"Our goal is to improve the quality of cancer care in the country"
A social project "Oncology for non-oncologists" is developing in Russia, designed to increase the alertness of primary care doctors and help patients across the country. In the near future, a single digital platform will be created for the training of non-core specialists and medical students, which will eventually help to detect such diseases at the earliest stages. In an interview with Izvestia, Doctor of Medical Sciences, professor of the faculty group of the Scientific and Educational Center at the Russian National Research University named after Academician B.V. Petrovsky, told about this, as well as about the innovative approaches that lead to many types of cancer becoming controlled chronic diseases and why personalized medicine is the future., Head of the Department of antitumor drug therapy at Clinical Hospital No. 1 of JSC GC Medsi, oncologist and chemotherapist Anastasia Mochalova.
"A routine blood test from a vein will allow us to detect cancer at stage zero"
— Anastasia Sergeevna, today doctors are increasingly saying that a number of oncological diseases can be classified as chronic. How can this be achieved?
— Ten years ago, as a doctor, I had to deal with despair in the eyes of patients much more often. At that time, the diagnosis of cancer was really perceived by society as a verdict. But today the situation has changed dramatically. We have really learned how to transfer many types of cancer to the category of controlled chronic diseases.
This breakthrough occurred due to the fact that medicine abandoned the principle of "treating everyone equally" and switched to a personalized approach. As a result, severe diagnoses such as melanoma, lung cancer, or breast cancer have in many cases become similar to diabetes or hypertension. Yes, a person needs to regularly receive supportive therapy and undergo examinations, but he lives a high-quality, long and fulfilling life.
— What technologies help to achieve such results?
— Today we have three powerful tools in our arsenal. This is targeted therapy: we no longer strike "blindly", but examine the genetic passport of the tumor and prescribe drugs that selectively destroy only cancer cells without damaging healthy tissues. Immunotherapy is a revolutionary method for which the Nobel Prize was awarded. We have learned how to "unmask" the tumor so that the patient's own immune system begins to see the cancer and successfully fights it. There is also an ultra-accurate early diagnosis. Modern methods allow us to find the disease at an early stage, when the chances of a complete cure tend to 100%.
— There is a lot of talk about cancer vaccines today — they are already being used in Russia. Tell us, how does this approach work?
— The topic of antitumor vaccines is really causing a huge resonance today, and as a scientist, it is important for me to immediately dot the I's: this is not a classic vaccine that is vaccinated against the flu in order not to get sick. This is a therapeutic, therapeutic drug created individually for an already ill person.
Imagine that a tumor is a criminal who has put on a mask and is hiding from our immune system. The method of personalized therapy is as follows: we take a fragment of the patient's removed tumor tissue, fully decode its genetic code and find unique mutations — the so-called neoantigens. Then, based on this information, an individual mRNA or peptide vaccine is created. Once in the body, it "trains" T-lymphocytes (our killer cells) to recognize this particular cancer and destroy it wherever it hides. This is the pinnacle of personalized medicine.
— Which patients can this approach help?
— Recently, the first clinical applications of such domestic personalized mRNA vaccines began in Russia. At this stage, they show tremendous potential in aggressive skin melanoma and inoperable or metastatic forms of cancer. Vaccines against colorectal cancer and glioblastoma (brain tumors) are also being actively developed and tested.
This therapy is designed to help those patients in whom standard protocols have failed or there is a critically high risk of relapse.
— What other treatment methods can significantly increase the life expectancy and quality of cancer patients today?
— Progress is progressing in several directions at once, and today we have technologies that seemed fantastic yesterday. If we list the main methods that radically change and prolong the life of patients, these are innovative nuclear medicine, cellular CAR-T therapy (a method in which the patient's own immune cells are reprogrammed), minimally invasive and robotic surgery (for example, using Da Vinci), simultaneous operations when a cardiac surgeon operates on the heart in one anesthesia. the patient, and then oncologists remove the tumor. Both modern supportive and palliative care. This is the most important invisible foundation of oncology. New antiemetics, smart pain relief, nutritional (supplemental nutrition) and psychological support allow patients to tolerate even aggressive treatment while continuing to work, travel and spend time with their family.
— What promising areas and scientific developments in modern oncology do you consider the most significant?
— It is extremely important for us to catch the disease at the earliest stage of its manifestation. That's why I'll mention the liquid biopsy. This is a new technology that can replace traditional, often traumatic organ biopsies. The bottom line is that at the earliest stages, a tumor releases fragments of its DNA (circulating tumor DNA) into the bloodstream. A routine blood test from a vein will allow us to detect cancer at the "zero" stage, years before the tumor becomes visible on CT or MRI. This is the key to an almost 100% cure.
There are a lot of new things related to artificial intelligence. Neural networks process giant arrays of CT, MRI scans and histological glasses, noticing microscopic changes that the human eye may miss due to fatigue. AI helps us predict how a particular tumor will respond to therapy by simulating hundreds of treatment scenarios in seconds. In addition, there are now programs that allow you to identify those who need to undergo an earlier, in-depth examination. This is the future.
— A significant part of your scientific work is devoted to the rehabilitation of patients after cancer treatment. To what extent is this stage integrated into the medical care system today?
— You have raised a topic that is of fundamental importance to me personally, as a scientist and a practicing physician. For a long time, there was a rigid stereotype in our medicine: the main task of an oncologist is to destroy a tumor and save a person's life, and then he must cope on his own. Moreover, for decades it was believed that any restorative procedures, massage or physical therapy were contraindicated for cancer patients. Patients were literally sent home to an information vacuum.
Today, the situation is changing, but the integration of rehabilitation into the overall system is still insufficient. We have learned how to operate brilliantly and perform the most difficult chemotherapy, but saving a life is only half the way. The real victory is when the patient returns to work, his family, hobbies and full—fledged physical activity.
"Our project is an attempt to create a single "safety language" between doctors of all specialties"
— You are actively involved in the implementation of social projects. One of them is "Oncology for non-oncologists". How did this initiative come about, who is it designed for, and what tasks does it help to solve?
— The idea of creating this project was born from my daily practice. You see, as a practicing oncologist and chemotherapist, I too often see patients who come in at the third or fourth stage. And when we start to analyze the medical history, it turns out that a person went to different doctors for six months — he treated a cough with a therapist, changed crowns at the dentist, or treated inflammation with a gynecologist. Time was lost not because the patient did not take care of himself, but because the non-oncological specialists had a blurred eye and the diagnosis was not made on time.
That's when I realized that the first line of defense against cancer is not an oncological dispensary. This is a general practitioner in a polyclinic, an obstetrician-gynecologist, a dermatologist, a gastroenterologist, and even a dentist. A person's life depends on their vigilance. This is how the project "Oncology for non-oncologists" appeared.
— Who is this program designed for?
— We have created it for primary care physicians and specialized specialists in civilian medicine who are the first to meet a patient. The program is built without overloading with academic theory — only rigorous practice.
The social project "Oncology for Non—oncologists" is my attempt to create a single "safety language" between doctors of all specialties. Oncology has long ceased to be the business of oncologists alone, it is the common responsibility of the entire medical community to save lives.
— How will the project develop in the near future?
— We are creating an educational platform for primary care physicians, digitizing lecture materials and field trainings. Such a doctor does not need to know oncology in depth, but it is important to route the patient correctly. We also plan to make the course available to medical students.
— The project has materials not only for doctors, but also for patients. Tell us more about it.
— When a person hears the diagnosis of cancer, he and his family instantly find themselves in a situation of severe stress and information chaos. There is often not enough time at a doctor's appointment to answer all human, domestic, or legal questions. That is why the "Patient's School" direction has appeared within the framework of our project. It's a free supportive space, such a therapeutic compass for the whole family.
Patients often come for a so-called second opinion. We do not replace the attending physician, but we give a person a deep understanding of their treatment route, remove fear of the unknown, and teach them how to eat and take care of themselves during therapy. There is also a psychological block of questions. The most common ones are: "How do I accept the diagnosis and stop blaming myself?" and "How do I tell this to children or elderly parents?" Equally important is the support of loved ones — we work a lot with the burnout syndrome of relatives who take care of the patient around the clock. Our psychologists help transform paralyzing fear into a conscious desire to fight and live.
In addition, we have provided a legal block. Unfortunately, patients often do not know their rights or face bureaucracy. Our lawyers provide clear algorithms, help you draft statements correctly and protect a person's legitimate right to timely free assistance.
— The project is being implemented in different regions of the country. Are there differences in the requests of doctors and patients depending on the region? What features do you notice?
— We clearly see the specifics of each region and adapt our programs to their real needs. If we talk about the requests of doctors, the following pattern can be traced here: in large cities and those with millions of people, primary care doctors are more informed. Their main request to us is subtle nuances: for example, how to notice the specific toxicity of the latest targeted drugs in time, or how to properly arrange complex patient routing between clinics at different levels.
The situation is different in remote regions and small towns.: There is an acute shortage of staff and a huge burden on the remaining doctors. The request from local therapists and surgeons is the simplest, "reinforced concrete" step-by-step checklists for everyday appointments. They need to know exactly which three tests to prescribe right now if cancer is suspected, so as not to miss the time while the patient is waiting for an appointment with the regional oncologist.
Noting these differences, we set ourselves the most important task — to equalize the quality of cancer care in the country. Regardless of where a person lives — in Moscow or in a small Siberian village — they should have an equal chance that the local doctor will be cancer-alert, and the patient himself will receive modern treatment and support.
— Can you give examples of stories where participating in a project has really helped patients or their families cope with a difficult situation?
— I'll tell you the two most revealing ones — they clearly illustrate what our team is working for.
The first case is a story of a saved life thanks to the training of doctors. In one of the regions of the Volga region, a young dentist came to our seminar on cancer prevention. Just two weeks later, an elderly man came to her for a routine appointment to replace the seal. During the examination, the doctor noticed a small, painless lump under the tongue. Previously, she probably would not have paid attention to this, because the patient did not complain. But, remembering our algorithms, she not only sounded the alarm, but she herself correctly routed the man to the oncologist. As a result, he was diagnosed with oral mucosal cancer at the earliest, first stage. The patient was successfully operated on, he was completely cured, and his speech and quality of life were preserved. His family still writes us letters of gratitude. This is the main victory — when our knowledge is used by other doctors.
The second story is from our "Patient School," and it's about how we save families from burnout. A young woman from a small town approached us. Her mother was diagnosed with advanced colorectal cancer. The family was in absolute shock and paralysis: the mother withdrew into herself and refused chemotherapy, believing that "she was going to die anyway," and the daughter herself cried around the clock, torn between work, a small child and caring for the patient. Our team got involved in a comprehensive manner: a clinical psychologist, an onconutrientologist and a lawyer provided assistance. As a result, my mother successfully underwent several courses of therapy, the tumor shrank, and she was able to undergo surgery. The disease has entered a controlled stage. But the main thing is that we have returned peace, order and hope to this family. The young woman was able to smile again and just be a loving daughter, not an exhausted nurse.
— How do you assess the prospects of fighting cancer? Is it possible to expect that in the future cancer will cease to be one of the main causes of death?
— I am absolutely sure that in the coming decades cancer will lose its position in the global mortality structure and will cease to be the frightening leader it remains today.
But it's important to be realistic here. As a scientist, I understand that cancer is not an externally introduced infection that can be completely eliminated with a single vaccine, like smallpox. Cancer is the price of our longevity, it is the result of accumulated genetic errors in the division of cells in our own body. It is unlikely to be possible to completely erase it from human nature.
However, the vector of medical development is aimed at depriving cancer of its main weapon. Today we know how to fight, and tomorrow we will learn how to win before the battle begins. And I am happy that my scientific work, our social projects and the daily work of oncologists across the country are bringing this moment closer. There is hope, and science proves it every day.
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