Features of national oncology
Preliminary results of the national cancer program – in the comments of specialists
The participants of the round table not only talked about the achievements, but also outlined the problems identified during the implementation of the program.
The draft of the National Cancer Program appeared when Russia's dramatic, almost 20-year lag behind developed countries in the provision of medical care to cancer patients became apparent. To eliminate the problems, it was necessary to develop a set of measures and allocate substantial funding for their implementation.
About the programAn in-depth analysis of the situation in the country led to the appearance of the project of the oncoprogram.
A list of equipment necessary in the regions for the treatment of patients at the world level was formed. The list includes various devices that allow you to find and mark the tumor, develop a treatment plan, transmit the information received to the irradiator, and then ensure proper treatment.
Within the framework of the program, from 2011 to 2013, 664 billion rubles were allocated for the cancer program. This money was used both for the construction of new centers, and for the modernization of existing ones, as well as for the purchase and commissioning of modern equipment for the diagnosis and treatment of neoplasms.
NumbersAt the beginning of 2014, 7 federal centers and 56 dispensaries out of 82 available in Russia were equipped with radiation therapy equipment, and this is an amazing result.
However, during the implementation of the National Cancer Program, many problems were identified.
Technology alone was not enough. Difficulties often arose at the stage of laying special canyons for radiation equipment, the construction of which was approaching the cost of equipment at a price. Difficulties also arose with the availability of competent personnel: radiologists and especially medical physicists.
"Now 250 medical physicists work in the country, which is 28 times less than in the USA, and 10 times less than in Europe. There are also not enough oncologists," commented the vice–rector of Moscow State University, Head of the Department of Accelerator Physics and Radiation Medicine, Professor Alexander Chernyaev. "Out of 1,500 radiation therapists, 65% are of retirement age," added Professor Anna Boyko, head of the Department of Radiation Therapy at the Herzen Moscow State Medical Institute.
Problems and their solutionThe report of the Minister of Health of the Russian Federation Veronika Skvortsova says that in Russia the mortality rate from cancer has decreased by only 1%.
To increase this figure, it is necessary to take a whole range of measures – all the participants of the round table agreed with this. According to experts, an alliance of various parties is needed to solve this problem.
One of the most important problems lies in the field of oncology costs. "It is impossible to allow a person who has worked in production all his life to be denied treatment. If a patient cannot pay for his treatment, the state as an employer must pay for him," says Anna Boyko. According to the chairman of the Board of Directors of MSM-Medimpex, the former head of the Federal Fund of Compulsory Medical Insurance Vladimir Grishin, further implementation of the National Cancer Program will take place in conditions of cuts in federal and territorial budgets and funds in the system of compulsory medical insurance. In this connection, the expert pointed out the need to take a number of organizational and economic measures.
For example, to monitor the state program "Oncology" in all subjects of the Russian Federation and to form technological passports in all medical institutions of oncological profile (including private ones), including three main sections: equipment, personnel, diagnostic and treatment technologies. According to Vladimir Grishin, this will allow preparing for the formation of a single consolidated final report on the implementation of the state program.
The participants of the discussion also questioned the decision of the Ministry of Health to assign exclusively to the CHI system all the costs of diagnosis and treatment of oncological diseases. This is basically impossible due to the high cost of treatment and medications. As a result, the personal costs of the population are still high. As an alternative, the experts suggested considering paying for the diagnosis and treatment of cancer entirely from the budget with additional involvement of CHI funds, as well as the resolution of VMI in oncopathology, which is currently prohibited.
Another problem is the acute shortage of medical physicists, and their specialized training for the industry is, in fact, only MSU. In this regard, MSM-Medimpex presented the university with a linear accelerator worth 120 million rubles for training specialists. However, according to Chernyaev, the accelerator is not working at the moment: the university needs 40-50 million rubles to equip the research institute around the radiation apparatus.
The issue of maintenance of installed equipment was discussed separately. According to available estimates, for these purposes, from 3 to 10% of the cost of purchased equipment is required annually (up to 3 billion rubles per year). Localization of the service should become a mandatory requirement for suppliers of expensive equipment when it is introduced to the Russian market.
To save resources and extend the life of the unique equipment, its widespread modernization is needed, since it is morally and physically obsolete due to the long duration of the program. Modernization is 2-3 times cheaper and allows you to extend the service life by 5-7 years.
For these purposes, in the 4th quarter of 2014 and in 2015, it is necessary to make appropriate changes to the health budgets of medical institutions and territories. According to experts, this issue should be under special control of the Ministry of Health of Russia.
Summing up the discussion, the head physician of the Moscow Regional Cancer Center, Alexander Seryakov, reminded the participants that in some countries they struggle not with cancer mortality, but with risk factors, controlling the state of the environment, as well as offering programs to combat bad habits. This is something that works for the long term.
Portal "Eternal youth" http://vechnayamolodost.ru17.11.2014