The prognosis is clear: in the near future, cancer will become the main cause of death in Poland – the question is what next? While changes in oncological prophylaxis also depend on the patient himself, we will not improve the effectiveness of oncological treatment, and thus five-year survival rates, without thorough diagnostics and wider access to new drugs and innovative oncological therapies …
“Oncological tsunami”
The numbers do not lie and speak for themselves – cancer is a growing medical, social and economic problem. According to the forecasts of the National Cancer Register (KRN), in 2026 we can expect about 190 thousand. illnesses every year! Against 180,3 thous. new cases estimated in 2016 and 159,2 thous. cases recorded in 2014
The report of the Alivia Oncology Foundation “Access of oncological patients to drug therapies in Poland against the background of current medical knowledge” provided us with a reflection on how this will affect everyone’s life five years ago. According to it, every fourth inhabitant of our country will develop cancer in their lifetime, and every fifth will die because of it! This means that even if we are not directly affected by a cancer diagnosis, it will affect our loved ones, friends, acquaintances or neighbors. So we are talking about an “oncological tsunami” that will roll over, and taking into account the “oncological debt” incurred in the pandemic – it is already sweeping through Poland.
The soaring statistics are, on the one hand, the effect of the aging of the population, and, on the other, the increased exposure of the population to carcinogens, partly related to lifestyle, such as smoking, alcohol consumption, inadequate diet or lack of exercise. And although the increased incidence of cancer is characteristic of most developed countries, what distinguishes Poland is its high mortality. OECD data (Organization for Economic Co-operation and Development) shows that Poland, along with Hungary and Croatia, is in the top three European Union countries with the highest mortality from malignant neoplasms.
Does the long-awaited National Oncology Strategy (NSO) have a chance to change that? Time will tell, the plans are ambitious. Activities planned under the long-term NSO program include: increasing the number of oncologists and related specialties, introducing new screening tests, increasing the possibility of oncological patients participating in clinical trials, facilitating access to innovative cancer therapies and expanding the list of reimbursed drugs in oncology, as well as increasing access to modern medical equipment.
Living with cancer in Poland
The list of the greatest problems of Polish oncology has not changed for years… We will find there: underfunding, shortage of staff, insufficient access to modern drugs and innovative oncological therapies, and suboptimal organization of the system.
Although there is more money for cancer treatment every year, Poland is far from the European standard. According to the Swedish Institute of Health and Medical Economics (IHE), Belgium spends EUR 260 per capita on oncology per year, France – EUR 254, Ireland – EUR 207, the Czech Republic – EUR 147, and Poland – EUR 96. Only Bulgaria, Estonia, Latvia and Romania spend less on the fight against cancer.
There is also a gap in our access to modern cancer drugs. While in Austria and Germany almost EUR 100 per person is allocated to innovative drug therapies, in Poland it is only EUR 13-16. We can see it on the example of lung cancer, which generates the most cases and deaths from malignant cancer in our country. The NHF’s expenditure on innovative lung cancer treatment as part of drug programs is much lower compared to other malignant neoplasms. The number of patients eligible for the drug program is equally unsatisfactory, due to the lack of appropriate diagnostics or the lack of reliable results of molecular tests.
When it comes to staff shortages in oncology, according to the data of the Supreme Medical Chamber (NIL), at the end of June 2018, 842 oncological surgeons were registered in Poland, 826 of them practiced. In addition, the NIL database includes 909 clinical oncologists, 254 oncological gynecologists, 208 specialists in the field of pediatric oncology and hematology, and 632 pathologists. Out of 657 registered radiotherapists oncology, 612 doctors practiced the profession. The above-mentioned numbers do not in any way compensate for the increasing number of oncological patients. Especially since the high average age of medical workers creates additional problems.
The last “problem of Polish oncology” is the suboptimal organization of oncological care, non-coordination of individual stages of diagnostics and treatment, as well as non-compliance with diagnostic and treatment standards.
Opportunities and hopes …
Although there are many challenges facing Polish oncology, experts emphasize that the increase in the 5-year survival rate, which is an indicator of effective treatment for the system and a hope for the patient to overcome the disease, will not be achieved without greater access to the most effective, innovative therapies. Especially since, as we know, chemotherapy, which is a treatment that is toxic and burdensome for the patient, brings a spectacular short-term improvement, but does not bring about significant changes in its prognosis. This targeted treatment, using the latest achievements in molecular biology, allows for a significant extension of the patient’s life while maintaining a satisfactory quality of life, and also changes the profile of side effects.
The fact that molecularly targeted therapy is the greatest achievement of modern oncology is evidenced by the growing financial investments in personalized medicine all over the world every year. As a result, more than two hundred targeted anti-cancer therapies have already been approved in clinical practice, and many more are at the stage of clinical trials. Only in the treatment of non-small cell lung cancer (NSCLC) in Poland, reimbursement currently covers 14 targeted drugs (including immunotherapy), targeting 5 different molecular targets. It is estimated that in the near future as much as 60% of diagnosed non-small cell lung cancers could receive molecularly targeted treatment. Experts emphasize that in the case of NSCLC, a revolution has been underway for several years thanks to modern drugs, including molecularly targeted drugs aimed at a specific change in cancer cells. Recent evidence for the provision of precision oncology to patients with advanced NSCLC with current RET gene rearrangement is the approval of pralsetinib by the European Commission.
However, despite the fact that in recent years there has been a significant increase in the availability of targeted therapies and immunotherapy, many patients are still without treatment in accordance with current medical knowledge. A necessary condition for the success of targeted therapy is molecular diagnostics, i.e. a thorough assessment of the genetic material of the patient’s cancer cells and determining the predicted susceptibility to a specific treatment. Unfortunately, as emphasized by the authors of the report “Lung cancer – 2021. Pharmacological treatment”, we have a lot of catching up in this area in Poland. The lack of a standardized, fast and comprehensive molecular diagnostics pathway is a significant barrier to access to reimbursed, modern NSCLC therapies, not allowing them to fully use their therapeutic potential.
The fragmented and uncoordinated model of lung cancer treatment means that the patient has to wait months for diagnosis and treatment implementation. Molecular tests are performed in less than 10 percent of patients, the mean time of diagnosis is 10 weeks, and the mean time from diagnosis to drug administration is 52 days, which translates into an average treatment start time in patients with lung cancer of over 4 months. In addition, in many patients cancer is not fully diagnosed in molecular terms – and the patient is given chemotherapy.
Another problem is the quality of the tissue or cytological material in patients with a highly advanced disease. Reliable performance of molecular tests requires the availability of good-quality and properly secured tissue or cytological material. Obtaining a test material that meets these criteria is particularly difficult in lung cancer patients, which in some patients makes it impossible to perform the entire required series of separate tests, and in some it may even result in abandoning molecular diagnostics. According to the report of the Supreme Audit Office (NIK) from 2020, over 90 percent. patients who came to the outpatient clinic of the National Institute of Oncology who had undergone an earlier diagnosis did not have a description of the study that could be the basis for a decision on the treatment method.
Hence, as experts point out, an urgent, and perhaps the most urgent need of Polish oncology is to improve the coordination of activities in the diagnostic and therapeutic process with the use of funds from the Medical Fund. The more so because, as we know: investment in a good, effective therapy allows to reduce the remaining costs related to the treatment of the patient: hospitalization, treatment of complications, absenteeism and the need to treat relapses.