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In the Crimea care to cancer patients remained at the level of 1950-ies

13.05.2014

This conclusion was made by representatives of the Russian Ministry of Health, Association of Oncologists of Russia and Russia's leading organization for the protection of cancer patients’ rights, non-profit partnership “Equal Right to Life” after the on-site visit to Crimea. Experts pointed out that local patients are deprived of quality diagnostics, effective medicines and up-to-date equipment. It is possible to change the situation in the region by integrating of regional medicine into national program for the development of health care in Russia. The Report on the current state of oncology service on the peninsula and proposals for the development of measures to improve it will be sent to the Russian Ministry of Health, World Health Organization and the United Nations. The expert team also plans to report on the situation in this area, as an example illustrating medical care in the regions of Ukraine, to the Commissioner for Human Rights.
Assessing the situation in the Crimea, experts agreed that today care provided to cancer patients is at the level that was in the mid of the last century. However, official statistics of the Ukrainian Ministry of Health contradicts the real situation on the peninsula. For example, according to data of the Ministry of Health, the one-year mortality rate of cancer patients (the main indicator for assessing the effectiveness of treatment) is 22.3% which is lower than in Russia and the developed European countries, introducing innovative technologies. These figures do not reflect the real situation, because they the collection and processing of statistical data is extremely poor, said Deputy Chairman of the Board of the Russian Association of Oncologists, executive director of NP Equal Right to Life Dmitry Borisov.

The results of expert survey showed that the Crimea residents have to pay for all the treatment at their own expense. “Everything that is declared by the Ukrainian authorities as free medical care is not backed by financial resources. More than 80% of all funds used to finance cancer care in the Crimea are direct payments from population,” Dmitry Borisov comments. Experts estimate that in terms of investment in cancer care, taken as per capita spendings, Russia spends about 200 times more than what was allocated for the Crimea by Ukrainian authorities.

It is known that success in the treatment of any disease, especially cancer, significantly depends on the accuracy of diagnosis, however today the Crimea residents are deprived of the opportunity to get a qualified diagnosis in public health care institutions, they can do that only in a few private laboratories for their own expense. Medicines purchased using budget funds are not manufactured or approved anywhere in the world; experts have questioned their quality and effectiveness. “What is written in leaflets is a violation of patent rights, these drugs are generics and biosimilars of original drugs that are currently under patent protection,” Dmitry Borisov said. Accordingly, doctors in the Crimea and Sevastopol are not able to provide adequate care in compliance with current standards adopted in Russia and in the world.

However, “there are unique surgeons in the Crimea doing everything to maintain their level of professionalism and to follow modern developments in oncology. These enthusiasts are the backbone of the certain areas in the surgical treatment of cancer patients,” said Alexander Petrovskiy, Executive Director of the Association of Oncologists of Russia and oncologist at the N.N. Blokhin Russian Center Research Center. The expert adds however that such cases are rather exceptions to the rule: “In general, the principles of treatment of cancer patients in the Crimea were frozen at the level of 1980-ies, when the possibilities of medication and radiation therapy were significantly lower than today and doctors mostly relied on surgery. For example, let’s consider the widespread pathology, breast cancer. At the Crimean Cancer Center the very concept of organ-preserving therapy is absent. They routinely perform the type of surgery, which at the N.N. Blokhin RCRC was last performed as far as in 1984, since that time we do not use such interventions, but for them it is a standard.” The problem is even more complicated by the fact that patients have no opportunities for adequate recovery after surgery due to the degradation of resuscitation services, absence of a well-functioning patient care system. “Physicians in the Crimea hope that after the reunification with Russia they will be able to use all the technology in order to provide care to patients at a decent level,” Petrovskiy noted.

Natalia Falaleeva, oncologist-haematologist from the N.N. Blokhin RCRC, has also described the situation in the Crimea as extremely unsatisfactory: “
Most anticancer drugs, even the ordinary ones, are purchased by patients; innovative drugs, including targeted medicines, were not purchased using budget funds and patients had no access to them. The registry of patients with hematological diseases is absent, as well as the possibility of full diagnosis, while under the Russian program “Seven Nosologies” these components are mandatory to ensure appropriate treatment of patients.

Another key problem is the absence of adequate diagnostic facilities. According to expert, morphological studies were conducted only at laboratories in Kyiv and were paid exclusively by patients. Patients who did not have enough money for the test were not included in statistics. “There is no fully-featured inpatient care. The number of hospital beds is not enough; conditions for patients are extremely unsatisfactory. The lack of basic conditions makes it impossible to use intensive chemotherapy regimens, necessary equipment and transplant centers are absent. Medical care that is standard in Russia is simply absent in the Crimea,” Natalia Falaleeva comments.

The expert notes that to solve these problems, creation of the unified registry of patients with hematological diseases by nosology, this will allow determining the real need for drugs; it is necessary to improve the quality of diagnosis, create and develop outpatient hematology service, as well as to improve quality and increase the volume of inpatient care.

Speaking about medical radiology, radiation oncologist from the N.N. Blokhin RCRC Valeria Glebovskaya told that the Crimea is behind the developed countries by more than 30 years, the number of devices for diagnosis and treatment tens of times less than required. “Currently in the Republic of Crimea the available equipment is very poor and not capable to support high-quality radiation therapy. Radiation therapy is provided to only 30% of patients, while it is needed for 70-80%. Pediatric radiology department is absent. Eighty per cent are obsolete radiation therapy equipment that is out of service life, a large part of it is still in use for more than 30 years instead of 10 years as intended. The uncertainty of dose exceeds 30% instead of 5% according to international standards; in Sevastopol radiation therapy is not available at all.”

All proposals for improving cancer care in the Crimea will be integrated into a "roadmap" for the development of health care on the peninsula, said Mikhail Kramarov, Head for special programs at the Department of organization of medical care and health resort services of the Russian Ministry of Health. It is planned to include the Crimea and Sevastopol in the Russian health care development program until 2015; this program have provisions on improvement of specialized medical care to cancer patients. “We hope that next year we will be able to implement it. The main problems are training of staff and preparation of premises. These are the basic conditions for participation in the program,” Mikhail Kramarov commented. He also noted that now almost all the buildings and premises of medical institutions in the Crimea do not meet current Russian sanitary standards and regulations.

Patient organizations will take active part in solving the problem of provision cancer care to Crimeans. “Since the non-profit partnership Equal Right to Life was granted a consultative status with the Economic and Social Council of the United Nations, we cannot ignore this. We believe that it is not only medical problem, but also a common human problem, and it is important for us to draw attention of other countries to it,” Dmitry Borisov said. “Ukraine, as a member of the UN and the WHO, and that has ratified all international acts defining the right to access to health care, in this case failed to implement almost all provisions. We will submit all comments and ideas for the improvement of situation in the Crimea at the UN ECOSOC meeting and ask the international community to pay special attention to the problem of availability of specialized medical care.”

According to Igor Lanskoy, adviser to the Minister of Health of Russia, the minister Veronika Skvortsova plans to visit Crimea with a working visit in the nearest future.

Full version of the press conference is available here: pressria.ru/pressclub/20140421/949186885.html