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Video: I Think That This Year We Will Feel The Improvement
I think that this year we will feel the improvement
30% of oncological patients sought medical help during the year before the diagnosis was made, but due to a lack of knowledge among doctors, they did not go to the oncologist, and the examination of the quality of oncological care revealed various violations in 44% of cases. The industry is underfunded and technologically lagging behind. The implementation of the federal cancer control project should turn the tide, experts hope.
Photo: kremlin.ru /
Almost a third of patients had sought medical help during the year before the oncological diagnosis was made, but due to the lack of specialized knowledge of general practitioners, they were not referred to an oncologist. The industry is underfunded and lags behind in technological development, patients everywhere face difficulties in obtaining medicines, there are practically no opportunities for rehabilitation. And the examination of the quality of care provided to patients with cancer, carried out by insurance companies, revealed various violations in 44.3% of cases. The implementation of the federal cancer control project should turn the current situation around, experts hope. This was discussed at the XI Forum "Movement Against Cancer", which took place the other day in the Public Chamber of the Russian Federation.
The project "Fighting Cancer Diseases" is a key part of the National Project "Public Health"; 969 billion rubles will be allocated for its implementation in six years. It is planned to use these funds to organize a network of outpatient oncological care centers, re-equip regional medical institutions, develop a network of federal medical centers providing high-tech assistance, and establish drug supply. It is expected that as a result, mortality from neoplasms is planned to decrease by 7.8% by 2024 compared to 2017: from 200.6 cases per 100 thousand people to 185.
About the quality of medical care
As the vice-president of the All-Russian Union of Insurers Dmitry Kuznetsov said, speaking at the Forum, appeals to large insurance companies from cancer patients make up just over 5% of the total. When conducting an examination of the quality of medical care provided to patients with oncopathology, violations were revealed in 44.3% of cases. Of these, almost half (48.2%) of cases revealed violations of rules and standards, creating a risk of disease progression, and almost a third (27.9%) - violations leading to the progression of malignant neoplasms and the emergence of new diseases. The situation will be improved by "the implementation of the unified principles of support and expertise developed by the FFOMS," Kuznetsov promised.
About drug supply
Nikolai Dronov, Chairman of the Coordinating Council of the Interregional Public Movement Against Cancer, member of the Public Council and the Council of Public Organizations for the Protection of Patients' Rights at the Ministry of Health of Russia, presented the results of monitoring the quality of medical care on the example of patients with melanoma. 28% of the patients surveyed are faced with the fact that the drug prescribed by the attending physician cannot be obtained. Another 21% reported that doctors delay the appointment of the necessary drug or refuse altogether. 14% complain about the lack of information on the procedure for prescribing drug therapy. 16% - on the ambiguity of medical recommendations, patient misinformation, the need for additional consultation.
In total, in 2018, the Anti-Cancer Movement received more than 7 thousand requests from cancer patients related to the availability of drugs. Most often it was about “unaffordable expensive drugs”, since “not every region can afford to purchase them”. There were also "completely egregious cases" when a person was simply driven between the dispensary and the regional hospital - and it was not clear where to treat him, Dronov said. “Of particular concern are the signs of a possible inadequate medical competence - or the priority of non-medical criteria in prescribing drug therapy,” the expert said.
About diagnostic problems and personnel
According to Andrei Kostin, First Deputy Director General of the National Medical Research Center of Radiology, Andrei Kostin, the reason for the late diagnosis of oncological diseases in Russia is often gaps in the education of primary care physicians - therapists, gynecologists, surgeons, dentists. According to him, more than 30% of patients during the year before the oncological diagnosis were made to general practitioners and did not receive a referral to an oncologist. “The problem is that these doctors did not pay attention to the signs of cancer that were already there. This speaks of a huge gap in special education,”explained Kostin.
The Ministry of Health is well aware of this problem and is already working on changes in the programs of postgraduate medical education. A new, mandatory first-contact program for physicians will focus on learning to identify early signs of cancer. The system of training doctors-oncologists will also change: “it will no longer be possible to immediately become a narrow specialist, a multi-stage residency will be envisaged,” Kostin said. In addition, changes will be made to each of the stages of early diagnosis.
He stressed that he has no doubts that the goals of the national cancer program are realistic, and by 2024, it will be possible to achieve its targets. In particular, thanks to structural changes in the oncology service, an increase in the number of oncologists in primary care and an increase in the competence of doctors working in it.
The Ministry of Health is also reviewing the attitude towards the rehabilitation of cancer patients. According to Kostin, this system in Russia has not been debugged, and today the task is "to make the rehabilitation of patients an obligatory component of treatment." That is, to create such a regulatory framework according to which the patient must undergo rehabilitation regardless of where he lives. “In the near future, we are waiting for the development and implementation of tariffs for cancer rehabilitation, when it will be included in the system of medical care for cancer patients and will make it not only mandatory, but also cost-effective for medical institutions,” Kostin said.
The chief freelance oncologist of the city, director of the Moscow Clinical Research Center named after I.I. A.S. Loginova Igor Khatkov. According to him, today the key task is to centralize specialized oncological care. This is necessary to ensure that patients are treated only in specialized medical institutions. In addition, according to him, since last year, all devices located in Moscow federal centers and private institutions have been involved in the radiation therapy program.
As for drug supply, Khatkov said that Moscow will become a pilot city for working out a law on treating patients on the basis of federal clinical guidelines (while we are talking about six nosologies), within which patients will be fully provided with all the drugs recommended in these documents. In the country as a whole, changes to the legislation on health protection, according to which clinical guidelines should become the basis for a new uniform standard of care, will enter into force in 2022.
About civil monitoring
The forum participants agreed on the need for an independent assessment of the work of the oncological service in the framework of the project to combat cancer and the importance of individual patient support. Today, patients expect from the healthcare system to reduce the waiting time for diagnosis and treatment, ensure continuity in treatment and the reliability of the system for protecting the rights of patients, said Yuri Zhulev, co-chairman of the All-Russian Union of Patients.
In the near future, the "Movement Against Cancer" is launching a project on civil monitoring of the federal project. “I think that this year we will feel improvements,” Dronov said. "At the same time, we have comments on how to improve the project or make it more dynamic."