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The creation of a comprehensive care system in centers known as Ovarian Cancer Units and access to new drugs regardless of mutations in the BRCA1 and BRCA2 genes – these are currently the greatest needs of patients with ovarian cancer in Poland. The introduction of these changes may improve the treatment outcomes of patients with this insidious cancer.
Ovarian cancer treatment in Poland
In countries where there is a good organization of the care system for patients with ovarian cancer, a five-year survival rate is as high as 70–75%. sick. In Poland, this percentage is only 40 percent.
Possibility of treatment with new drugs from the group of the so-called PARP inhibitors, regardless of the presence of mutations in the BRCA1 and BRCA2 genes, could in turn contribute to the extension of the time without recurrence in patients with ovarian cancer. Currently, in our country, only women with mutations in these genes have access to maintenance treatment with one of the PARP inhibitors from the first line of treatment. But about 80 percent. patients are still waiting for access to drugs from this group.
Difficult diagnosis of ovarian cancer
Every year, ovarian cancer is diagnosed in about 3700 women in Poland, and nearly 2000 women die from it. A huge problem is the fact that this cancer is detected in more than 70 percent. stage 3 and 4 patients. The lack of characteristic symptoms as well as an effective screening test are considered to be the main reasons for such a late diagnosis of ovarian cancer.
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Most patients with ovarian cancer experience less specific gastrointestinal symptoms such as gas, abdominal pain, constipation and diarrhea. – When we ask women who come with ovarian cancer to oncology centers if they have experienced any ailments, most of them say that they were problems from the gastrointestinal tract, abdominal cavity, back – says Prof. Mariusz Bidziński, head of the Gynecological Oncology Clinic of the National Institute of Oncology and national consultant in the field of oncological gynecology. Women often ignore them or report them to primary care physicians (POZ).
After prescribing medication by the GPC, these discomforts should disappear or be alleviated within 2-3 weeks. – If they do not decrease at all, or are still bothersome, let’s visit a gynecologist. It is worth remembering that abdominal and gastric ailments may accompany gynecological diseases, especially ovarian cancer. This is a guideline for both patients and doctors – argues prof. Bidziński.
The second very important thing is to pay attention to your family history. – Ovarian cancer is often a disease that runs in families. If we can ask our ancestors – grandmothers, grandparents and parents – what diseases were in the family, it is worth recording this information and passing it on to GPs – emphasizes prof. Bidziński. Such families should be genetically consulted and, if indicated, genetically tested for mutations in the BRCA1 and BRCA1 genes.
Genetic testing for breast and ovarian cancer – you can buy BRCA1 and BRCA2 gene analysis at Medonet Market.
Currently, there are no effective screening tools for the early detection of ovarian cancer, such as mammography in breast cancer or cytology in cervical cancer. – There are ongoing studies trying to use cheap, generally available, easy to apply, painless and safe methods, because only such prophylaxis in a wider population would make sense. Most often these are attempts to combine ultrasound examination with marker tests. Recently, for example, washings from the genital tract have been studied. But as of today, we do not have a method that we could propose to every Polish woman as a method of early detection of ovarian cancer – comments prof. Paweł Blecharz, head of the Gynecological Oncology Clinic of the National Oncology Institute Maria Skłodowskiej-Curie, Branch in Krakow.
However, as the specialist points out, it is worth taking care of your health through regular gynecological examinations, because some cases of ovarian cancer will be diagnosed thanks to this.
Comprehensive, specialized treatment of ovarian cancer
Ovarian cancer requires comprehensive treatment in specialized centers. – The main treatments for this disease are: surgical treatment combined with systemic treatment. The preparation of surgical treatment – which should be of good quality – is quite complicated – emphasizes prof. Blecharz. First of all, the patient must be well qualified for it. – It is also about metabolic preparation, including nutritional preparation of the patient, because the cytoreductive procedure in advanced ovarian cancer is associated with a very large loss of protein, blood and plasma components – explains the specialist.
Surgery should take place in centers with specialists experienced in treating patients with ovarian cancer. – The right technique allows us to achieve the goal that we, surgeons who operate on ovarian cancer, should strive at all costs, of course on the condition of the patient’s safety. This goal is to remove all disease foci from the peritoneal cavity – says Prof. Blecharz.
The treatment is very difficult and comprehensive. – It is difficult to compare it to other procedures in oncology, because when operating ovarian cancer we also operate on the uterus, colon, spleen, liver and peritoneum – explains the specialist. In a center where such operations are rare, doctors have no chance of gaining experience in this field.
In addition, it is also important to plan the treatment properly: one patient may gain more benefits from the primary surgery, another – from a deferred surgery, after chemotherapy has started. – Such decisions can only be made in centers where the treatment of advanced ovarian cancer is part of everyday life – says Prof. Blecharz. – That is why I would like to appeal to women diagnosed with ovarian cancer to devote two or three weeks after diagnosis to find a suitable center, rather than let their longtime doctor who actually treated ovarian cancer several times in their life – he adds.
Necessary changes in the treatment of ovarian cancer
Specialists in the field of gynecological oncology agree that in order to improve the effectiveness of ovarian cancer treatment in Poland, it is necessary to create a system of comprehensive patient care and to establish the so-called Ovarian Cancer Units. These are to be centers for comprehensive diagnosis and treatment of ovarian cancer.
– In countries where the healthcare system is professionally organized, the results of ovarian cancer treatment are much better than in Poland – explains prof. Bidziński, who as a national consultant in the field of oncological gynecology, aims to implement these changes. The system proposed by him is to be developed, among others in collaboration with the family medicine division.
According to the concept of prof. Bidziński, women diagnosed with ovarian cancer should not go to random medical facilities for treatment, but to centers equipped with appropriate equipment, where teams of specialists prepared to treat patients with ovarian cancer work.
– There are many random places where ovarian cancer is treated. For example, in the Mazowieckie Voivodeship in 2020, treatment of ovarian cancer was carried out by 27 hospitals. In most of them, individual cases were treated within a year – explains Prof. Bidziński. Meanwhile, according to his estimates, there should be no more than four such centers in the Mazowieckie Voivodeship, and in Poland there should be a total of around 30, up to 35.
– We often pay not only with the tears of patients, but also pay very high bills for ineffective activities in the field of ovarian cancer treatment. Our Institute receives patients who have been badly qualified for treatment, and in oncology, unfortunately, the first error is usually beyond repair. Therefore, my task, as a national consultant, is to prepare a strategy that will give patients a chance for appropriate treatment from the very beginning – explains prof. Bidziński. Today, patients often have to look for specialists on their own and overcome various other problems in order to get treatment at a good center.
According to prof. Bidziński, after the diagnosis of ovarian cancer, which can be performed in district hospitals, information about the patient should be consulted with the reference center (included in Ovarian Cancer Units) and, if necessary, the patient should be referred to it within 24, and at most 48 hours.
Prof. Bidziński believes that if the system he proposed started working, it would be possible to improve the effectiveness of treatment of patients with ovarian cancer, measured by the time to relapse and the general experiences of patients.
Ovarian cancer. New drugs – new hopes
After surgery, ovarian cancer patients receive chemotherapy. Most of them respond very well to platinum chemotherapy. However, 80-85 percent. patients, over time, their cancer comes back and must receive further courses of chemotherapy.
– This is the biggest problem with this disease: although in many women with advanced ovarian cancer we are able to get the so-called complete remission of the disease thanks to the combination of surgery and chemotherapy, unfortunately, in most of them the disease returns. However, recent years have brought new hope to patients – new drugs that maintain remission – says Prof. Blecharz. They are very effective in preventing the recurrence of ovarian cancer. They include: bevacizumab and newer, much more active and effective drugs from the group of PARP inhibitors.
PARP inhibitors are most effective in patients with ovarian cancer and mutations in the BRCA1 and BRCA2 genes. – But they show their activity in practically all patients with ovarian cancer – although in some groups it is more, and in some it is less – explains prof. Blecharz.
For several years, Polish patients with advanced ovarian cancer have had the option of being treated with one of the PARP inhibitors (olaparib) in the second and subsequent lines of treatment. However, they must have the so-called cancer. serum, highly differentiated, and the patient must have a confirmed mutation in the BRCA1, BRCA2 genes and first respond to chemotherapy with platinum analogues. Importantly, from May 2021, olaparib can also be used in patients with newly diagnosed ovarian cancer, if they have responded to chemotherapy and have mutations in the BRCA genes.
The problem is that most of them – about 65-70 percent. – patients with ovarian cancer have no mutations in these genes. These patients still do not have access to PARP inhibitors, which could significantly prolong remission time and delay cancer recurrence.
Clinical trials (PRIMA, NOVA) show that the PARP inhibitor niraparib benefits all patients, regardless of the mutation status in the BRCA genes and in other homologous recombination genes – both in line XNUMX and line XNUMX maintenance therapy . The drug increases the time it takes for the disease to come back.
– Ovarian cancer treatment is progressing through the availability of different therapies at different stages of treatment. Having a certain portfolio of drugs, we can manage the patient very effectively even through her relapses. In the case of patients without mutations, access to drugs is very limited – in some cases it requires writing individual applications, and in some cases it is not possible at all – explains Prof. Blecharz.
An additional problem is that in Poland only about 30 percent. advanced ovarian cancer patients have a genetic test that determines the mutation status of the BRCA genes.
In the current reimbursement conditions in Poland, the remaining 70 percent. women who do not have genetic tests lose their chance of being treated with PARP inhibitors – summarizes prof. Blecharz.
Press material prepared by the Journalists for Health Association as part of a series of expert debates Live with ovarian cancer. Like a butterfly. True stories, under the patronage of the Polish Society of Oncological Gynecology and the Blue Butterfly Association
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