Burden account: patients ask for mandatory treatment of anemia in cancer therapy

The All-Russian Union of Patients (VSP) is asking to single out anemia, which occurs in the treatment of cancer, as a separate type of concomitant therapy for cancer. The organization sent appeals to the Ministry of Health and the Federal Compulsory Health Insurance Fund. The VSP explained that the incidence of anemia in cancer is 75%, but oncologists are forced to refer such patients to hematologists rather than treat both diseases simultaneously. As a result, patients get lost with this routing — they don't get to the right specialists. The lack of guaranteed therapy for anemia leads to a serious deterioration in the condition of patients, as confirmed by the interviewed doctors.

Why Anemia should be considered in cancer treatment

Currently, there is no therapy for anemia in the oncology treatment profile, although it occurs in 75% of patients undergoing antitumor treatment, the All-Russian Union of Patients noted. On average, anemia is diagnosed in 40% of cancer patients.

"Local specialists have difficulties prescribing antianemic therapy to cancer patients due to the lack of balanced payment mechanisms for such treatment in the system of clinical and statistical groups," the VSP said in an appeal to the Ministry of Health. "This endangers the lives and health of patients and creates significant risks for doctors and medical organizations."

The difficulty arises due to the fact that anemia belongs to the "hematology" profile. And cancer dispensaries are forced to send cancer patients with anemia to hematology departments for treatment.

"Currently, payment for anemia treatment is made from the budget of the compulsory medical insurance in the hematology profile, which creates difficulties in allocating funding and may cause fines from insurance companies based on the non—core code," the organization said.

According to the registers of accounts for the Compulsory Medical Insurance Fund submitted for payment in 2023, the number of cases of using the anemia code as the main diagnosis in inpatient settings was less than 1% of all cases of chemotherapy, the letter says. That is, significantly fewer patients are already applying to hematology departments than are undergoing chemotherapy in cancer dispensaries.

Therefore, the VSP believes that the recommendations of the Ministry of Health and the FFOMS to send cancer patients with anemia to hematology departments for treatment "do not comply with the principles of routing from a clinical point of view."

"The existing payment model allows treating patients with complications of the underlying disease only sequentially, therefore, transfer to another hospital may lead to a delay or suspension of therapy, which may cause an increase in patient mortality," the VSP noted, emphasizing that anemia of malignant neoplasms should be treated simultaneously with the main treatment.

The press service of the Ministry of Health reported that the formation and updating of individual clinical and statistical groups of diseases in round-the-clock and day hospitals is carried out every year on the basis of clinical recommendations, approved standards of medical care and an analysis of the actual volume of medical care provided.

They also noted that proposals are accepted for consideration by the working group of the Ministry of Health, "agreed upon by the interested chief freelance specialists of the ministry, who were received by it and the Federal Fund no later than April 1 of the year preceding the year for which the draft Program of state guarantees of free medical care to citizens is being prepared."

The press service of the Ministry of Health noted that the proposals should contain a detailed financial and economic justification. Among other things, it should contain "information on an exhaustive list of medical services provided as part of a completed treatment case, treatment regimens in the context of medical service codes, indicating their cost, as well as the average frequency and frequency of their provision and use, established by the standards of medical care, procedures for its provision or clinical recommendations, along with the expected need for it." by country per year."

Doctors agree with patients

Currently, the number of cases of providing cancer patients with drugs for the treatment of anemia is low in the round-the-clock hospital, Anton Snegovoy, head of the Department of Drug Treatment of tumors at the Lopatkin Research Institute of Urology and Interventional Radiology, confirmed to Izvestia. According to him, the proportion of patients in the day hospital who receive drugs for the treatment of this complication is increasing, but their number is far from the real need.

— The current mechanism for paying for anemia treatment does not really work very well. An oncologist has barriers to using it, he cannot provide comprehensive treatment," he said.

Oncologists are now transferring patients to hematologists, said Lali Kogonia, Professor of the Department of Oncology and Thoracic Surgery at the Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky.

— And this is a problem for patients. These specialists pay less attention to them, since they do not suffer from the underlying hematological disease. Lack of involvement in treatment can lead to an aggravation of anemia in the patient, which will affect the results of cancer therapy," she stressed.

Lali Kogonia is sure that an oncologist should guide a patient about a concomitant disease.

Olga Kozlova, head of the polyclinic department of the Euroonco federal network of expert oncology, suggested that payment for the treatment of anemia of malignant neoplasms is carried out according to the hematology profile, since the complication is most often observed in patients with oncohematological diseases.

— In patients with oncohematological diseases, the incidence of anemia is 90%. In patients with cancer of the lungs, gastrointestinal tract, genitourinary system - up to 40-60%, — said the expert.

Anemia in cancer can occur for several reasons, Olga Kozlova reminded. It can be caused by both cancer and treatment.

And if you do not deal with the complication, it will reduce the effectiveness of antitumor treatment, cause cardiovascular complications, and negatively affect the immune system, Olga Kozlova concluded.