​The standardized path of the cancer patient, from the moment of diagnosis to removal from the cancer registry to recovery, regardless of whether it is due to death, is one of the most important goals of the National Cancer Control Plan, recently approved by the Parliament and released by the President. Klaus Johannis, says Associate Professor Dr. Michael Shenker, President of the Oncology Commission of the Ministry of Health.

It is necessary to shorten the time intervals between different stages of patient management

The route taken by the patient from the moment of diagnosis to death or removal from the oncological registry for other reasons includes the totality of the patient’s interaction with doctors, with the medical system, with institutions involved in the treatment of each individual patient.

According to Professor Dr. Michael Schenker, President of the Oncology Commission of the Ministry of Health, there are 5 stages characteristic of routine oncological diagnosis: suspicion after the first symptom/sign revealed during paraclinical studies, focusing the diagnosis on a certain type of cancer, confirming the validity of the diagnosis, assessment of the prevalence of cancer (stage) and assessment of the patient’s biological status. All these stages must be clearly defined for each type of cancer.

“This standardized patient pathway has very clear goals. One of them, perhaps one of the most important, is the uniformity of medical services offered in different cancer centers. For our country, this task is very important, because at the moment there is a very high degree of heterogeneity both in terms of the type of medical services in centers of the same level of competence, and in terms of the quality of the services offered. A second goal of the patient course is to ensure that the patient has completed all necessary steps, all recommended diagnostic tests, or all optimal therapeutic interventions have been performed. Another extremely important goal is to reduce the time intervals between different stages of patient management,” said Professor Dr. Michael Schenker during the debate “European and Romanian Oncology Policies and Strategies” organized by Health Policy magazine.

Among the reasons identified by the specialist, which can lead to a delay in shortening the patient’s journey, there are problems related to the legislation on public procurement, namely the availability of drugs in closed oncology dispensary pharmacies, the availability of funds in the national oncology program. , lack of diagnostic equipment in individual centers or even in certain regions of the country, lack of sufficient human resources associated with large volumes of patients who refer to individual centers.

Access to screening in Romania is still extremely limited

The European Commission has invited Member States to nominate competent authorities to take part in joint action against cancer inequalities with a budget of one million euros.

The National Institute of Public Health (INSP) is the competent authority for joint action on cancer inequalities, for the fight against cancer and other non-communicable diseases and for joint action on HPV vaccination. Also, specialists of the Institute participate as support staff in a joint action, the consortium leader of which is the European Oncology Organization.

“A major cancer inequality profile using data from the registry will be published during February 2023. One of the conclusions is that we are very lacking in data that would allow us to identify national inequalities between socio-occupational groups and between regions or regions. of the country,” said Dr. Carmen Ungurian, Cancer Prevention and Screening Coordinator at the National Institute of Public Health.

However, Dr. Carmen Unguran notes that “there are preventable cancers whose incidence and mortality rates are unacceptably high compared to the European Union (for example, cervical cancer has three times the European average).”

“Access to screening in Romania is still extremely limited both at the population level and between socio-professional groups. There is inequality in access, which depends a lot on equipment, infrastructure as well as people. I would like to point out that we should have a cancer registry that would also allow us to identify inequalities, but it does not provide us with solutions. Everything depends on the human resource. People have the power to analyze and interpret these data provided by the registry and make decisions based on the data,” said Dr. Carmen Ungurian during the debate “European and Romanian Oncology Policies and Strategies”.

The expert also drew attention to another existing source of funding – the Operational Program of Health Care (POS), which is at the approval stage until the end of 2022, which considers the field of oncology comprehensively, from prevention to palliation, from simple solutions based on low-cost solutions precision research, diagnosis and treatment. The total value of POS is almost 6 billion euros, of which an important percentage is for oncology.

Screening for all types of cancer and personalized medicine

The European Union is responsible for ensuring a high level of human protection by harmonizing health care strategies. However, the main responsibility for health care lies with the member states, said MEP Cristian Bouchoi, President of the Cancer Interest Group in the European Parliament, during the debate “European and Romanian policies and strategies in the field of oncology”.

The success and value of the European Cancer Plan largely depends on the EU’s ability to encourage and enable member states to invest in cancer care, from prevention to cure, says an MEP.

“It is important that the EU encourages European countries to fully understand this investment opportunity. This will help to avoid new cases of cancer and, no less important, will provide people with oncological diseases with the best medical care,” emphasizes Christian Bushoy.

Key to this: moving from a reactive model of treatment to an innovative approach to healthcare: “In addition to creating a framework for innovation, the European Cancer Plan will need to incentivize and support Member States to invest in the plan if it achieves its goals, but also provide the right foundation for the pharmaceutical sector to continue to invest in oncology innovation. The new policy should have an adequate budget and set clear performance indicators and targets to ensure that the implementation of the policy is not compromised by a lack of resources.”

“Investing in cancer care across the board, with a strong focus on research and innovation, has clear benefits. Effective person-centred prevention and treatment improve outcomes not only for the individual, but also for their families, communities and society at large,” says Christian Bouchoy.

Screening is necessary for all types of cancer, emphasizes the MEP: “I welcome the President’s desire to stop the debate on recommendations for screening programs and cancer patients and to expand screening programs to other types of cancer. There are significant medical and policy differences between EU countries when it comes to screening. As Chair of the European Parliament’s cancer interest group, last week I sent a letter to the Council and the Commission on the importance of investing in lung cancer and extending the Council’s recommendation to also cover lung cancer screening. But I don’t want to single out some cancers today, because our common goal should be to promote and screen all cancers: to promote and combat the fragmentation of treatment for all cancers and, of course, to convince Member States to include as many cancers as possible , in their national plans”.

Personalized medicine is also a big step forward for patients: “I would like to take this opportunity to highlight the importance of access to personalized care in oncology. Advances in personalized medicine will create an approach to treatment that is specific to the individual and their genome, and will enable better diagnosis with earlier intervention and the development of more effective drugs and therapies. This will have great potential for cancer patients, especially for patients with rare cancers or pediatric cancers.”