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National cancer control strategy developed
In Russia, a National Strategy for Combating Cancer Diseases may soon appear - a global document that determines the development of the country's oncological service until 2030. Experts hope that the implementation of the Strategy will help solve the global problem of neglect of cancer patients.
In Russia, the National Strategy for Combating Cancer Diseases may soon appear - a global document that determines the development of the country's oncological service until 2030. The draft strategy was presented at the III meeting of the profile commission of the Ministry of Health on the specialty "Oncology", which took place last week at the Russian Oncology Center. Blokhin.
According to the chief freelance oncologist of the Ministry of Health Mikhail Davydov, there is still no single and consolidated position in the country that would allow solving the global problem - the neglect of cancer patients. “The most important and only indicator of the effectiveness of the oncological service in each region is a decrease in the death rate of patients in the first year of detection of the disease,” noted Davydov. "The task of the national strategy is precisely to create a system capable of analyzing statistics, monitoring the cancer register and the work of institutions, improving educational standards and modernizing logistics."
Even the official statistics demonstrate the flaw in the current system. So, according to the Ministry of Health, in 2015, mortality rates from cancer in most of the country exceeded the indicators of the state program "Health Development". In 28 regions this excess was less than 5%, in 22 - 5-10%, in 10 - 10-15%. In Tver, Bryansk, Leningrad, Chelyabinsk and Amur regions, it was already possible to speak of an epidemic - here the cancer mortality rate was 15-20% higher than the calculated values. The Yamalo-Nenets Autonomous Okrug (> 20%) became the leader of the anti-rating.
In the Ministry of Health, the situation is explained by “low activity of primary care” in early detection and prevention of cancer, untimely seeking help from patients themselves, “flaws in routing schemes”, insufficient use of effective treatment methods, and a shortage of personnel. The oncologists themselves also add to this the shortage of oncological beds and significant wear and tear of equipment in the regions. In particular, according to official statistics, for more than 10 years, 52.6% of electron microscopes, 48.2% of gamma-therapeutic devices for remote-conventional radiation therapy, 39.7% of X-ray therapeutic devices, 30.5% of devices for brachytherapy, etc.
The National Strategy, designed for the next 11 years, should correct the existing situation and, as a result, reduce the premature mortality of Russians from cancer. The document formulates 10 main tasks for reforming the industry. First of all, it is necessary to put things in order in the regulatory and legal framework. According to experts, a special law "On the fight against cancer" should appear in Russia. And, among other things, this law will have to regulate the maintenance of registries of patients with cancer (adults and children) in order to provide them with quality medicines.
Another challenge is to expand the range of screening programs. At the same time, screening coverage should be at least 80% of the relevant target groups. In addition, the procedures for the provision of cancer care, medical rehabilitation and palliative care should be changed. Telecommunication technologies play an important role in the Strategy - from the creation of a remote consultation system to the implementation of an automated selection of the optimal treatment algorithm for each patient.
All patients should be provided with dispensary observation at two levels - in the primary oncological office and the interdistrict oncological dispensary. The very same system of oncological care should become a three-tier one: we are talking about methodological, organizational and personnel support of interdistrict cancer centers from the RCRC and the main freelance oncologists of the Ministry of Health of the Russian Federation and federal districts.
As for the treatment itself, increasing its effectiveness is possible only with the introduction of highly effective radiological, chemotherapeutic and combined surgical methods of treatment based on clinical guidelines, the authors of the document say. In addition, innovative methods must begin to develop (personalized pharmacotherapy, regenerative medicine, etc.). Realizing the inability of the state to independently pull a full-fledged oncological program, the authors of the document also propose to seriously develop public-private partnerships and additional medical insurance, including voluntary cancer risk insurance.
As they said in the profile commission, first of all, within the framework of the Strategy, programs will be implemented to reduce preventable mortality. Taking into account the demographic groups and tasks set in the framework of the strategy for the socio-economic development of the Russian Federation, it is planned to significantly strengthen the work on six nosologies for which there are effective screening methods. These are cancers of the breast, cervix, prostate, colon and rectum, skin, mouth and pharynx. And also about lymphomas (especially Hodgkin's lymphoma) and lung cancer, for which effective technologies of treatment and targeted therapy have recently appeared.
A specific plan for the implementation of the Strategy will appear after agreeing on its target indicators and indicators. As expected, the final version of the document will be presented in June this year at the congress of oncologists in Ufa.
