ACCESS TO OPTIMAL TREATMENT IS OUR PRIORITY – INTERVIEW WITH DR. N. MED. MARCIN HETNAŁ
Doctor, the last two years have been quite difficult for oncology. First the COVID-19 pandemic, now the influx of patients from Ukraine seeking help. How does our oncology deal with these challenges? (in a broad context)
It seems quite good considering the current situation. However, we must know that Polish oncology is in a state of constant shortage of staff and full-profile oncology centers. The two aspects you mentioned (first the COVID-19 pandemic, now the influx of patients seeking help from Ukraine - editor's note) have caused an even greater burden on the system, as well as a burden on the employees themselves. Over the last period, the inflow of patients has been increasing. In some periods of the pandemic, the decline in patients seeking diagnosis and treatment, limited access to family doctors and specialists, and finally the increased mortality rate due to COVID infection in oncology patients probably translated into worsening cancer treatment results in Poland - especially if we are talking about the pandemic period. Statistics from studies conducted in Great Britain indicate that the results of cancer treatment could worsen by 10-15% in the perspective of 5-year survival. The most common problems we encounter when serving Ukrainian patients are: incomplete or missing medical documentation, lack of document translations, or the choice of a treatment facility that is inadequate to their health needs. Sometimes patients come to us who require completely different methods of treatment or management, in such cases we refer patients to other hospital departments or centers.
And looking through the prism of your center - how are you coping in these difficult times? Can all patients feel properly cared for and have access to optimal treatment?
What you are asking about is always our priority, regardless of whether it is a time of peace or the situation we are currently dealing with. We are doing quite well, although, as I mentioned earlier, staff shortages are slowly becoming visible and felt. In fact, from the very beginning, and more precisely from the moment the National Health Fund announced its readiness to provide full medical care to refugees from Ukraine, we have been accepting these patients at the Amethyst Radiotherapy Center and they can start or continue oncological treatment with us. These are people at very different stages of advancement and at different stages of treatment. During the visit, we also offer the support of a translator, which enables appropriate mutual communication between the doctor and the patient. What is important and important to emphasize is that all patients have one queue. A patient from Poland and a patient from Ukraine are qualified for treatment under the same conditions and principles.
Amethyst Radiotherapy Center thanks to cooperation with the Multispecialty Hospital. L. Rydygiera in Krakow offers patients - in one place - the so-called combined treatment. What does it involve and what is the value of such behavior?
We have 3 main methods of treating cancer: surgical treatment, systemic treatment, radiotherapy. Combining these different cancer treatments is called combination treatment. In many cases, combined treatment significantly improves the results, but because it is sometimes more toxic, it also requires supportive treatment. This type of treatment of cancer patients is currently, and has been for 20-30 years, a global standard. This approach, by proposing and implementing optimal treatment measures, gives measurable, positive effects. And most importantly, the patient does not have to take care of the components of the procedure himself, because it is prepared at the very beginning by the consultant. And then consistently implemented. Of course, modifications and changes may occur during treatment.
Rydygier and Amethyst not only share a common address in Krakow. Most often, they also have a common patient who is diagnosed with "cancer" and undergoes comprehensive therapy. As indicated by the statistics of the Małopolska Branch of the National Health Fund, it is the Specialist Hospital. Ludwik Rydygiera in Kraków took first place compared to all other healthcare providers from Małopolska who provided oncological treatment as part of hospital and outpatient admissions throughout the entire pandemic year of 2020. These statistics are hardly surprising; Rydygier with 8 departments that provide oncology packages, chemotherapy and 39 drug programs dedicated to specific cancers; with 15 Specialist Clinics, available to patients as part of the so-called Fast Path Oncology, as well as with its own extensive endoscopic and imaging diagnostics, nuclear medicine tests and 6 preventive programs (including prevention of breast cancer, cervical cancer and colorectal cancer), is becoming a new oncology center in Krakow and Małopolska.
Your specialization is primarily radiotherapy. How do you see the current place and role of radiotherapy in cancer treatment?
Radiotherapy is one of five oncological specialties (oncological surgery, clinical oncology, hematology, gynecological oncology and radiotherapy). Radiotherapy is used in approximately 60-70 percent of cases. oncology patients. And it generates relatively low costs compared to other specialties. The costs of radiotherapy constitute only 6% of the costs of cancer treatment. if we refer to the entire systemic care of an oncological patient.
At what stages of cancer and in which diseases is radiation used? What is the purpose of such treatment?
Radiotherapy is a local treatment, just like surgery. Surgery uses a knife and a scalpel, we use electromagnetic radiation - high-energy photons. The goal is exactly the same in both cases, which is to prevent the cancer from developing further; we want to cause the necrosis of cancer cells, sparing healthy tissue. Radiotherapy is used in the vast majority of oncological diseases. It is a treatment that is becoming more and more precise and, in some cases, very effective in its effectiveness.
Is there still a chance for further progress and improvement of irradiation techniques in radiation treatment, and thus for an increase in the effectiveness of treatment? What is the future of radiotherapy in your opinion? Even more precision?
I would draw attention to two basic points. Increasing precision of treatment, including reducing the number of complications after procedures and combining radiotherapy with systemic treatment, especially immunotherapy. In my opinion and perspective, immunotherapy has a great future in oncological treatment. This is a form of systemic treatment in which the treatment stimulates the body's own immune system to fight cancer. The results here are very promising, even spectacular. The undoubted advantage of cancer immunotherapy is the favorable ratio of therapeutic benefits to toxicity. Immunological treatment stimulates our immune system cells to fight cancer cells. Of course, it is not the case that immunotherapy solves all oncological problems once and for all. Like radiotherapy or any other treatment method, it is never a zero-sum situation, meaning that either you have 100 percent. cures or not at all. But there is visible very significant progress in this field. A few years ago it was announced that oncological immunotherapy would dominate the treatment of cancer diseases and in the future it may be used to treat even every second cancer. This is a breakthrough. By adding radiotherapy to immunotherapy - both methods stimulate each other, which is a phenomenal phenomenon from the point of view of medicine. Let us remember that in the past 25% of people experienced cancer. there are now forty-something people in Poland, which is still one of the worst results in Europe. But I would like to emphasize that this is still not a treatment that is applicable to most cancer patients, although the list of indications is gradually expanding.
Are any new products in this area also available in your center? What equipment do you have at your disposal in Krakow and is the treatment reimbursed by the National Health Fund?
Amethyst is equipped with accelerators from Elekta, one of the two global leaders in the production of such specialized medical equipment. The center performs highly specialized radiotherapy procedures, including: stereotactic radiotherapy, IMRT (Intensity Modulated Radiotherapy), dynamic techniques such as VMAT, which significantly increases the effectiveness of the therapy, shortens its time and reduces side effects. Accelerators precisely modulate the radiation beam, which allows it to be maximally focused in the area of the lesion and protect healthy tissues. Medical services provided in Amethyst Radiotherapy Center in Krakow are reimbursed by the National Health Fund.
