ANDRIY BEZNOSENKO: How Cancer Treatment Is Changing in Ukraine

Photo: babel.ua

Andriy Beznosenko is the Chief Physician of the National Cancer Institute and an oncology expert for the Ministry of Health of Ukraine. He is one of the founders of the OncoHub project, which facilitates experience sharing among colleagues, as well as the public association «Ukrainian Clinical Oncology Union».

In an interview with Huxley, Andriy Beznosenko spoke about how the quarantine affected cancer treatment, how oncology is treated in Ukraine, and how successful the healthcare reform has been.

The conversation was conducted by Lana Synytska, a lawyer and partner at ARZINGER Law Firm.

ON THE IMPACT OF THE PANDEMIC ON CANCER CARE

he Cancer Institute was fortunate that the first waves of COVID-19 hit the United States and Western Europe first. We had two to three weeks to prepare and learn from the experience of our foreign colleagues.

Another advantage for Ukraine, paradoxical as it may seem, was the legacy of Soviet medicine. Because of it, the oncology service is separated from the general healthcare network, and 75% of patients receive treatment in cancer centers where coronavirus patients are not treated.

The biggest challenge was funding. While resources were allocated for COVID-19 treatment and vaccine procurement, no additional funding was provided for other areas, including oncology. We needed a lot of antiseptics, masks, and gloves, so some patient organizations and foundations urgently helped us.

We had only three cases where patients contracted the coronavirus during treatment. We isolated them and arranged transfers to other hospitals. All other patients who got COVID-19 contracted it outside the hospital, in everyday life. However, there is also tragic news: more than 100 staff members contracted the virus, and two of them died from complications.

In 2020, the Cancer Institute received 800 fewer patients than in 2019. This does not mean that malignant tumors became less common — it means that fewer cases were diagnosed due to lockdowns and fear of COVID-19. These diagnoses will be made this year, but at later stages, when patients will face more traumatic and less effective treatments.

ON COVID-19 VACCINES

As a doctor, I have two criteria when it comes to vaccination: effectiveness and safety. If Ukraine procures a vaccine that has successfully passed clinical trials and demonstrated over 70% effectiveness, my family and I will get vaccinated. If it is something like «Sputnik», then no.

Clinical trials for all three vaccines were conducted on healthy individuals. Two international organizations — the American and European oncology associations — have provided recommendations regarding the vaccination of cancer patients.

They state that doctors should be vaccinated first due to their high level of contact with people, while cancer patients should be vaccinated in the second wave. The only condition is that patients must be in remission, and at least six months must have passed since their last course of chemotherapy.

ON THE RESULTS OF THE HEALTHCARE REFORM

There was no win-win outcome in the healthcare reform. There was no active communication, no motivated chief physicians who would become local ambassadors of change.
There was no systematic increase in salaries: they still depend on the chief physicians. Some doctors officially earn 20,000–25,000 UAH, while others receive minimum wage despite handling the same patient flow.

In my opinion, the biggest problem of the healthcare reform is communication. A Facebook post or an interview on a top TV channel is meaningless. Doctors are too overwhelmed to track such information. It was necessary to visit medical institutions, ask questions, and provide explanations.

The second problem is speed. In civilized countries, systemic healthcare changes take decades. We went through in three years what others manage in ten. However, oncology funding has improved. Patients who were treated before 2015 and are now involved in advocacy through patient organizations can see the increase in available medications and the transformation of cancer centers.

Today, the state provides nearly 100% of basic chemotherapy drugs, whereas before it was only about 15%. Renovations, online consultations, electronic appointment systems — none of this existed five years ago.

ON THE MINISTRY OF HEALTH

The Cancer Institute is subordinate to the Ministry of Health. In the five years that I have served as Chief Physician, five ministers have changed — and I see this as the biggest problem. With some of them, we didn’t even have time to meet and define a further action plan.

In civilized countries, there are unwavering plans: priorities and personnel may change, but the goal remains clear. Here, everything can be canceled a week before the implementation of the second stage of healthcare reform. Because of this, the Cancer Institute receives conflicting messages and lacks a strategic plan that would provide clarity on where we should be by 2030.

ON NEW STAKEHOLDERS

We now have additional stakeholders in healthcare — the National Health Service of Ukraine and the state enterprise «Medical Procurement of Ukraine.» I believe they are no less important players than the Ministry itself.

Last year, «Medical Procurement of Ukraine» purchased targeted drugs for the treatment of kidney cancer for the first time. Prior to that, patients had been buying these medications out of their own pockets for 30 years, spending tens of thousands of hryvnias.

Thanks to the National Health Service, oncology institutions significantly increased their funding starting April 1, 2020. The treatment tariff for cancer is still lower than we would like, but even skeptics who opposed the reform of cancer centers have realized that they now have more resources.

ON STANDARDS IN ONCOLOGY

Currently, there is a Ministry order allowing the use of international protocols. It is a beautifully written document that, unfortunately, does not function in practice. National protocols take into account the specific healthcare structure, funding mechanisms, and disease incidence. International recommendations are called «recommendations» precisely because they are not mandatory for use.

The Cancer Institute has translated over fifty protocols from the European Society for Medical Oncology. They have been approved, but we have not adapted them because the Ministry’s order prohibits adaptation. Moreover, we lack the resources needed to fully implement these protocols.

Protocols and recommendations are a very dynamic process. For example, I specialize in colorectal cancer, and the standards in this field change every three months. We do not have the resources to translate 150–200 pages every time.

We have developed a national cancer control strategy for 2020–2030. One of its key points is to create Ukrainian standards and recommendations based on international protocols and evidence-based medicine. Our goal for this year is to approve 30 treatment standards for the most common oncological diseases, covering nearly 80% of patients.

International Short Story Competition «ODESSSIADA»

ON THE CAUSES OF CANCER

Cancer is not a disease of the 21st century. Manuscripts from Ancient Egypt contain information about malignant tumors. In absolute numbers, there are indeed more people with cancer today.

This is linked to the natural aging of the population: the longer people live, the more frequently they develop cancer. In Ukraine, the incidence rate is higher than in Africa, but that does not mean Africa has better healthcare — people there simply have a shorter life expectancy.

Moreover, cancer is always the result of genetic mutations. These can be associated with heredity, harmful habits, viruses, and negative environmental factors such as radiation and water quality.

Following the Chernobyl disaster in the late 1980s, thyroid cancer among young people became more common in Ukraine. Today, however, our incidence rate is lower compared to our closest neighbors — Hungarians, Romanians, and Bulgarians.

ON CANCER TREATMENT IN UKRAINE

Cancer is not a death sentence. Worldwide, the leading cause of death is cardiovascular disease. Oncology ranks second — and with a significant gap. If last year all attention hadn’t shifted to COVID-19, the biggest medical news would have been the decoding of the human tumor genome.

Medicine has advanced to the point where we can now prevent some types of cancer with 100% effectiveness. There are one million people living with this diagnosis in Ukraine, nearly 800,000 of whom are in remission. Most of them received treatment within Ukraine, proving that effective cancer treatment is possible here.

We have linear accelerators, nuclear medicine, and cyberknife technology — all available. Ukrainian patients have access to 98% of the cancer drugs available worldwide. As for innovative and patented molecules, most of them can be purchased privately.

Ukraine does not have proton therapy, but there are only a few such machines even in Europe, as they are used in exceptional cases. Where we lag behind developed countries is in service quality: no one wants to come to a facility with peeling walls and rude staff. And this is directly linked to a lack of resources.

ON EARLY DIAGNOSIS

Breast cancer and colorectal cancer account for about 20% of cancer cases in Ukraine. Unfortunately, every third patient comes to us at a late stage, unlike in Europe. We rank low in terms of cancer incidence but are among the highest in mortality rates because we lack a culture of healthy living and self-examination.

Since April 1, 2020, an early diagnosis calendar has been in effect, under which the state provides endoscopic examination methods, colonoscopy, gastroscopy, and mammography screening for women. Every two years, people over the age of 45 can undergo these examinations free of charge.

ON CHILDHOOD CANCER

Childhood cancer cannot be prevented — it can only be detected and treated. Unfortunately, the survival rate for children with tumors in Ukraine does not exceed 70%. In the United States, it is 90%, which is directly linked to resources, as treatment often lasts months or even years.

At our pediatric oncology department, there is even a school so that children do not miss their education. As a rule, the treatment is traumatic and often leads to disability, especially in cases involving brain surgeries or musculoskeletal operations with bone prosthetics. Children and their families need ongoing rehabilitation and psychological support.

For me, the treatment of childhood cancer is a litmus test — a measure of our humanity and modernity. If we do not invest enough resources into fighting childhood cancer, then there is little point in discussing the rest.

ON PALLIATIVE CARE

A year ago, the National Health Service of Ukraine signed 400 contracts for the provision of palliative and hospice care. Many people thought that 400 hospices had been established and that the system was fully operational.

It is indeed developing, but not at the desired pace: there is a shortage of personnel, largely due to inadequate wages, given the complexity of the work performed by specialists who care for terminally ill patients.

Today, there are private hospices and a growing palliative care movement. Even non-fiction literature on the subject has appeared. One person, who lived through the dramatic experience of a loved one’s battle with cancer, wrote a book titled Not a Scary Book at All. About Life, Death, and Everything in Between. I highly recommend reading it — it strikes directly at the heart.

ON ORGAN TRANSPLANTATION

The development of transplantation in Ukraine over the past year is an example of how small legislative changes and a good communication strategy can lead to coverage of a large number of patients. We have saved enormous amounts of money by performing transplants domestically instead of sending patients abroad. In oncology, transplantation is used only for hematological diseases — meaning bone marrow transplants, not organ transplants.

We began performing them back in 2017, even before any legislative changes, because doctors felt the need to do more. Since then, we have carried out 300 bone marrow transplants in children and 80 in adults.

I believe that the next stage of changes in the healthcare system will be the implementation of the national strategy for combating malignant tumors.

When copying materials, please place an active link to www.huxley.media