Russian Oncology needs a major upgrade – from organization and financing to training programs of doctors, experts say: in the Public chamber leading oncologists and patient community discussed prospects of the National cancer strategy.
Funding for the Russian health care system is inefficient and does not always produce the desired results, and the actions of its members don’t agree – this is the conclusion reached by the authors of a recent study of “Healthy health care: a step into the future for the Russian medicine” conducted by the Moscow office of The Boston Consulting Group (BCG). Timely diagnosis, prevention and rehabilitation remain in poor condition, education of doctors low quality and informing patients and medical literacy of the population are actually zero.
A vivid illustration of these findings is the state of the national Oncology service.
Last week in Public chamber of the Russian Federation, which hosted the III all-Russian Congress of patients with cancer, discussed the challenges of implementing the National cancer strategy. In a broad discussion took part the representatives of the Association of cancer patients “Hello!”, Russian society of clinical Oncology (RUSSCO), Eurasian Federation of Oncology, MPs and officials.
The national strategy for the fight against cancer for the period until 2030 was adopted наV national meeting of the specialized Commission of the specialty “Oncology” on November 13, 2017. This is the first document that forms the priority of Oncology as a social and medical problem. Its main tasks are: improving the availability and quality of medical care, by determining patient routing and integrated approach to specialized treatment, prevention and reduction of disability.
The implementation of the plans prevents, above all, an acute shortage of qualified personnel, especially in the regions.
So, in the Volgograd region instead of 40 oncologists work half example the chief oncologist of the Ministry of health, academician Andrey Kaprin. And this is not the troubled region. The job of a medical oncologist severe, is associated with an enormous burden and responsibility, and queue empty rate of oncologists in the regions are not.
Not the best way is the situation with training. “Revision basic training programs of many health departments revealed the complete absence of cancer cycles, – said the Director of the cancer center sechenovskiy University, the head. Department of Oncology and reconstructive surgery academician Igor Reshetov. – Require attention and program continuing medical education, including residency with the transition to 3-years education: it is important not to miss during their formation questions of rehabilitation and adaptation of cancer patients, hospice care”.
In this case, you should change the training program not only oncologists, but other specialists in the General health of the network without forming of malignancies it is impossible to talk about early detection of cancer. It is particularly difficult to detect cancer in the early stages of pediatricians, said chief freelance children’s specialist oncologist of the health Ministry in the Central Federal district, Deputy Director of the Institute of pediatric Oncology and Hematology SMRC Oncology. N. N. Blokhin Maxim Rykov. “First, children’s cancers do not have specific clinical symptoms, and secondly, pediatricians have little experience in pediatric Oncology, given the rarity of this disease: according to statistics, the average pediatrician in his career, meets a total of 8 patients with cancer – said Rykov. And, thirdly, much depends on the work of pathologists, then oncologists who spend a lifetime diagnosis and who also do not have much experience in pediatric Oncology, not to mention the radiation therapists and other specialists involved in the treatment of children.”
In need of modernization and organization of conditions of oncologic service within
As stressed Deputy General Director for science of fsbi “NERC”, Professor Valery starinsky, we are talking about the creation of a network of reference centers at leading medical institutions of Russia, Federal management of the cancer register in the calculation of statistical indicators of the incidence of malignant tumors. But addressing these issues requires the creation of new normative documents, harmonization of the positions of the Ministry of health, government and State Duma.
With regard to the financing of Oncology, the funding shortfall test and the dispensaries of the regions and major Federal centers. There are cases when the cancer center to get a quota for treatment of the sick ten times less funds than required, and is forced to find the money yourself. Extremely low and the quota for a sick child: 129-137 thousand rubles. In addition, not solved the financial aspects of the organization of diagnosis and treatment in the system of cancer care, experts say. It is necessary to count the number of beds, the new staffing structure, to solve other large-scale tasks, both at the Federal and at the regional level. “We analyzed the per capita rate of OMS in all 85 regions, and it differs in dozens of times,” gave the example of Deputy Chairman of the Commission on health OP Valentine Civava.
Without sufficient funding and proper use do not have to talk about the distribution in the country of new technologies.
In this medico-economic efficiency of application is very high: “the active use of modern hospital-replacing technologies in the outpatient setting can be avoided up to 70% of surgical operations, for example, if under control of radiological methods is hardening of the cyst, an examination of the secretions of the nipple, various types of biopsy. Should know about doctors and patients,” said the head. national center of Oncology of the reproductive organs, Moscow Oncology research Institute named after P. A. Herzen Professor Nadezhda Rozhkova.
About the need to inform and educate patients and the active role of patient organizations was echoed by other members of Congress.
In addition, it is important that patients who Express the aspirations and problems that are visible to them from within were heard, said the academician Reshetov: “they form a kind of technical assignment for the development of our professional community.” “We have a position on certain issues based on the experiences of patients from different regions of Russia, which we want to present to doctors and legislators, – confirmed the head of the Association of cancer patients “Hello!” Irina Borovkova. – I can say that a program of screening, preventive and rehabilitation measures need further development”.
Recently SMRC radiology launched the outreach project “Open Oncology”, aimed at bringing the doctor and the patient, eliminating the distance between them, preventing the effective cancer, said the head of Department on public relations and working with the regions, mnioi. A. P. Herzen, Alexander Gnatyuk. One of the activities in the framework of the project is to provide psychological assistance to patients and their relatives. Provides concrete steps for providing scientific, clinical and practical care for both patient and professional community. That should ultimately improve cancer care in the country.
“A constructive dialogue with the patients is certainly a big step forward in improving the quality of cancer care, believes Borovkova. We hope for further close cooperation with doctors and authorities offered to move to a broad discussion of patient community National cancer strategy.”
Presentation of the National strategy is expected in mid-December.
As said earlier the head of Ministry of health Veronica Skvortsova, the objectives to be achieved, must become “the increase in early detection of cancer and 5-year survival rate of patients after treatment up to 70%”. The Minister acknowledged that, despite the results achieved Oncology service, “yet remain some personnel and organizational issues”.
Experts hope that the document could be the basis for increasing the funding and development of infrastructure of cancer care. We finally came from the state of understanding that cancer is a challenge for all healthcare specialties, from primary care to rehabilitation specialists,” – said the first Deputy Chairman of the Public chamber Commission for the protection of health, Professor Nikolai Dayhes.