Cancer: is it a shame to be a survivor?
Stay alive
Medicine, having learned to "pull out" cancer patients, faced a new problem – what to do with the rescued?
Alla Astakhova, the magazine "Results" No. 48-2010
An amazing fact: American doctors gathered at the largest congress of the American Society of Clinical Oncologists (ASCO), at several meetings at once discussed not so much how to treat cancer, but what to do with those whom they managed to cure. In countries with advanced medicine, such survivors are becoming a real challenge for health systems. People who managed to get out remain very difficult patients – no one has yet learned to predict the moment when a new cancer cell will appear in the patient's body. This leads to such a heap of problems that the question arises of creating a new direction – "survivor medicine". Only no one anywhere in the world knows where to put it in the ranking of medical care and with what money to finance it. In Russia, however, the issue is even tougher.
Sometimes they come backAccording to American experts, already in 2007, the number of cancer survivors in the United States exceeded 14 million, which accounted for 4 percent of the country's population.
Moreover, meticulous sociologists have already calculated that a million of them are raising their own minor children. It seems to be necessary to rejoice, but there is an important circumstance – these people will never be considered absolutely healthy. They need special medicine, almost like those who underwent a transplant at the time. The very fact that this problem has come to the forefront testifies to the new era that has come in oncology. The number and quality of life of survivors is a litmus test for any cancer service. After all, that's what it exists for, so that people don't die of cancer.
In Europe, the situation is similar. The results of a recent study conducted in Italy indicate that four percent of women and three percent of men in this country suffered from cancer. And what about Russia? Last week, the next congress of domestic oncologists took place, and so far many of them are in no hurry to put the problem of survivors in the category of the most urgent. "In 2009, the rate of newly detected cancer cases in Russia for the first time exceeded half a million per year," explains Dmitry Borisov, executive director of the non–profit partnership Equal Right to Life. – Of these 500 thousand, about 27 percent will die in a year. Less than 50 percent will live five years. The United States and Europe have reduced the cancer mortality rate by 20 percent over the past 10 years. In Russia, over the same period, the number of deaths from cancer increased by 15 percent. What kind of survivor problem can we talk about here?"
However, anyway, there are still a lot of such people in our country – this is evidenced by medical statistics. "According to our data, in 2008 there were 1 million 315 thousand people in Russia who had already lived for five years or more after they were diagnosed with cancer," says an oncologist surgeon, senior researcher at the Research Institute of Clinical Oncology of the N. N. Blokhin Russian Cancer Research Center of the Russian Academy of Medical Sciences, Executive Director Eurasian Cancer Program Somasundaram Subramanian. "No matter what they say, it's already about a percent of the entire population." Of course, much less than in the USA and Europe, but still almost every hundredth.
Under controlAll the survivors have the same medical problems.
They need to treat not only the effects of chemotherapy – osteoporosis, hypofunction of the thyroid gland, a decrease in hemoglobin levels, changes in the immune system. "The most worrying thing is the possibility of a subsequent relapse of the disease, which may occur in a year, two, ten years," says Dmitry Borisov. – All survivors should be monitored by an oncologist. For life. You need to be examined every six months or a year. But it is psychologically difficult for people to plunge into the hospital fuss every time."
The question arises, should the doctor who treated the patient force him to be observed? Oncologists of well-known hospitals and research institutes, dealing with life and death issues every day, do not consider work with survivors a priority. They can be understood. "Every year we take 600 primary patients to our 150 beds, despite the fact that children often lie with us for several months before they get better," says Deputy Director of the Research Institute of Pediatric Oncology and Hematology of the N. N. Blokhin Russian Cancer Research Center of the Russian Academy of Medical Sciences, Corresponding member of the Russian Academy of Medical Sciences, Chief children's oncologist of the Ministry of Health and Social Development Vladimir Polyakov. – There are not enough places, according to the quota, often only a tenth of the child's treatment is paid – they pay a little more than a hundred thousand rubles, and treatment often comes out in a million. In addition, we constantly receive very difficult children from small oncological departments in regions where they were not treated properly."
Those who survived are dealt with by the same doctors who pulled them out – it is to these doctors that they come for examination (here is a whole list of tests and other studies) once or twice a year. In America, when the flow of such patients began to increase, a problem arose – oncologists began to run out of time. That is why the Americans came to the conclusion that other doctors, most likely therapists, should deal with the survivors. And they offered to allocate this assistance in a separate direction. Now, when medical reform is underway in the States, the patients themselves are determined to fight for their right to treatment (the social movement of survivors there is gaining strength). Will it work? Experts are optimistic, although the authorities and insurance companies have the floor. "Cancer is a diagnosis that radically changes the patient's life. Even if he is cured, he will always need help. Today we are trying to develop new models in healthcare, different from those that existed 15-20 years ago. Now we need close cooperation between oncologists and primary care physicians. Perhaps oncologists will be involved more somewhere, and general practitioners in some places. There is no single recipe for everyone," says George Sledge, president of ASCO.
In Russia, where the problem of survivors has not yet been raised even at the medical level, the situation is as follows: our cured often achieve everything themselves. For example, patients with myeloid leukemia should take a special blood test every six months. However, they pay for it out of their own pocket – this study is not yet included in the treatment standards, which means that there is no way to justify the costs of it under the CHI. It is not uncommon for the chief doctors of well–known and sought-after medical institutions dealing with oncology to give unspoken instructions - to send cured patients under the supervision of a doctor at their place of residence, to district oncologists, and to accept them only in case of relapses of the disease. It seems to be necessary, if not for one thing ... "In Russia, which now has almost more oncologists per capita than in any other country, the qualifications of an average doctor in this field are very low," says Somasundaram Subramanian. "The problem is whether the district oncologist will be able to detect the same relapse, whether he will have the necessary diagnostic tools at his disposal."
Ashamed to be a survivor?"Several patients who are in remission participate in the public movement against cancer.
Their initial diagnosis was stage 4 breast cancer," says Dmitry Borisov. – I am familiar with one of them, by the time of diagnosis she already had metastases in the liver, in other organs. At first, doctors believed that she had at most three months left to live. However, she was saved thanks to modern treatment: she has not had any signs of the disease for six years. But she faced another problem – doctors familiar with her diagnosis often look at her as a living dead person. Oncologists do not take her word for it and ask for a medical history. Officials once accused her relatives of fraud – when they came for some kind of certificate, they did not believe that she was still alive, and decided that her relatives were trying to appropriate her pension."
Experts state that the public attitude towards survivors in our country is also far from civilized. Lilia Matveeva, director of the autonomous non-profit organization for assistance to patients with oncological and oncohematological diseases "Assistance", created on the initiative of patients with myeloid leukemia, recalls that patients have repeatedly refused the disability group only because they wanted to avoid frightened looks when applying for a job. Recently, medicine has made great strides forward in the treatment of myeloid leukemia, giving patients decades of normal life. That's just the diagnosis of "cancer patient" is not liked by personnel officers. Why, adults – even children after cancer often do not want to admit it to their peers. "Moscow keeps records of such guys," says Vladimir Polyakov. –Modern medicine is able to cure 80 percent of children from cancer, while most recover completely and irrevocably." However, the attitude of others to this topic has not changed yet – many families are trying to move in order to forget all the bad things and start life from scratch. And children disappear from the sight of doctors.
Domestic experts have not even thought about sending Russian survivors to therapists, as in the USA. District precinct officers often have too low qualifications. But, as the American experience has shown, the more survivors there are, the more powerful they become in society – it is impossible not to notice them. The delusional Russian situation, when it is a shame to be a survivor, will probably be resolved when our medicine begins to demonstrate the same results in the treatment of oncology as the American one. It would be faster.
Portal "Eternal youth" http://vechnayamolodost.ru29.11.2010