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- Lost time: only one in six cancer patients gets to a doctor within the right timeframe
Lost time: only one in six cancer patients gets to a doctor within the right timeframe
The majority of Russians with cancer (80%) face delays in treatment. Only one in six can get to an oncologist in time after a referral and one in five starts therapy in time, according to a study by the Interregional Public Movement "Movement Against Cancer". "Izvestia" found out what problems patients with cancer diagnoses face and how it is solved.
Problems of cancer patients
Almost 80% of cancer patients in Russia face delays in treatment. Only 20% of patients start treatment on time (within a week after diagnosis), the Interregional Public Movement "Movement Against Cancer" told Izvestia.
In December, the organization completed a large-scale study on the availability and quality of cancer care in Russia (the results are available to Izvestia). It involved 502 patients from cities and rural areas and they told us what barriers they faced and how quickly they received the necessary diagnostics, treatment and information.
According to the survey, only 16.9% of patients were able to get an appointment with an oncologist within the standard three working days after referral. Delays in biopsies, a key test for diagnosis, were observed in 39.8% of respondents. In rural areas, the figure reached 66.7%.
- Treatment also often starts late. Only 20.1% of patients started it within seven days of diagnosis. In rural areas, the figure drops to 10.1%. More than 79% of respondents face delays, which significantly reduces the chances of a successful outcome," the organization told Izvestia.
Every third patient (34%) reported interruptions in receiving anticancer drugs, and this problem was more pronounced in rural areas. Every fourth cancer patient said that he had to buy drugs at his own expense, and in rural areas this is done by 46.4%.
In addition, patients (especially in rural areas) complained about the lack of data on rights, treatment options and available medicines. Nearly half of respondents said they lacked clear and structured answers to these questions.
Lack of resources
Galina Margevich, Deputy Chair of the Coordinating Council of the Movement Against Cancer and member of the Public Council under the Russian Ministry of Health, explains to Izvestia that the problems with accessibility of oncologic care are related to several reasons. The first is staffing at the primary level.
- There are not enough therapists and oncologists in the field. Patients find it difficult to make an appointment for an initial examination, and then they wait a long time for an appointment with an oncologist. Because of this, there are delays in diagnostics. Patients have to wait two, three weeks or a month for an appointment for examinations. And patients living in remote areas have to wait even longer, as they have to either go to the regional center or wait for mobile treatment and diagnostic complexes, for example, "Health Trains", - says Galina Margevich.
Another problem, according to her, is related to drug supply. The movement's hotline receives about 8 thousand appeals a year. About a third of patients complain of difficulties in obtaining medicines.
- Most often, delays in obtaining medicines are related to violation of procurement terms and shortage of medicines. Problems with the provision of medicines also concern medicines included in the list of VED (vital and essential medicines). There are problems with drug supply everywhere - appeals come from the capital as well," says the Izvestiya interlocutor.
All this, she emphasizes, affects the result of treatment for each person. A week's delay in diagnosis is not terrible, but sometimes it takes three or four months. And the earlier the diagnosis is made, the faster the treatment will be prescribed. If cancer is detected at the first or second stage and timely prescribed therapy, there is a good chance of cure or remission.
- The same applies to interruptions in drug supply. Many anticancer drugs must be taken in courses. If the course is interrupted, the treatment can become less effective, and in some cases the interruption causes life-threatening conditions," Margiewicz explains.
That's why, she says, patients often have to buy the drugs themselves. This is especially true for expensive drugs and targeted therapy.
Position of the Ministry of Health
The Ministry of Health explained to Izvestia that the program of state guarantees of free medical care for 2024 and for the planning period of 2025 and 2026 established the following terms:
- holding consultations of specialist doctors in case of suspicion of oncological disease - not more than three working days;
- conducting diagnostic tests in case of suspected oncologic disease - not more than seven working days from the date of appointment of the test;
- establishment of dispensary observation by an oncologist for a patient with a diagnosed oncologic disease - no more than three working days from the day of diagnosis.
- Compliance with the timelines established by the PGG is the most important goal in the process of providing medical care to patients. For this purpose, within the framework of the federal project "Fighting Oncological Diseases" of the national project "Health Care" (FP BOP), the work of more than 550 centers of outpatient oncological care (CAOC) has been organized, of which 77% are located on the basis of central district hospitals, polyclinics. <...>. On the basis of CAOPs the necessary range of diagnostic tests is organized, - said the Ministry of Health.
It added that in all the subjects the routing procedures for patients with suspected cancer and patients with already diagnosed disease have been approved.
As noted in the press service, in 2019-2020, 18 modern reference centers of immunohistochemical, pathomorphological and radiation research methods were created on the basis of federal medical organizations, designed to raise the diagnosis of oncological diseases to a new level in terms of providing expert opinion in complex clinical situations.
- Also within the framework of the FP BOP, the material and technical base of both federal institutions and the regional level is being upgraded. Over the period 2019-2024, more than 16 thousand units of medical equipment have been commissioned, including more than a thousand units of heavy equipment of various types. Construction and reconstruction of facilities for the provision of medical care to patients with oncologic diseases is being carried out, - said in the Ministry of Health.
The "Movement Against Cancer" noted that the results of the survey not only revealed the problems, but also showed what has been done in recent years within the framework of the federal project. At the moment, said the organization, significant results have already been achieved:
- 481 oncological outpatient oncological care centers have been created.
- New equipment has been purchased: mammographs, CT, MRI and other equipment necessary for diagnostics.
- Access to expensive anti-tumor drugs has been ensured.
- The level of early diagnosis has increased: from 2018 to 2023, the number of diseases detected at stages I-II increased by 8%.
- However, the results of the study emphasize that the established systems are still working unevenly. In large cities, patients are more likely to receive care on time, while residents of smaller communities face barriers at every stage of treatment," the organization stressed.
Solutions
In general, the results of the survey show that for millions of Russians with cancer, timely help is still unattainable, concludes Galina Margevich, deputy chairman of the Coordinating Council of the Movement Against Cancer. The medical infrastructure created under the federal project is often inaccessible for those who live far from major centers. In rural areas, the share of patients starting treatment on time is twice lower than in urban areas.
This gap, according to the expert, requires a systematic approach:
- accelerate the timeframes for diagnosis and start of treatment, especially for rural residents;
- ensure an even distribution of medicines and strengthen control over their availability;
- to develop educational programs for patients and their families so that they can better understand treatment options.
According to Izvestiya's interlocutor, , Russia as a whole has "a fairly effective system of drug provision for patients - a large budget has been allocated for this purpose. However, most of the problems with access to medical care are related to financing.
- No financial system in the world can provide cancer patients with all the necessary drugs. There are countries where financing through supplementary medical insurance is actively used, and somewhere the state partially buys drugs. Of course, we would like to see innovative drugs included in the list of VEDs. Especially if these drugs are included in clinical recommendations and their effectiveness is proven. This could significantly improve the situation with their availability," says Galina Margevich.
In addition, she adds, it is important to establish continuity of prescriptions of federal centers and regional medical institutions. There are situations when the federal center prescribes a drug to a patient, but the medical commission in the region is not ready to give a prescription for it.
- Financing of medical care for cancer patients should be in line with clinical recommendations, and budget planning should take into account the growing number of patients with cancer, as well as the necessary therapy and diagnostic options. In addition, inflationary changes must be taken into account. In other words, the amount allocated under the "Fight Against Oncological Diseases" program should be indexed taking into account these factors," says a member of the Public Council under the Russian Ministry of Health.
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