Despite the coronavirus epidemic, other diseases have not disappeared. Unfortunately, doctors already predict an increase in the number of advanced cancer patients whose diagnosis has been delayed by the pandemic. Is the National Oncological Strategy a recipe for this problem? Prof. Piotr Rutkowski explains what this plan to fight against cancer is.
- How did the epidemic affect cancer diagnosis? According to prof. Rutkowski, the number of patients with advanced stages of cancer will increase
- The expert explains the assumptions of the National Oncological Strategy
- Family doctors will play a very important role in cancer prevention in Poland – they are the ones who have the greatest contact with patients. Their role in prevention is priceless
- You can find more such stories on the TvoiLokony home page
Let us start with the most pressing issue. Do you think the National Oncology Strategy should not be updated due to the pandemic situation?
Prof. Piotr Rutkowski: I don’t think we are going to change anything about the assumptions of the NSO. The pandemic has delayed schedules and we should just start implementing it. Overall, prevention has been the hardest hit. Some patients did not go to the doctor or for tests. There are voivodships where we have recorded huge drops in the number of diagnosed cancers. Endoscopy in particular has suffered from the pandemic. Unfortunately, 2021 will be a terrible year. It will come out in the number of advanced stages of cancer – it can already be seen.
This is a multi-annual program for 2020-2030 introducing comprehensive changes in Polish oncology. NSO is called cancer plan, a comprehensive cancer-fighting program. The strategy is a response to the increase in the incidence of cancer in Poland. NSO sets the directions for the development of the health care system in the field of oncology
What remedial actions are being taken?
There are actions – among other things, the limits on imaging tests have been relaxed. If we had a National Oncology Network operating today, it would be easier. The pandemic damaged oncology, but oncology centers continued to work. We have no inheritance in the implementation of drug programs. In this respect, our Polish system has proven itself.
The National Oncological Strategy assumes that in Poland there will be an increase in cancer incidence by 28%. in 10 years. Does this number already take into account the effects of implementing the strategy?
The goals of the strategy are designed to reduce mortality. So, unfortunately, patients will get sick, but they will be treated better and more effectively. The document clearly stipulates that these cure rates are expected to improve as early as 2025. It is much more difficult to curb the long-term trend in morbidity. I think it will also be possible at the end of this period. It is mainly related to primary prevention, i.e. changing the lifestyle, disseminating pro-health behavior. Secondary prevention, on the other hand, is aimed at detecting the number of neoplasms as quickly as possible, which increases the chances of their cure.
What new elements does the National Oncological Strategy bring to Polish oncology?
There are many of them. In the area of prevention, the strategy introduces vaccination against HPV, and thus action against cervical cancer as well as HPV-dependent head and neck cancers.
- See also: What are the most common symptoms of head and neck cancers?
We then envisage introducing alternative testing methods such as HPV-DNA for cervical cancer cytology, a new generation FIT test for fecal occult blood for people who do not opt for colonoscopy.
From 2021, efforts will begin towards the early detection of lung cancer in high-risk groups using low-dose computed tomography.
Besides, youth education – an element that was not there before. Works with the Ministry of National Education are already underway so that pro-health education will enter schools from the next semester.
The next steps are related to human resources, including increasing the pool of oncology teaching at the level of undergraduate education, and this also applies to nurses and other medical specialties, e.g. psychologists. Before, we focused mainly on doctors. Unfortunately, this year it was not possible to move on, among other things, due to the COVID-19 pandemic. The activities that are already underway are a new element – it is the development of non-commercial clinical trials in the area of oncology thanks to the activity of the Medical Research Agency. There are also teams dedicated to building new good guidelines that will be approved by AOTMiT.
- Editors recommend: Oncology in the times of COVID-19. “At the moment we have postponed death sentences”
The already mentioned National Oncology Network is also an innovation.
KSO is the most extensive element of the new organization – here we have a lot of news. Cancer care coordinators will be a new and important element of the system. Also appointing a social guardian for patients, who is to support the patient in returning to professional and life activity. Data will also be collected as part of the KSO. Unfortunately, there is a problem with that in Poland. Data from the KSO will be correlated with all data from the National Health Fund on cancer in Poland. I think it will be interesting because we used artificial intelligence to connect all the Big Data areas that exist at the NFZ.
How will the patient benefit from the creation of the KSO?
First of all, the point is that the patient should be treated in the same way in every place in Poland, regardless of the center in which he is located. Quality monitoring is also to be introduced as centers will report to the coordinating center. It is already visible in the voivodeships where the centers were established that the standardization of pathomorphology reports has started, their quality has improved, and the quality of radiological reports has increased – these are fundamental things for all of us.
The creation of the National Oncological Portal is also announced. What will be in it?
Work on this portal is currently underway. In one place there will be collected knowledge for patients and potential patients (i.e. for everyone), doctors and the media on prevention, treatment, procedures, guidelines, statistics and many other information in the area of oncology. We create the portal in cooperation with cancer patients with whom we coordinate the work of the steering committee.
Are GPs involved in this strategy?
Yes – and this is the basic element, among others in the area of prevention. The Ministry of Health plans to establish a team for oncological prevention with the participation of representatives of family medicine and primary care physicians. Because no one in the world has managed to build a cancer prevention system without the participation of primary care physicians. Without them, it’s a fiction. Eight hundred clinical oncologists, eight hundred oncological surgeons and five hundred radiotherapists – because we have so many – will not solve this problem without the support of primary care physicians, whose role in prevention is key. Another innovation is worth mentioning – the Internet Patient Account. If it works, new forms of patient-doctor contact will develop. Better communication will contribute to disease prevention.
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What about rehabilitation?
This was an element so far overlooked when it comes to the patient’s quality of life. We recently had a meeting at the Ministry of Health devoted to the development of rehabilitation as a separate path for the patient. Work in progress.
How does the NSO intend to fill the staffing gaps in oncology staff?
At the educational level, a system of incentives, announcements and information for students on oncology is provided. This area was run down. In addition, there is a desire to fill the places for oncology residencies.
What are the chances of implementing new drug therapies?
The assumption is that 90 percent. innovative therapies in oncology present in the EU will be reimbursed in Poland by 2030.
We have one ambitious program behind us. What were the lessons we learned from the 2015 Oncology Package – what worked and what didn’t?
All the comments we made at the time were confirmed. However, the package helped a lot in the field of oncological diagnostics. It can be said that he improved the settlements in oncology centers. It was not a perfect creation, it was too bureaucratic.
Are we moving away from bureaucracy in the system?
Some things have changed. Our goal is to build the fewest systems that burden the oncology center when reporting.
You mentioned the professor about primary prevention consisting in changing the lifestyle. Will it be correlated with the entire state policy on the market of stimulants and food?
Of course. The controversial sugar tax is a very important element of our strategy. This is one way to combat poor nutrition.
Encouraging the movement of people of all ages?
This is the task of the Ministry of Sport. Our activities are multifaceted.
Which countries are we going to catch up with as a result of the strategy?
Mainly to the European average. We are still below the recovery rates in the EU – if we succeed, it will be very good. Our strategy is based on solutions from other countries. In the international aspect, we would need a common anti-tobacco policy and the development of minimum standards for molecular diagnostics, and increased molecular cooperation.
The last but important question: when will the budget for the National Oncology Strategy be secured?
I hope that there will be a budget in December, as declared by the Minister of Health at the last meeting of the Scientific Council of the National Institute of Oncology. The problem, the minister stated, was not with the Ministry of Health, but with the Ministry of Finance (the NSO budget has still not been approved by the Ministry of Health – ed.).
head of the Department of Tumors of Soft Tissues, Bones and Melanomas at the National Institute of Oncology Maria Skłodowskiej-Curie – National Research Institute in Warsaw, Chairman of the work of the team of the Minister of Health for the National Oncological Strategy
Authorized press interview prepared by the Journalists for Health Association in connection with the 2020th edition of the Quo Vadis Medicina? Workshops. Fri “CANCER – lifestyle and TIME counts!”, December XNUMX.
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