Fight against cancer needs long-term strategy

Ukrainian doctors have long sounded the alarm about the steep increase in the numbers of cancer patients. All discussions about the causes, prevention, and treatment of cancer are only the first stage in the arduous and-if the government finally heeds the doctors-long-term efforts to fight cancer.

Every 50th Ukrainian (over 910,200 officially) suffers from this serious disease. But the worst thing is that 80 percent of cancer patients in Ukraine were diagnosed at a late stage in their illness, when it is very difficult to treat, and the percentage of those who are cured is low. According to oncologists, it is possible to cure cancer in 90 to 100 percent of cases at Stage 1, 70 to 80 percent at Stage 2, and 30 to 35 percent at Stage 3.

In Western Europe and the US people changed their attitudes to cancer a long time ago: the word “cancer” is no longer synonymous with “death” but with “treatment” — a long, expensive, and complicated cure that finally leads to full recovery. The public health system in developed countries is aimed at prevention and early detection. In contrast, Ukraine prefers to “put out local fires.”

315 MILLION DOLLARS FOR DIAGNOSTICS

In order to launch the system of early cancer detection, Rinat Akhmetov’s charitable foundation, Development of Ukraine, has donated $315 million for the purchase of expensive PET (positron emission tomography) scanners that diagnose diseases very precisely. PET centers with radiopharmaceuticals — producing laboratories will be set up soon in Donetsk, Lviv, and at the Kyiv-based National Cancer In­sti­tute. Ukraine has never had such computerized devices before, but they are commonly used in Western Europe and the US.

“This is one of the most high-profile charitable programs aimed at curing cancer. The state either does not purchase this kind of equipment, or does it very seldom,” said Anatolii Zabolotny, administrator of the Development of Ukraine Foundation.

“Unfortunately, nobody in Ukraine cares about long-term strategy, i.e., detecting and treating cancer at an early stage. There is nothing but a patchwork approach. Because our medical system has been in decline for almost 20 years, any innovation is a difficult process, but we are still going to adopt a systematic approach.

“We are tackling three problems at the same time. The first is to obtain information from national and foreign experts about the equipment we are dealing with, and what medical and other aspects should be taken into account to make the right decision. The second is to take advantage of the expertise offered by other countries, including the training of specialists. The third is to develop professional contacts between our doctors and leading foreign specialists.”

Mr. Zabolotny made these remarks at a conference attended by top oncologists from Ukraine, Germany, Poland, and Lithuania, who identified the companies that will take orders to produce medical equipment as part of the all-Ukrainian project “Cancer Is Curable: Timely Detection and Treatment of Oncological Diseases in Ukraine.”

“The receipt of these huge funds for the fight against cancer is an unprecedented event. The fact that the Ukrainian state underfunds medicine is having a disastrous effect on anti-cancer programs and, hence, our cancer patients. Rinat Akhmetov has been in contact with doctors, so he is very aware of the problem. He says that the worst thing is not so much the number of patients as inadequate diagnosis of diseases. This is why Ukraine badly needs PET scanners, a type of equipment that doctors have never even dreamed of using. PET is the gold standard not only in diagnosing cancer, but also in monitoring the course of this disease as well as cardiovascular and neurological ailments.

“There are 2,000 PET computers in the US, about 800 in all of Europe, and 18 in Paris alone, 15 in Moscow, but not a single one in Ukraine,” said Tetiana Bakhteieva, chairperson of the Parliamentary Public Health Committee.

The $315 million for PET scanners is only the beginning of a multi-million charitable project (215 million has been earmarked for Donbas, 50 million for Kyiv, and the same amount for western Ukraine). Some of the money will be used to purchase the CyberKnife cancer treatment system for the Donetsk Anti-Tumor Center, a painless, non-surgical method for treating tumors, including malignant ones. It may be used even in outpatient clinics and does not require traditional rehabilitation therapy.

SPECIALISTS TO UNDERGO PROFESSIONAL TRAINING

One of the problems facing the medical system in Ukraine is the lack of specialists who can handle state-of-the-art equipment. According to Zabolotny, there have been many cases in post-Soviet countries where expensive and effective equipment is either underutilized or not used at all because of the lack of specialists. For this reason, the Development of Ukraine Foundation is adopting an anticipatory approach: oncologists from Ukraine and Europe are now negotiating about training Ukrainian doctors.

“It is crucial to raise the educational level of health care specialists in Ukraine to the Western European level,” said Professor Lothar Schweigerer, the director of HELIOS, Germany’s largest pediatric clinic. “According to my information, Ukrainian doctors earn about 180 dollars a month, while his European counterparts earn around 800 euros.

“I also think only the best candidates should take up medicine. Once we have selected the best people, we must provide them with a good education by establishing an educational and specialization system approximately in the same way that this has been done in Europe or the US. I think education and staff training is a more important problem than purchasing state-of-the-art equipment because if no one can use a certain type of technology, it won’t be of any use.

“A PET scanner is a very good device, but it should complement basic hospital equipment, which should include computers and magnetic resonance tomography devices. The cancer cure rate in Europe has sharply risen in the past few decades to 70-80 percent. But we are always striving for improvement, so PET scanners are a necessity for every oncologist,” said Dr. Schweigerer.

Ms. Bakhteieva says that staffing is not a problem in Ukraine. “Our doctors can do everything, and I think one day others will be learning from us.” Under an agreement signed with some companies that have undertaken to supply medical equipment to Donetsk and Kyiv (Philips Medical Systems and GE Medical Systems SCS), foreign doctors will be hired to teach Ukrainian specialists.

The National Cancer Institute in Kyiv and specialized hospitals in Donetsk will admit their first patients only one year from now. According to Dr. Ihor Shchepotin, director of the National Cancer Institute and chief oncologist at the Ministry of Public Health, practical work will start “once we go through all the procedures. We have only taken the first step.” The next step is up to the designers and builders, who will draft plans for the new laboratories.

“I have instructed the National Cancer Institute that everything should begin functioning by the end of 2009 or early 2010. One of Mr. Akhmetov’s conditions is that all checkups should be accessible and free of charge. But I wouldn’t like to create the impression that we are greenhorns, who don’t understand how to use the equipment we are purchasing. It will be used for medical purposes only: the PET scanner is not so harmless as to be used for anyone who wants a diagnosis. But if you use these technologies for their designated purpose, they are invaluable,” Dr. Shchepotin explained.

Experts say that Ukraine is lagging behind Europe in terms of medical equipment, not in the quality of surgery. Oncologists are convinced that in one or two years, once PET technologies start to be used in Ukraine, there will be positive results, such as larger numbers of people who will recover from cancer.

The program created by Development of Ukraine is expected to spur the government into thinking hard about cancer treatment in the country because even such a generous benefactor as Akhmetov’s foundation will find it difficult to work systematically in conditions where this system simply does not exist.

“The Ukrainian state has honored the pledges it made with respect to the 2008 oncology program. But there is still a problem with the new program that the state has failed to adopt in the past two years. Red tape is the root cause: the previous government discussed, approved, and submitted a program to the Verkhovna Rada for approval, but after the last elections the Ministry of Finance said that it is not in a position to fund it.

“This is the dilemma: either the amount of funding must be reduced and the program brought in line with the given quota or a program that can really produce results must be created. This means reducing the mortality rate and increasing the number of cases where cancer is detected at an early stage. Unfortunately, the proposed government funding prevents us from fulfilling this task,” said Ukraine’s chief oncologist.

Thus, saving more lives through early detection of cancer is the main task of the state-sponsored anticancer program. At the moment, though, it is mostly charitable organizations, not the state, which are striving towards this goal. Ukraine’s public health system must find ways to improve the prevention and treatment of cancer. It would be ideal to join efforts, like the Akhmetov foundation is doing. This would mean that out of the 160,000 Ukrainians who are diagnosed with cancer every year, fewer than 90,000 would succumb to this disease.