Antimicrobial resistance is part of a perfect storm of health. Lancet Microbe 2021; 2: e645. 2 Pokharel S, Raut S, Adhikari B. Tackling antimicrobial resistance in low-income and middle-income countries.
Providing end-of-life care within the cultural context of a Filipino patient in the United States is a complex process for clinicians, patients, and their families. An inclusive approach is crucial, especially because a significant proportion of patients belong to minority groups such as Filipinos, who represent the fourth largest group of immigrants in the United States as of data available in 2019. The case provided in this paper highlights the importance of family, religion, and finances in guiding the best possible way of providing end-of-life care for Filipino patients with cancer. At the end of this review, we discuss concrete action points that may give a non-Filipino physician a deeper understanding of end-of-life care for Filipinos.
Around 40% of patients with cancer in some Western countries (1) to over 80% of patients in some Asian countries (2) use traditional, complementary, and alternative medicine (TCAM). Its increasing popularity has sustained global efforts to integrate TCAM into national healthcare systems, and integrative oncology-the use of TCAM alongside conventional cancer therapies-is a field born from this movement. Integrative oncology, however, remains elusive for most patients in low-and middle-income countries (LMICs), where many seek TCAM despite concerns about regulation, safety, and financial toxicity (3). Given this steady patronage amongst patients with cancer, there is a need to examine socio-cultural drivers of TCAM use vis-à-vis the landscape of health systems in LMICs. We write from the Philippines, a lower-middle income country in Southeast Asia, where cancer is the fourth leading cause of death (4) and where TCAM remains popular among patients and families dealing with cancer.As in other resource-challenged LMICs, Filipino patients with cancer face geographic obstacles to healthcare, unaffordable conventional therapies, and underdeveloped palliative and survivorship care (2,5). These barriers, compounded by low socioeconomic status and poor health literacy, drive patients to seek alternative forms of treatment, such as TCAM. However, structural and health system barriers are only contributory drivers of TCAM usage. Deeply ingrained historical and sociocultural influences heavily impact health attitudes and behaviors among Filipinos and, in particular, the role of TCAM in cancer care in the Philippines.As a nation with a strong agrarian profile, many traditional theories of illness causation in the Philippines revolve around balance and harmony of humans with the natural environment, as well as mystical and supernatural
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