New horizons in oncology and hematooncology. Opportunities for patients

- Looking at objective indicators, one has to conclude that in key cancers, patient survival rates are increasing. Unfortunately, prevention remains a sore point," the expert admitted.

Perhaps not a sore point, but certainly a challenge, is the personalization of therapy. As Prof. Rutkowski stressed, at the moment the guidelines provide for the implementation of molecular diagnostics and therapy based on its results - but in some cancers the goal has not yet been achieved. One of the problems is the need to accredit centers that will perform the best quality molecular tests, it is also necessary, the specialist hinted, to simplify bureaucratic issues (at the moment, for example, the patient must give consent for each test separately), and finally - last but not least - to ensure full reimbursement of available tests.

The groundbreaking role of the tests for patients and the system was pointed out by Dr. Michal Jarzab, Center for Diagnosis and Treatment of Breast Diseases at the Maria Sklodowska-Curie National Cancer Institute. Maria Sklodowska-Curie - National Research Institute in Gliwice, speaking about multi-gene tests, he pointed out that those having prognostic, but also predictive value can determine with great accuracy which patients with early breast cancer, in addition to hormonal treatment, should receive chemotherapy, and for which it not only will not benefit, but is simply not needed. - Recently, at 8 cancer centers in Poland, we had the opportunity to use the Oncotype DX multigene test - the only multigene test that has predictive validity. Such tests in the United States appeared already two decades ago, in Europe much later, but they are already widely used and save many women from aggravating treatment. If chemotherapy is necessary, it should be used, but only then, he said. Chemotherapy - if oncologists could reach for multigene tests - could be avoided by tens of percent of patients. - Performing such a test makes it possible not to expose the patient to unnecessary treatment. This is the personalization of treatment," commented Prof. Piotr Rutkowski, adding that the public discussion at the moment centers around the availability of molecular tests, when in the meantime there are already ready-made products available that oncologists and oncology patients can use. And even if they are costly, they make sense - including economically. - Spending even 8-10 thousand zlotys for a test saves on chemotherapy, which lasts six months," recalled Prof. Rutkowski, stressing that in Poland we still spend too little on diagnostics in relation to treatment expenses. Access to diagnostic tools, on the basis of which all decisions prior to the implementation of oncological treatment should be made, would allow better management not only of the disease and the therapeutic process, but also - of costs.

- Some patients may feel anxious that their treatment will be less effective if they don't get chemotherapy, so it is extremely important to communicate properly and explain why this is a much more beneficial solution, said Dr. Mariola Kosowicz, Mental Health Outpatient Clinic at the Maria Sklodowska-Curie National Institute of Oncology - National Research Institute in Warsaw, who shared a personal experience, as her loved one benefited from such diagnostics abroad, which allowed her to avoid debilitating chemotherapy. The expert stressed that in the U.S., where such diagnostics have been performed, it is a routine procedure, and the test results are precisely explained to patients, so they have no doubt that doctors are making the best decision for them.

Regarding the situation in hematology, Prof. Ewa Lech-Marańda, national consultant in hematology and director of the Institute of Hematology and Transfusiology in Warsaw, stressed that recent years have brought enormous progress. - In five years, the number of molecules in reimbursement has increased by 75, and this year by another nineteen, she said, recalling that only six or seven years ago, during similar discussions, long lists of relatively simple drugs that were unavailable were enumerated. At the moment, the national consultant stressed, hematology faces a systemic task - building a National Hematology Network, along the lines of the NSO, with reference centers and comprehensive and coordinated care for patients.

This does not mean, of course, that all patients' health needs have been met. Prof. Anna Czyż, deputy head of the Department of Hematology, Blood Tumors and Bone Marrow Transplantation, Jan Mikulicz-Radecki University Clinical Hospital in Wroclaw, cited the example of patients after allogeneic hematopoietic cell transplants, who are particularly vulnerable to infections. Transplantation itself is already a procedure used routinely - in Poland for three decades, advances in treatment have been tremendous, prevention and treatment of complications becomes crucial. Part of the infections can be prevented by an ever-improving immunization program for this group of patients, but vaccination protects only against part of the diseases. The problem includes cytomagalovirus (CMV) - the infection is asymptomatic, so the prescription is to constantly monitor (test) patients, and if the infection is confirmed, to start treatment. - We have a drug available, but it causes a lot of side effects, in addition, some patients do not tolerate it, some do not respond to it, the specialist said. Doctors would like to be able to use the more effective and at the same time less toxic maribavir, but it is not funded. - This drug is needed for a relatively narrow group of extremely difficult-to-treat patients, she explained.