According to the official statistics, over 3.5 million Russian nationals have cancer. Mortality rate due to oncology diseases was in 2017 traditionally second highest, as Olga Golodets, deputy prime minister of Russia, put it. In Russia, this rate is higher than in developed countries, and one of the causes for that is the difficulty in detecting the disease at its earliest stages.
Cancer surgeon Andrei Pavlenko is certain screening programs could improve the situation if launched in the medical institutions of the country. Andrei Pavlenko, Director of the Oncology Center for Combined Treatment Methods in St Petersburg, is now struggling with the disease himself. When he learned his diagnosis, he launched Human Life project at Life as It Is portal to openly answer the most diverse questions Russians have about cancer diagnostics and treatment.
Yet medical institutions funding and industry administration mechanisms also require a general overhaul reform. Andrei Pavlenko shared his views with Invest Foresight on digitalization and blockchain being capable of lowering the worryingly progressing oncology statistics.
– If a disease is detected at an early stage, can that really help in improving the situation?
– Nowadays, 65% to 70% of patients come to consult a doctor when they feel a strong pain, which means when cancer is at the stage III or IV. But a screening could help in detecting early stages of the types of cancer for which mortality rates in Russia are much higher than elsewhere, i.e. cervical cancer, colorectal cancer and breast cancer. Scoring is very efficient is detecting colorectal cancer while an early diagnosis can help reducing mortality by at least 50%.
Screening which can be performed by both specialists and general practitioners, is aimed at detecting high risk groups. The test is not an ordinary thing, so 95% of the patients with positive test results must go through a colonoscopy. Here, we see a problem. Guess, how many patients eventually visit an endoscopist? One third, at best. Another third delays a visit for a lengthy time while the rest delay it indefinitely.
– In your view, what is the cause for that?
– The patients’ awareness is nonexistent. That is a fundamental matter, yet it is not even mentioned in the therapists’ regulations. Pilot projects have been launched in some of Russia’s regions on preventive care of breast cancer and cervical cancer, but there are no programs whatsoever on all other types of cancer.
National TV channels must incessantly talk about the problem. Yet how can a national state-run TV channel call on the people to buy a test kit and check their health in a country of free medicine?
Screening must be a national program. Yet it should not be similar to the health survey program which suggests that people of certain age are to be examined in the clinics, since such a program does not help in detecting cancer.
Colorectal cancer screening does not require any substantial resources. It will suffice merely purchasing test kits and supplying them to the clinics where endoscopy may be performed. If there is a wish, there is a fast and cheap way. But the Healthcare Ministry must have such a wish. We attempted to launch a pilot screening project in a clinic in St Petersburg. The regional healthcare committee was prepared to support it two years ago. Nevertheless, nothing has happened so far. At the end of the day, it’s not to their advantage. Selling a CT scanner is much more simple and much more advantageous in economic terms.
– How do you think the situation may be improved?
– One can do nothing about the current combination of the problems alone. So various people must start pulling all the diverse strings available to them. Anna Federmesser does her best to promote palliative care. I pull my surgery strings. Other people must contribute their efforts as well.
– Since you mentioned Anna Federmesser, at the recent St Petersburg International Economic Forum she reproached the Healthcare Ministry for manipulating statistics. In reply, she got an advice to adjust her language output. How do you see her speech and the response to it?
– Federmesser told the truth which is the Federal State Statistics Service lies. Hence it is a problem of transforming their data into some reasonably reliable statistics. These days, an oncologist in a local clinic puts down a diagnosis he or she finds fit. If a patient does not show up for a check up examination, that probably means the patient has died. The death could probably occur on such and such date. Nobody really verifies anything at all, nobody places a phone call on the patients. To get out of the situation, we need digitalization and implementation of distributed ledgers which must be put in operation in every medical institution, accumulating all and every data available.
– Do you refer to blockchain?
– Blockchain can help in sorting it out. I advocate setting up an aggregate register of all surgeons. Each of us must have an individual number listing all of the surgeries performed, all of the treatment outcomes, all of the aftertroubles, all of the mortality cases. The information should not be disclosed to the general public and should not be used to label someone as a bad surgeon, but to indicate such a surgeon should be visited and helped with identifying and sorting out a problem. Maybe, it is not about a wrong surgery. Maybe, the problem is, incurable patients are chosen for undertaking a surgery. Sticking labels, as media often do by wording their headlines like ‘A doctor killed his patient’, is absolutely impermissible.
For doctors to be interested in supplying reliable initial documented information, the Healthcare Ministry must take a different approach. Officials should not be prosecutors but helpers, i.e. the information submitted by the doctors should not be a cause and grounds for punishments but a call for a detailed situational analysis.
– How are your ideas perceived by the professional community?
– I have support of all professional practitioners. Yet there is a gap between the surgeons (or any other industry professionals) community and bureaucrats. Ultimately, the patients are the ones who face the problem. Do you remember Daria Starikova, a poor girl from a remote town of Apatity in the extreme north of Russia? She asked Russia’s president, during his annual direct TV line with the country, an absolutely right question, why medical services are not available to most residents of small towns and settlements. Still, the real problem is not the closure of the clinic in that town. The medical superintendent over there had no option but closing it down since the clinic was incapable of meeting any standards of medical assistance. The problem is, the girl had had her disease detected back in 2014 when she was recommended a surgery, yet she only visited a doctor in 2018 with a stage IV cancer. At such a stage, no president can help. Why should the doctors be at faults? Nevertheless, they are the ones who are declared to be ‘murderers’.
– You did not mention an extra layer between doctors and bureaucrats, the Federal Compulsory Medical Insurance Fund.
– Most of the medical institutions which can provide hi-tech assistance, get funding from the Insurance Funds. But the money from the government budget is also used to pay the administrators at the Fund. Why do we need that entity? Why not eliminating it and funding medical institutions directly pro rata the scopes of their operations?
Nowadays, surgical oncology is loss making. Yet the bureaucrats have obligated the doctors to look for ways of making money and not being dependent on a single channel of the government finance. The rates for treatment of oncology and surgery patients are low, therefore specialized medical institutions find it hard to make their ends meet. A standard government funded clinic which has no special allotments and no special rates and fares, is loss making. That means, it can not ensure favorable conditions for a doctor and pay that doctor a reasonable salary. The situation may be improved if there is no Federal Compulsory Medical Insurance Fund which ultimately just accumulates and distributes huge amounts of money. Instead, direct funding may be introduced which depends on the treatment provided and is strictly monitored. Besides, it should not be the government who supervises the finances provision, but the professional community. The community has started to take shape since long, yet one can not claim it has matured. To sum up, we need doctors’ registers, strong professional associations and direct government funding.
– Is what you say applicable to any other area of medicine?
– Absolutely.
– When may we be there and what shall we start with?
– There should be few pilot projects launched in Northwestern Federal District, for example, or in any other Federal District which can afford that financially, since apart from investors and extrabudgetary funds there should be government funding too, or a government will. Moscow could be involved.
Certainly, we must think of developing and administering a mechanism which can allow gradually shifting over to the new principles. No doubt, I have painted an ideal picture. I do not know, how it may be implemented technically. Yet we must do it!
By Olga Blinova and Ann Oreshkina