VI Meeting of the Council of Experts on Oncology

Prof. Pawel Kowal, chairman of the Parliamentary Group for the European Health Union, reminded that cancer mortality is still higher in Poland than in other EU countries, and cancer is the biggest killer of people of working age. Therefore, the safety of oncology patients becomes crucial.

System monitoring

Prof. Piotr Rutkowski, president of the Polish Oncology Society, pointed out that an important part of building safety for cancer patients is monitoring the system. - The emerging National Oncology Network and the Law on Quality in Health Care assume that we will monitor the results of treatment of patients and know what is happening in individual health care facilities. We will gain real-time data and, like the Netherlands, Germany or Scandinavian countries, we will check the effectiveness of the therapies carried out," informed Prof. Rutkowski.

Prof. Maciej Krzakowski, national consultant in clinical oncology, pointed out the most urgent challenges to improve the safety of oncology patients. In his opinion, it is necessary to improve the staffing situation among both doctors and nurses and medical secretaries. Equally important is the provision of modern diagnostics that also includes genetic and molecular testing. - It is necessary to ensure staffing facilities and adequate funding for these procedures so that all tests are performed efficiently at the same time, he pointed out. Another problem is the undervaluation of many services, which is compounded by a host of unnecessary bureaucratic hurdles that doctors are burdened with. The national consultant reminded that clinical oncology is making tremendous progress and many new drugs are being introduced. Therefore, it is important for doctors to know how to use these drugs. - Education is needed on new therapies, the indications for their use and the management of complications, he enumerated.

Education and prevention

Prof. Piotr Rutkowski recalled that the Oncology Strategy points to the huge role of educating the public about cancer prevention. - We can reduce the risk of cancer by 50 percent by leading a healthy lifestyle, he stressed. He regretted that despite the preparation of an education program in this area, the subject of health science has still not been introduced into schools. Barbara Dziuk, chairwoman of the Parliamentary Standing Committee on Oncology, pledged to look into the issue. In her opinion, in terms of improving participation in preventive examinations, POZ is still an untapped potential. She informed of a mechanism being prepared, under which the National Health Fund will promote POZ facilities that better conduct preventive examinations.

The head of the Polish Cancer Society drew attention to the quality of screening tests. - We have no monitoring of the colorectal cancer screening program or FIT tests, he lamented. - If we had a colonoscopy reporting rate of 50 percent, we could reduce deaths by the number of people who die annually from traffic accidents, he said.

Also, Prof. Jaroslaw Regula, national consultant in gastroenterology, stressed that there is no quality oversight over the colorectal cancer screening program, yet the invasive test is performed on healthy people. He recalled that as early as 3 years ago, the National Cancer Strategy envisioned the introduction of the FIT test, which would qualify for colonoscopy. 2 years ago, AOTMIT gave a positive assessment and recommended the introduction of this technology. And so far it has failed.

Network across the divide

Prof. Adam Maciejczyk, chairman of the AOTMiT Transparency Council, said that the pilot of the National Oncology Network proved that it is possible to coordinate oncology care, even though the patient's pathway passes through different facilities. He added that during the pilot, the level of satisfaction of those treated was monitored, and analysis of the surveys conducted showed benefits for patients.

Prof. Mariusz Bidzinski, national consultant in the field of gynecologic oncology, pointed out the security threat of the patient's fear of being excluded from the system. He pointed out the necessity of introducing an oncology network, despite its shortcomings, which will have to be improved. - This is because it presupposes the coordination of the patient's therapeutic path and guiding him through this path so that he does not get lost, he stressed.

Dr. Janusz Meder, president of the PUO, referring to the controversies and disputes surrounding the oncology network, noted that the biggest problem is the inconsistent position of the entire community of both oncologists and policymakers. - We will not succeed if some experts want to change something at all costs, not knowing what we have already achieved and what potential there is to develop. It is necessary to act above politics," he appealed.

Prof. Jaroslaw Rule added that as a result of disputes in the medical community, patients are losing confidence in health care, and a prerequisite for the patient's safety is confidence in doctors.

Problems reported by patients

Grzegorz Blazevich, deputy Patient Ombudsman, reported that the number of reports concerning oncology has not changed over the past few years, and most of them concern outpatient specialized care, especially waiting too long for an appointment. Concerns have also been raised about the quality of services and the lack of comprehensiveness of their provision.

Attorney Piotr Mierzejewski, co-chairman of the Health Expert Committee of the Ombudsman, pointed out that the Ombudsman's Office receives reports of lack of care in the field of nutrition during oncological treatment. - We do not have oncological safety without proper nutrition. It is the most important weapon in the fight against cancer," stressed Dr. Aleksandra Kapała, who heads the NIO-PIB Clinical Nutrition Department. She spoke about the importance of proper nutrition in the prevention of oncological diseases and during their treatment. She pointed out that a malnourished patient will not qualify for therapy or will not respond to treatment and will be at greater risk of side effects.

Attorney Piotr Mierzejewski also reported on complaints about the lengthening of radiotherapy queues. He also spoke about the fact that Emergency Access to Medical Technologies has in many cases turned out to be a sham institution that does not guarantee access to needed therapies.

Dr. Mariola Kosowicz, who heads the Mental Health Outpatient Clinic at NIO-PIB, pointed out that patients completing treatment at the cancer center do not have the opportunity to receive services from psychologists. Meanwhile, it is important for them to be able to have psychotherapy on an outpatient basis.

Unmet reimbursement needs

Prof. Tomasz Wróbel, head of the Department of Hematology, Blood Tumors and Bone Marrow Transplantation at the University Clinical Hospital in Wroclaw, pointed out the need to change the first-line treatment of Hodgkin's lymphoma. Recent studies show that the use of an anti-CD30 antibody in the 1st line with 4th cytostatic drugs improves the survival time of patients.

Meanwhile, brentuximab vedotin is reimbursed in Poland only for patients in relapse, not for first-line treatment.

Dr. Agnieszka Jagiello-Gruszwfeld of the Behavioral Unit of the Department of Breast Cancer and Reconstructive Surgery at NIO-PIB pointed out that for patients with early hormone-dependent, HER2-positive breast cancer, up to 20-30% experience recurrence despite currently available treatments. These patients are waiting for access to abemacycline, which has shown efficacy in reducing the risk of invasive recurrence and distant metastasis compared to the current reimbursable standard of care. - Since we can't effectively treat breast cancer recurrence, all measures to prevent it are very important," added Prof. Barbara Radecka, head of the Oncology Department at the Opole Oncology Center.

The expert also talked about the results of the SUNLIGHT international randomized trial testing the efficacy and safety of combination therapy - trifluridine/typiracil with bevacizumab compared to trifluridine/typiracil in monotherapy in patients with refractory metastatic colorectal cancer after two chemotherapy regimens. She stressed that the study showed that the use of FDT-TPI + bevacizumab combination therapy more effectively prolongs patients' physical function and opens up the opportunity for treatment in subsequent lines of therapy. This therapy represents an opportunity to extend life and improve quality of life in patients with advanced colorectal cancer who have experienced disease progression despite two lines of systemic therapy. - The addition of bevacizumab has been shown to be twice as effective. The combination of these drugs does not increase treatment toxicity, she added.

Dr. Iwona Skoneczna, who heads the Chemotherapy Department at Grochowski Hospital, spoke about the need for immunotherapy in the treatment of genitourinary cancers.

Pof. Marek Dedecjus, head of the Department of Oncologic Endocrinology and Nuclear Medicine, announced that with the September reimbursement list, patients with medullary thyroid cancer will receive effective treatment in the second line. The high efficacy of selperacatinib in patients with advanced medullary thyroid cancer with a mutation in the RET gene has been confirmed in trials. However, there is still no much-needed drug for patients with differentiated thyroid cancer refractory to radioactive iodine treatment. Differentiated thyroid cancer accounts for more than 90% of all thyroid cancer cases. Cabozantinib is an available therapeutic option for patients after progression on first-line therapy.

Quality of life of patients

Dr. Joanna Kufel-Grabowska of the Department of Oncology and Radiotherapy at the Gdansk Medical University stressed that the form of administration of the drug for patients who are expected to take it for many months or years is important. A drug in subcutaneous form is expected on the upcoming reimbursement list. This is a combination of pertuzumab and trastuzumab. - The subcutaneous forms reduce the feeling of morbidity. Patients have shortened contact with the treatment center and medical staff, reduced risk of complications associated with intravenous treatment, the expert pointed out.

Prof. Malgorzata Lukowicz, national consultant in rehabilitation, noted that rehabilitation doctors take a holistic approach to patients. She added that pain management is not just pharmacotherapy. In her opinion, a multispecialty team caring for an oncology patient should include a rehabilitation specialist. - The 10-year survival rate in the rehabilitated group is much higher than in the operated ones, she pointed out. Meanwhile, hospital directors are getting rid of rehabilitation departments because they are not profitable.

Father Vladislav Duda, director of the Archdiocesan Home Palliative Care Team, pointed out the need for rehabilitation in hospice care. - Palliative medicine is becoming long-term, and the sooner it is integrated into oncology treatment, the longer it guarantees survival calculated even in several years or decades. Unfortunately, we have tragically long hospice queues and these are urgent referrals," he lamented. According to him, this is due to the underfunding of hospices and the lack of palliative medicine specialists who do not want to work for the rates offered.