagship hospital for children.

The hospital offers services in almost all areas of pediatric medicine. Some services—such as pediatric dermatology, pediatric dentistry and perinatology—are either the first in the country or unique to PCMC.

The majority of patients at PCMC have infectious diseases, mainly respiratory and diarrheal illnesses, but cancer cases, especially hematologic malignancies, are the second major cause of hospitalization. Oncology patients account for approximately 17% of inpatient service admissions.

This high volume of pediatric patients permits the institution to maintain high quality training and research initiatives. The concentration of subspecialty cases in some pediatric disciplines, e.g. cancer, is seldom duplicated elsewhere in the Philippines.

The ten most commonly seen types of cancer are ALL, AML, non-Hodgkin's lymphoma, germ cell tumors, medulloblastoma, gliomas, neuroblastoma, rhabdomyosarcoma, retinoblastoma and osteosarcoma. There are about 250 in-house interdepartmental referrals each year.

Fellowship Training

The hospital runs one of only two accredited post-residency fellowship training programs in pediatric hematology-oncology in the country. The three-year program includes clinical rotations in various disciplines during the first two years, with the last year devoted to research. This program started in 1991, and so far has graduated twelve fellows. Seven are already board-certified diplomates of the Philippine Society of Medical Oncology, while the remaining five are board-eligible. All of them are playing important roles in establishing cancer care programs in their hospitals in various parts of the Philippines.

Hospice Care

The Hospice Care Service was started in 1995 to provide long-term support to cancer patients and their families, including pain and/or symptom management. Both hospital and home visit teams participate in these services. This multidisciplinary team not only provides the vital link between hospital and home-based care, but also facilitates financial support to patients from various sources.

Research & Development

The Research and Development Office, created in 1992, was charged with developing strategies and action plans for building institutional research capability. Under the Office of the Executive Director, it was empowered to formulate policies, rules and regulations necessary to establish the hospital as a research center.

Aside from developing the organizational and operational systems for research, RDO has created an Institutional Review Board and codified all policies, rules and regulations on research activities into a Research Primer. The Office has also designed training programs for researchers; rationalized the allocation of research funds, and instituted a system of fund disbursement and monitoring within the government accounting system.

PCMC adapted the "Essential National Health Research" concept. Consequently, research that results in the provision of tools for decision-making or a guide for policy is particularly encouraged. Areas in which PCMC has demonstrated pre-eminence or sole expertise are particularly emphasized. Priorities include pediatric oncology, pediatric neuroscience, genetics and perinatal medicine. Multidisciplinary collaboration and multi-institutional approaches in research projects are of particular importance.

Research capability building is now focused on three areas: research infrastructure, research manpower training and international linkages.

Cancer Research

A pediatric cancer registry has been given priority in order to gain baseline clinical epidemiological data upon which both clinicians and researchers can better understand the local behavior of the disease, and guide them in defining future priorities for research and/or interventional educational programs. We hope to gain insights on why patients present in the late stages of their diseases, or why they do not complete their prescribed treatment. In addition, we should be able to compare clinical behavior patterns with western patients in the same histological and treatment groups.

By the Numbers
Patient Population Per Annum
Total Outpatients	60,000
Total Inpatient Admissions	9,000
Cancer Outpatients	2,500
Cancer Inpatient Admissions	530
Number of Beds	200
Attending Pediatricians	163
Medical Residents Per Annum	60
Post-Residency Fellows Per Annum	50
Indigent Patients	60%
Paying Patients	40%

In response to limitations in resources for cancer treatment in a financially challenged country like the Philippines, locally adapted and cost-effective protocols are studied. The main goal is not to rival the cure rates seen in advanced countries (although that is desirable), but to at least improve by 50% our current track record of survival rates. This goal entails not only local treatment protocols but embraces educational programs (under a research framework) that focus on improving cancer early detection, treatment and follow-up, as well as enhancing the competence of the care-givers (focused and rationalized around internationally-funded projects).

Lastly, a tumor tissue bank has been established to provide specimens for future studies, and linked to the database of clinical information gathered under the clinical registry. This will later allow us to understand the genetic aspects of our cancers as they relate to clinical outcomes to better tailor specific cost-effective treatment to specific groups of patients.

Looking Ahead

We will continue to focus on our training program in pediatric hematology-oncology in order to create a critical mass of experts and scientists that are needed to improve our standards of cancer care. The ultimate goal is to distribute this expertise across the country, but link resources more effectively for the sharing of information and synergy of services. This is critical for a country like the Philippines that is composed of many islands, posing geographic barriers to patient access to care.

We will continue to use our own clinical data and those of countries at similar socioeconomic levels to drive our clinical and research initiatives.

Lastly, we will link with selected international partners for the long-term. Our goal is developmental. Therefore, we hold the holistic view that treatment protocol projects, for instance, must be brought to a programmatic level where it becomes likewise the nidus for manpower skill, competence development, and mutual transfer of information that will have a lasting impact. This is the framework in which we view our partnership with the INCTR.

Ultimately, working with INCTR, we hope to help create a research-oriented culture among a community of resource-challenged countries like ours, in partnership with advanced countries, and make research the tool for decision-making, with a resultant beneficial impact on outcomes for our patients.

--Julius A. Lecciones, M.D. Chief Research Officer, PCMC