NIO Director: Oncology diagnosis a critical moment of patient qualification

To what extent can Polish women enjoy the benefits of innovative therapies? How big a barrier is the hindered access to genetic diagnostics?

For several years we have been observing, but especially in the last year, the registration and reimbursement of new innovative molecules in typically female cancers, such as breast and gynecological cancers, but also in others. Indeed, oncology in this area is developing very rapidly. We are talking about treatment tailored to the patient, his disease and molecular abnormalities. Of course, the basis of this treatment is properly performed diagnostics: molecular genetic diagnostics, that is, on the cancer cell we look for abnormalities, which will be the basis for the implementation of treatment.

Unfortunately, these abnormalities occur in a few, at most a dozen percent, but we need to examine all patients. And we have two problems here. The first problem is that we have reimbursement for diagnostic methods, but the dynamic development of oncology indicates that this reimbursement should change its nature, that is, there should be greater accessibility to tests, to reimbursement for tests that we can perform in outpatient care. Let's remember that all the time in the back of our minds we have an inverted pyramid of benefits, which in oncology is of overwhelming importance due to the frequent visits of the patient to the oncology center. We want to hospitalize these patients as little as possible, yet perform the bulk of these services at the outpatient level.

On the other hand, the new molecules that we are dedicating to new molecular abnormalities mean that we need very modern diagnostics. We are talking about comprehensive diagnostics precisely in ovarian cancer. We are waiting for further decisions. The Agency for Health Technology Assessment and Tarification has given a positive opinion on comprehensive testing in ovarian cancer, so I hope that this next legislative stage will already happen quickly.

It is a very important role to perform complex advanced tests, but also complex tests. We are talking about a diagnostic situation where we do not test one abnormality, we test many, sometimes dozens of them, or we test a specific abnormality for which we use these advanced technologies.

This is the case with ovarian cancer. The changes - which are being forced by the innovation that has entered oncology for good - will force paradigm shifts in the financing of diagnostic tests in oncology. Why? The treatments we prescribe, which are reimbursed, are insanely expensive.

This is one element. But let's remember that also this innovation and a different approach to treating the patient(s) makes the treatment very effective. We are talking here especially about immunotherapy. It has broken into the halls of oncology, has taken hold and we use it in practically most cancers.

Immunotherapy has made this therapeutic effect completely different, more beneficial to our patients than standard chemotherapy. We must realize that oncological diagnosis done correctly will be that critical moment of patient qualification. Correct diagnosis determines correct qualification, that is, where the patient is likely to benefit most from the therapy.

Actually, we can't talk about good treatment without good diagnostics?

Absolutely yes, but let's also remember that since 2017, since January, these funding opportunities for molecular genetic diagnostics have drastically changed. This scheme, which is now being run and funded, allows us to add such building blocks, so without changing the whole structure, we are able to respond to new molecules, to new molecules and introduce new diagnostics. It is very important that this scheme, which has been implemented since 2017, allows us to expand rather than completely change the funding.

This is also important because the payer is able to determine this funding. It is easier for him to determine the costs that will unfortunately be associated with such diagnostics. Nonetheless, the cost of the diagnostics is not that big compared to the cost of the molecules that we prescribe, but most importantly, because we are talking about the patient, the cost is one element, but also the patient/patient who is likely to benefit very much from the therapy, because an innovative treatment is also a greater benefit from the therapy.

We already in many cancers - such as in breast cancer or lung cancer, we are able to say that in many patients this disease changes its status, becomes a chronic disease, we are able to determine the management strategy. This was not possible with standard treatment, that is, this classic chemotherapy. At the moment we are able to plan a strategy that if not the first stage, then the second stage, and this is very important for our patients.