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– In Poland, 90 thousand people die of cancer every year people, about 3 thousand die in road accidents people. However, it is the car crash fatalities that appear in the news, not the deaths of 250 people a day from cancer. His treatment is still not a priority in our country – says the eminent oncologist Prof. Cezary Szczylik.
- The cure rate of cancer in Western Europe and the USA is about 50-60 percent, in Poland it is 30 percent. This means that 90 Poles die of cancer every year
- We detect cancer too late, we have too few oncologists, and we have poor access to modern drug therapies. The system also does not provide the patient with a quick diagnostic path and quick implementation of treatment
- Doctors who want to be treated in accordance with European standards, who stand up for patients’ rights, are often called pharmaceutical company lobbyists
Halina Pilonis, Medonet: It is estimated that every fourth of us will get cancer, which means that every Polish family will be affected by this problem. What is causing this epidemic?
Prof. Cezary Szczylik: The problem has been growing for years. First of all, because we live longer and the risk of these diseases increases with age. Second, cancer is also caused by the advancement of civilization. We are walking filters. The air we exhale is filtered through our lungs, and all that we eat and drink through the digestive tract. The problem of smog, underestimated by the Ministry of Health, has an impact on the epidemiology of cancer. In addition, we ourselves, to a large extent, make ourselves sick without leading a healthy lifestyle. I am amazed how many young people, both boys and girls in middle and high schools, smoke cigarettes. Not to mention the obesity epidemic and too little physical activity.
But fortunately, medicine is evolving and we are getting better at treating cancer.
When it comes to Poland, I would not be such an optimist. The cure rate of cancer in Western Europe and the USA is about 50-60 percent, in Poland it is 30 percent. This means that every year 90 Poles die of cancer, of which almost 30 are due to the inadequacy of our healthcare system. About 3 people die in road accidents. But traffic accidents are the main news, not the deaths of nearly 250 people each day from cancer.
Why do we die more often from cancer than in Western Europe?
First of all, because we detect cancer too late, we have too few oncologists and poor access to modern drug therapies. Our system does not provide the patient with a quick diagnostic path and quick implementation of treatment. The fast diagnostic path planned in the oncology package concerns only patients with suspected cancer. It is not used by patients diagnosed with cancer. For example, patients with brain tumors in Poland wait up to 6 months for an MRI. Meanwhile, it is known that during this time they may have a recurrence of the disease.
But the oncology package and the green card have been introduced so that a patient with suspected cancer does not wait for treatment …
The green carat cut the waiting time by three days. Under the assumption of a fast diagnostic path, there were no indications where a patient in whom a family doctor suspected cancer should perform an imaging test or a biopsy. As a consequence, doctors sent their patients to Poland with such suspicion. In order to shorten the queue for diagnostic tests, more tests need to be performed within a month, so more radiologists and pathologists are needed, as well as money to finance this diagnostics. Meanwhile, the oncology package has been introduced, but it has not been indicated who is to pay for it. No extra money has funded this project. The costs fell on the hospitals. In order to pay for all of this, the National Health Fund lowered the rates for hospitals. So they performed more procedures, but no money came for the new patients. In addition, in Poland, we have about 800 oncologists, while 160 people develop cancer each year. In addition, 300-400 live with cancer and need an oncologist’s consultation. Can these challenges be met with this amount of staff?
Why, in your opinion, is cancer treatment not a priority for the state?
I do not know. I am sure that if Poles were asked about it in a referendum, they would agree that there is a need for a health policy aimed at this goal. Meanwhile, the salaries of doctors and nurses do not contribute to the increase in the number of medical personnel in Poland. The average age of a nurse is 50 years, as is the case with doctors of some specialties. We don’t have enough of them all. But since a doctor earns PLN 2700 after his internship, it is hardly surprising. Especially that an attendant without any medical education earns PLN 2000 in connection with the applicable minimum wage. Recently, the British offered 800 jobs for family doctors with a monthly salary of 37. zloty.
Would increasing funding for oncology improve statistics?
Surely. This is evidenced by our successes in interventional cardiology, which, thanks to good funding, improved treatment outcomes so much that we are at the forefront of Europe in this respect. Moreover, in oncology, therapeutic success depends on access to modern therapies, and in this respect in Europe we are only ahead of Albania.
Are the new drugs really making such a breakthrough in cancer treatment?
A spectacular example is the treatment of leukemias and lymphomas. In many cases, these deadly diseases can be completely cured until recently. A study of modified immune system cells (CART) treatment showed that of 39 patients who had failed all treatments with chemotherapy and bone marrow transplantation and were given a 30 percent chance of survival, 38 were completely cured with the new therapy. Enormous opportunities open up for oncology. New treatments include using the human immune system by teaching it to destroy cancer cells. It is also personalized diagnostics and treatment, so not according to average standards, but tailored, best for a specific patient.
Why are doctors unable to convince the Ministry of Health that such therapies should be financed?
Doctors who want to be treated in accordance with European standards, who stand up for patients’ rights, are often called pharmaceutical company lobbyists. In my opinion, this is done on purpose so that the rulers do not have to admit that they are blocking the patients’ access to effective treatment. It is known that the interest of a pharmaceutical company is also profit maximization. That is why we have the Agency for Medical Technologies and Tariffs in Poland, which is to objectively assess whether a given therapy is cost-effective, i.e. whether its price is adequate to the benefits it brings. The upper barrier of costs established in Poland differs from the European ones and many therapies are considered by the Agency to be too expensive. But there are some she recommends for refunds. However, the health ministry does not make such a decision. As a consequence, we have less access to modern medicines, even than Romanians, Czechs or Hungarians.
Apart from rationalizing the financing of oncology in Poland, is there anything else we can improve?
As part of the so-called social justice people who smoke cigarettes should pay a higher health insurance premium or partially finance their treatment. The system should also treat people who do not undergo preventive examinations, e.g. cytology, differently. Organizational changes are also needed. There is no institution in Poland that would conduct research on cancer. We should, like the United States, establish a national Cancer Institute that would exclusively research this disease and would have adequate funding for independent action. The Oncology Center in Warsaw does not fulfill this role, because it treats patients under a contract with the National Health Fund. It is also worth changing the system of educating medical students so that they have greater contact with oncology in clinical centers. This is a really scientifically attractive field, where the most is happening at the moment. I never expected to see so many discoveries during my professional career. Meanwhile, every day a scientific publication surprises with new reports.