Finding a voice

Science and healthcare

Finding a voice

19. 06. 2019 14:21

Last year 29,245 people were diagnosed with some form of cancer in Slovakia, according to the International Agency for Research on Cancer. Colorectal, lung and breast cancers are the most common among the Slovak population. 15,587 oncological patients died last year. How many such deaths could be prevented if the Slovak healthcare system were better organized in terms of population-based screening programmes and quicker access to modern therapy? This is one of the questions that the newly established National Oncology Institute should help answer. And it all starts with…good quality data, as its director, oncologist Mária Rečková, says:

When you have good data you can extract valuable information out of it which is then used to perform a more precise analysis and design policies more in synch with reality. For example, the newest data in the Slovak National Oncological Registers is from 2011, which is very old, and we have to use data from our Czech colleagues and adapt it to Slovak realities in research. It's a long story why those registers have old data and it has something to do with a very bureaucratic way of reporting, which places an additional burden on the shoulders of already busy clinical oncologists. I am optimistic that we will soon have a more efficient way of collecting data professionally - that the deadline of 2020 for the registers to be up to date based on cooperation with our Czech colleagues will be met. Then they will be accessible via a link on our institute's website. Besides registers, our analysts will mine other data collected by the National Centre for Healthcare Information and prepare epidemiological analyses, which can be then used by researchers, academics, policymakers, whoever needs them.

And among the most sought after reports that the institute will produce is an evaluation of the population-based screening programmes that are being introduced in Slovakia this year. A pilot phase for colorectal cancer was launched in January on a sample of 20,000 people - with a lower than expected participation rate, so far only around 20%. The programme for mamographic screening for breast cancer is scheduled to start in September, with the one for cervical cancer to follow by the end of the year.

There are some quality indicators of the screening programmes that we evaluate based on European standards. There are three main areas we look at for all such programmes: the first one includes information about target groups, invitations sent, participation rates and so on; then we look at the methods involved - for example the occult blood test and colonoscopy for colorectal cancer, mammography for breast cancer and biopsies for cervical cancer - and the third area is the clinical one: how many positive results we had, how many malignant and how many benign tumours were discovered and which stage the disease had already reached at the time of diagnosis. All these details will be stored in some special databases, and I hope it will be coded in such a way that we can take maximum advantage of the information that the screening programmes can offer us.

Anca Dragu : Do you plan to use your position and the information you get from these evaluations to improve the design of screening programmes in the future? The low participation in the pilot phase of the screening programme for colorectal cancer already suggests that it was not well prepared, that the official communication campaign was not done properly, and some experts say that the invitation could have been written better, in a way that motivates people.

In Slovakia we have this habit of living in a bubble in which eveything looks bad, but we should say that it's a positive fact that this screening has started and others will follow. There can be many reasons why the participation rate is low and we will analyze them. Being a pilot phase, it's the health insurance companies that gather the data but I am sure we will have access to them too. It's important to use this information to improve the other two screening programmes, of course, and we will try to do it.

Once diagnosed - ideally when the disease is in an early stage - patients should receive the best treatment available. Oncological patients' organisations have been criticizing the fact that it takes too long - on average about 4 years - from the moment a modern therapy is approved by the European Medicines Agency until it reaches Slovak patients. And even then its cost is not always covered by the health insurance companies, which may judge it as too expensive. Patients complain about unclear rules based on which insurance companies decide on the coverage. One of the goals that doctor Rečková and her colleagues set for the near future is to draft a list of the innovative drugs whose availability is key for Slovak oncological patients.

This is a very sensitive topic that has triggered a lot of emotional reactions from patients and doctors too. In today's medicine, it is not possible to say from the beginning which drug will definitely work for which patient. If a drug is not expensive then ok, we try it and see what happens, but if the therapy is very expensive then we have to balance the cost and the benefit to the patient. The goal of any drug policy is to manage limited resources in such a way that as many patients as possible can benefit from treatment. That's why we have an expert in pharmaeconomics working for our institute, and together we plan to look at what is the total cost of a particular oncological diagnosis. I mean not only the cost of medical treatment as such but also the social costs, such as sick leave, disability pension and so on. We will create a model from this and then apply it to other cases too. Then in Slovakia we could improve access to innovative drugs by supporting clinical trials. There has been some progress lately in this respect with the launch of the Slovacrin project, which helps develop infrastructure to support clinical research in Slovakia. Our institute's webpage has a link to the Register of clinical trials in Slovakia and a database for those in the Czech Republic.

Says doctor Rečková, adding that there is still a lot of work to be done when it comes to the psychological and social needs of patients too. Those patients who are in remission should be monitored more efficiently.

It's a long distance race but we want to propose that such patients be monitored by GPs. This way we will allow oncologists to have more time for patients who are in an active phase of the disease. Of course we will need to educate GPs in this respect, but it could be a good solution.

And what would she consider to be an achievement in a year's time?

That we still exist, that we are an independent voice and that at least when it comes to epidemiological data we have something to show to the public.

Concluded doctor Mária Rečková , the director of the National Oncology Institute in Bratislava.

Finding a voice
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Anca Dragu, Photo: AP/TASR

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