Cancer treatment: when budget fails, charities help

February 15 was marked as the International Childhood Cancer Day. The problem of cancer is equally topical all over the world, although the incidence rate among Ukrainian children is somewhat lower than in other European countries: an average of 11 cases per 100 children, compared to 13-15 cases elsewhere in Europe. Experts say inadequate statistics can be the reason.

Over the past several years, the number of children with cancerous tumors has remained practically the same. At present, there are some 5,500 such registered cases in Ukraine, including survivors. Regrettably, in our country only half of children are cured compared to two out of three in Europe and the United States. The difference is explained by the lack of advanced technologies for the timely and accurate diagnosis and treatment. According to Hryhorii KLYMNIUK, Candidate of Medical Sciences, specialist in pediatric oncology at the Ministry of Health of Ukraine, and head of the Pediatric Oncology Department at the National Cancer Institute, if and when therapy can be practiced in Ukraine in accordance with the proper standards, it will be possible to cure almost all children. In the following interview, he tells about problems and prospects of treating ailing children, in particular at the department he is heading.

Dr. Klymniuk, what are the most pressing problems with pediatric oncology in Ukraine?

“In the past couple of years the children cancer problem has been addressed in a totally new way in Ukraine, after the adoption of the 2006-10 National Program “Pediatric Oncology.” This program was called into existence because of the inadmissibly low cancer treatment success rate. Prior to the launch of the program the children survival rate was 40 percent at the most. At that time, the leading children’s treatment centers, as well as those in the regionsn, were critically undersupplied with equipment. Practically everything was purchased by charities or parents, and the treatment remained expensive. In fact, we had reached a critical point.

“Thanks to the Pediatric Oncology Program, we started receiving funds. The program envisages 70 million hryvnias’ worth of annual budget appropriations. This amount has varied in various years, but some 40 million has been allocated for medications and the rest, for equipment. In two years’ time, we succeeded in completely supplying the children with cytostatic (anti-tumor) agents and by providing 60-70 percent of the required supportive drug therapy.

“This program has also partially provided for the required medical equipment at certain regional centers, Kyiv’s central specialized children’s hospital OKhMADYT, and our institute. In other words, things began to look up, the lethality rate among children less than one year old started to go down, while the recovery rate began to increase.

“We don’t have the 2008 statistics as yet, but we know that 47 percent of children recovered in 2007. And, of course, the financial burden on the parents has been lifted, partly owing to the involvement of charitable organizations. These organizations were established by parents who had gone through this hell. We are also constantly cared for by such foundations as Ukraine-3000, Rozvytok Ukrainy (Development of Ukraine), and Viktor Pinchuk’s charitable foundation, which supply us with fairly sophisticated equipment and medications we could never afford with budget money.

“At present, the problem is with our prospects because the budget envisages no allocations for equipment next year, and this applies to all cases, not just children. What makes things worse is that we didn’t purchase the linear accelerator, a device that performs high-quality and safe radiation therapy. Children need it badly. There are only two such accelerators in Ukraine, while the leading cancer treatment center has none.

“As far as medication supplies are concerned, they remain the same, for this clause in the subject is subject to no alterations and we expect to be adequately supplied this year. Yet if we don’t have the required equipment we won’t be able to adequately raise the diagnosing and monitoring level. In that case we can’t expect to fully meet the objectives of the Pediatric Oncology Program. Children will be dying, up to a hundred a year. Elsewhere in the world 60-70 percent of cancer-stricken children are cured so they can normally live the rest of their lives. Here in Ukraine, I’m repeating myself, it is 47 percent.

“If a country with limited resources undertakes to combat oncological diseases, the first place where the funds are channeled is pediatric oncology. Here the recovery percentage is high. These children grow up to become members of society. Next comes breast cancer, cervical carcinoma, stomach, lung cancer, and so on. All this requires expensive treatment and diagnostics. However, we are still optimistic, considering the kind of attention the state has paid to oncology in Ukraine in general. I mean the restructuring of this branch of medicine, the setting up of the National Cancer Institute, placing it under the jurisdiction of the Ministry of Health and replacing its administration, as well as President Viktor Yushchenko’s recent visit and granting our institute the national status.”

What are the current needs of your department?

“We need to open a new building because we don’t have enough room for patients. Children are crammed in with parents, with eight and ten children in a room. This increases the infection risk, what with chemotherapy that nearly kills the immune system. This, in turn, calls for more expensive treatment involving a larger amount of antibiotics and antiviral and antifungal agents. Between the chemotherapy sessions, children spend months and years undergoing courses of treatment at our department. Our protocols last for over a year with intervals of two-three weeks. This prolongs the course of treatment, with poorer results. New premises and equipment will allow us to adequately protect children against infection and themselves, eventually boosting the efficiency of treatment.”

Have you been receiving an increasing number of children in the past several years?

“No, the numbers are the same. We have more capacities than such departments at some other centers, so they are trying to send children to us, although there are several powerful children’s departments in Ukraine that are in the same league with us. True, our department is the only one with marrow transplant wards (we opened them last year and they are intended for patients with tumors in organs and tissues, not with blood diseases).”

Rozvytok Ukrainy Foundation is launching the program “Cancer is Curable.” Apparently you can count on its support.

“There is the 2006-10 national program. A large-scale 10-year program on oncology is pending parliament’s approval, if the Verkhovna Rada shows a stable performance. This program will embrace all of Ukraine. Of course, the state won’t be able to cover all of the required expenses. Rozvytok Ukrainy’s powerful program was formed alongside it in order to solve problems that cannot be solved by the central budget. Carrying out these programs will raise the diagnostics and treatment of oncological diseases to a higher level — and I mean both children and adults.”

You say that children are the priority in oncology. What would you recommend to the parents in terms of preventive measures? Is it possible to protect children from cancer in general?

“The best preventive measure is the expectant mother’s healthy lifestyle: no narcotics, no smoking, no alcohol, and no exposure to radiation. Cancer incidence in children does not depend on the environment. These malignant diseases are genetically determined and can develop in the intrauterine phase. This risk can be lowered somewhat by the pregnant woman’s proper conduct and diet.

“At the current technological level there is practically no way we can prevent cancer in children. Our task is to detect cancerous diseases at the earliest possible stage. This implies a complicated system, with parents paying more attention to their children and, when suspecting a tumor, promptly consulting physicians. A child with any kind of malignant tumor, if detected at an early stage, stands a chance of complete recovery. Even belatedly diagnosed tumors are cured in 80-100 percent of cases. Second, it takes qualified medical personnel. Third, it takes adequate diagnostic equipment, including computerized axial tomography, magnetic resonance imaging, and morphological labs. Children with cancer detected at an early stage are treated here using protocols practiced in the developed countries. Such children stand the biggest chance of recovery. Any medical examination of children must include oncological preventive examination. Experts know how to go about it. Tumors in children at an early stage are often mistaken for other diseases.”

How would you assess children cancer diagnostics and treatment in Ukraine, elsewhere in Europe, and in the United States?

“In terms of approaches and treatment as such, Ukraine, in general, differs little from most other countries. It lags behind in terms of hi-tech methods because we don’t have the kind of quality and precision equipment that other countries have, equipment that makes it possible to better monitor the disease and carry out a follow-up study. We don’t have the required morphological support to give us accurate morphological diagnosis. Nor do we have molecular genetics. We have just started working on it—and only in pediatric oncology.

“Let me mention radiation therapy again. It is not on the level it should be in Ukraine. In the European countries, estimates point to one linear accelerator per million residents. If so, how many accelerators should we have in Kyiv alone? We have two or three in all of Ukraine. I am very grateful to the charitable organizations that are helping us with funds. After all, every hryvnia spent this way has a direct or indirect effect on our children’s health.”

Renat Akhmetov’s Rozvytok Ukrainy Foundation told The Day that they are considering the setting up a radiation treatment section in the National Cancer Institute. The equipment to be purchased will include a modern linear accelerator and a positron emission tomograph (PET camera). This equipment is expected to be used in treating both children and adults.