Cancer clinical trials in the Philippines

In this Commentary, we discuss disparities in resources for and access to cancer trials from the perspective of the Philippines, a lower-middle-income country in Southeast Asia, where cancer is the fourth leading cause of death. Geographic disparities play out such that academic institutions and clinical trials are centralized in the island of Luzon, particularly in the capital, Manila. These disparities are compounded by the lack of comprehensive cancer patient and clinical trial registries in the Philippines. Additionally, sociocultural considerations influence clinical trial implementation. Providers must consider the role of a patient's family in the decision to participate in clinical trials; a patient's degree of health literacy; and the economic burden of cancer care, with attention to both the direct and indirect financial toxicities associated with cancer care. Our call to action is threefold. (1) Bolster locally led trials and encourage international collaboration to improve diversity in trial participation and trials' generalizability. (2) Strengthen national trial registries to improve awareness of trials for which patients are eligible. (3) Integrate cultural competency frameworks that move beyond parachutism and parasitism in research and instead promote trust, reciprocity, and collaboration. These challenges may yet evolve, but in emphasizing these barriers, we hope to kindle further dialogue, new insights, and innovative action towards solving these disparities in cancer research, not just in the Philippines, but also in other low- and middle-income countries.