We are not afraid of any other disease as much as we are afraid of cancer. Despite this, the coronavirus pandemic has pushed the treatment of cancer patients into the background in the healthcare system. We talk about oncology in the shadow of the pandemic with Dr. Marcin Hetnal, medical director of the Amethyst Radiotherapy Center and head of the radiotherapy department at the hospital. L. Rydygier in Krakow. 

I have the impression that in the era of coronavirus, we have forgotten about another - more dangerous from the point of view of patients' health and life - epidemic of the XNUMXst century, the cancer epidemic.

Definitely yes. In the medical community, we are all aware that the coronavirus pandemic has largely disrupted the entire health care system. This does not only apply to oncology, many other specialties experience the same. During the pandemic, all diseases fell into the background. It began to seem to us that the main problem was COVID-19. Of course, I am far from downplaying the coronavirus, but every day - also during the pandemic - several hundred people are diagnosed with cancer in Poland.

And Covid and cancer are a combination that can have dramatic consequences for the patient...

Unfortunately yes. Oncology patients are at greater risk of severe disease and death due to COVID-19. It is estimated that the mortality rate for older people, especially those over 70 years of age, with the coexistence of cancer and COVID-19, is as high as 27%. Much more than in the case of chronic obstructive pulmonary disease (COPD), ischemic heart disease or asthma.

The situation in oncology is serious, not to say catastrophic.

Research shows that comparisons of cancer treatment results before and after the pandemic are poor. Many countries use mathematical models that, based on available data, allow us to assess how much the treatment results will deteriorate. We do not yet have such studies for Poland, but we can confirm this by analogy to those published for Great Britain. Well, it is estimated that the five-year survival rate in the UK has decreased for colorectal, breast and esophageal cancer. For colorectal cancer, 15% and for breast cancer approximately 10% additional deaths are predicted for 5 years, comparing it to the period before the pandemic. British cure rates have so far been better than ours in Poland, so we can expect at least similar declines.

Many people took the slogan "stay at home" too literally.

This was especially visible in the first months of the pandemic. At that time, the number of radiotherapy and chemotherapy administrations dropped significantly compared to the same months in previous years. Both at the Amethyst Radiotherapy Center and at the hospital. L. Rydygier, we recorded a significant decrease in the number of patients in April and May last year, which was an obvious result of the suspension of the functioning of many medical facilities and the fear of patients about the coronavirus. Official data shows that significantly fewer DILO (Diagnostics and Oncological Treatment) cards have been issued, which enable patients to use the fast track cancer treatment. Unfortunately, the pandemic meant that patients with already diagnosed cancer had major problems with carrying out further tests or their planned surgeries were postponed. Another part of the patients was not diagnosed at all because primary care clinics had been working mainly by telephone consultations since March. This could limit the detection of disturbing symptoms and delay diagnosis. To this should be added the fear of many people before visiting a clinic or hospital. People were afraid of getting infected with the coronavirus, so they postponed all contacts with health care. Fortunately, this situation has changed. Patients understood that cancer would not wait until the end of the pandemic.

And that earlier treatment is one of the factors that gives a chance for recovery.

It must be clearly stated that delaying the start of treatment increases the risk of death by up to several percent. Therapy started later is also longer and more burdensome. In the case of rapidly growing tumors, including: located around the head and neck, lungs, cervix, every day counts. Therefore, despite the ongoing pandemic, we did everything to ensure that the effectiveness of the entire course of oncological therapy remained unwavering. As Amethyst Radiotherapy Center and hospital. L. Rydygier, I think we are passing this exam, at least so far. We had to take over some patients from hospitals whose wards were transformed into Covid wards. We did not leave oncology patients to themselves even for a moment. The worst was last fall. At that time, as medical staff, we were not vaccinated yet. There were situations when, in the morning before the start of duty, we learned about the positive test results of several nurses and patients. It was a time of great strain, both physically and mentally.

When I talk to doctors, I hear more and more often about victims of teleconsultations that were supposed to be only for a moment, but have been there for over a year.

Teleconsultation has many advantages and allows patients to contact a doctor even if it is difficult to reach the clinic. However, they have their limitations and cannot replace direct contact. In the case of the Amethyst Radiotherapy Center, we provide teleconsultations mainly for patients who have already completed treatment and remain under the care of a radiotherapist for further observation. If, during the teleconsultation, the patient signals that something is bothering him, I immediately make an appointment for him in the office. Introduction of mass teleconsultations in specialized fields of medicine, including: such as oncology is highly inadvisable. Unfortunately, I can multiply examples of patients who came to me too late because of closed clinics and hospitals. The case of a young mother in her forties is particularly memorable. It was a patient from a neighboring province. She had lung cancer. For three months she fought for attention. First, to register with a doctor, then to have someone examine her. She came to me with brain metastases. Of course, she could have had them before, but, as we have already said, a quick diagnosis definitely increases the patient's chances of recovery. This patient told me about the hardship she had to go through to fight for her health and life. We did everything we could to help her. However, in tumors metastatic to the brain, the prognosis of patients is not optimistic...

Unfortunately, there are more such patients left to their own devices. Is it true that after a year of waiting, more patients now see doctors in an advanced stage of the disease?

Unfortunately, there are many examples of patients diagnosed too late and those who did not see a doctor on time.  That's why it was so important for us to maintain business continuity. Both at the Rydygiera Hospital and the Amethyst Radiotherapy Center, we recognized from the very beginning that oncology was a field that could not wait. I have seen various cases in my work. However, I have no doubt that now more patients in advanced stages of the disease come to us. In the initial months of the pandemic, the suspension of supplies of many pharmaceuticals used in chemotherapy was also a problem. Of course, we then implemented replacements. Unfortunately, these deficiencies in the case of some drugs have not yet been compensated.

 One million Poles live with cancer. Every year, the disease is diagnosed in over 160 people. people, and 100 thousand sick people die. Despite this, oncology has been struggling with a lack of doctors and insufficient financing for years, and the pandemic has highlighted these shortcomings even more.

For many years, oncology was neglected. There are not many people willing to pursue this specialization. This is a fascinating, modern field of medicine, but different from all others. It requires teamwork in a large center and is very mentally demanding. Most oncologists do not have the opportunity to additionally see patients in private offices. Even though oncological specializations have been on the list of priority specializations specified by the Ministry of Health for several years, there is still a shortage of young oncologists. They prefer to start specialization that is easier and less burdensome. I conduct classes with students myself. When I ask them about their choices regarding specialization, only 2-3 people per year declare their choice of oncology very initially. It's very little. For this situation to change for the better, a wise recovery plan and much greater financing are needed.

 

The text was published in the Senior Forum supplement, which can be viewed in its entirety here Dziennik_Polski_dodat_specjalny_1_21_04_2021

We can belong to various social groups, but we definitely do not want to have contact with this one (although quite large and still growing). It does not smell optimistic and does not bode well for the future. Oncology patient. Before the pandemic, such a business card sounded serious enough, but COVID sharpened and dominated everything. He enforced strict rules of the game in which the choices between fighting cancer and fighting the virus only seem to make no sense.

You can be a super hero individually. But together you can do much more. The Rydygier Hospital in Krakow and the neighboring Amethyst Radiotherapy Center understood this strategy long before the pandemic. An oncology patient who comes here (now, but also during the strict lockdown) is there from the very beginning taken care of. Comprehensive, specialized, innovative and multi-faceted. Humanly. And without wasting time, which is the most expensive currency in cancer cases.

Artur Asztabski – President of the Specialist Hospital. Ludwik Rydygier in Krakow:
“We decided on a unique solution throughout the country, because only close cooperation between hospital oncology departments and a modern Radiotherapy Center allows for very careful management of the patient. We have already become accustomed to the slogan: "cancer is not a death sentence", but somehow it is difficult for us to get used to the idea that we have modern oncological therapy in Krakow and Małopolska and that it is available without any conditions to every patient who receives a diagnosis of "cancer". At such a moment, the world falls apart for the patient and his family. But I want to say clearly - Rydygier has everything that is most important for such patients: experienced oncologists, modern equipment, proven medical procedures and comprehensive therapy. And we do not send patients to further stages of treatment elsewhere in the world. Everything - from the first consultation of specialists determining the treatment plan, through in-depth diagnostics, therapy, surgery, chemotherapy, to the most modern radiotherapy, is available at one address: os. Złota Jesienia 1 in Krakow.

 Przemysław Zachwieja – President of the Amethyst Radiotherapy Center in Krakow
“It's true, we work together and this gives us not so much an advantage (though probably that too!) but a priceless value for the patient. Amethyst is part of an international network specializing in oncological therapies, mainly radiotherapy, but above all, we are a place of an extremely peculiar encounter: the helplessness that is always visible on the faces of new patients with the power of science and technology, which is entrusted to them in dedicated therapies. Everything is decided in just 2 weeks. This is how long it takes for diagnostics, analysis of possible solutions, decisions made by medical councils and a series of conversations with patients. Because the patient must have full knowledge of both the benefits and possible risks. Then we start fighting together. What counts here is not only modern equipment but, above all, the knowledge of the entire team focused on helping the patient: doctors, physicists, technicians, nurses and people responsible for patient service and coordination. We make sure to apply the highest standards of care at every stage of treatment. Give an example? During radiotherapy, we organize and finance transport to our Center for outpatients treated on an outpatient basis. We deliver patients from all over Małopolska. Free 24-hour nursing care is also available to patients in the free hotel. Yes, this may be surprising... But we assume that the prescribed therapeutic cycle cannot be interrupted by the patient's difficult financial situation or family problems. He must focus on the fight for life, not on the dilemma of how to get to Nowa Huta for radiation treatment.

Rydygier and Amethyst not only share a common address in Nowa Huta. Most often, they also have a common patient who is diagnosed with "cancer" and undergoes comprehensive therapy. Also during the difficult time of the pandemic. According to the statistics of the Małopolska Branch of the National Health Fund, it is the Specialist Hospital. Ludwik Rydygier in Krakow is occupied first position 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.

The hospital's strong position is confirmed by recent awards: Krakow's Rydygier, according to the prestigious World's Best Hospitals 2021 ranking, which assessed 2021 medical facilities from 2 countries around the world, turned out to be the 25rd best hospital in Poland! This is a valuable achievement, although the Alivia Foundation 3 ranking is also important, in which the patients themselves compared the quality of services and the level of oncological care provided in 2021 Polish hospitals where cancer patients are treated. These are usually very objective and critical assessments... and yet! Oncology patients gave the first place nationwide to the Rydygier Hospital in Krakow. The successes include the third place in the "Safe Hospital of the Future" competition, awarded a month ago for the implementation of minimally invasive oncological surgery. Regardless of the rankings, the experience of a specific specialist and his empathy towards patients will always remain the most important asset. The brutal "I'm checking" in this context was said during the pandemic. But then, neither in Rydygier nor in Amethyst did anyone slow down. It's the same today.

Prof. Andrzej Budzyński, Head of the Department of General and Oncological Surgery at Rydygier Hospital.

"During the lockdown, we had to refer scheduled non-oncology patients, but oncology continued
in the hospital in full swing. This is not surprising, cancer does not wait for safer times. Our multidisciplinary consultations, where each patient receives an individual therapy path, were held with the same frequency of 10 meetings a week, even during a complete lockdown. Monthly, this meant 800 patients included in specialized therapy. We run two comprehensive oncology programs - one for patients with breast cancer and another for patients with colorectal cancer; I have the first one in Małopolska launched in my branch Colorectal Cancer Competence Center. So how could we look all these people in the eye and say "let's wait for the pandemic to ease"? “Every day has a different conversion rate for us.”

Next door, at the Amethyst Radiotherapy Center - where, after advanced surgical, laparoscopic or endoscopic procedures, patients of Prof. also go to the next stage of treatment. Budzyński - the situation is almost identical. Amethyst operated at full capacity throughout the pandemic, although it should be noted that the growing number of patients required the implementation of new projects. An initial, but very important part of the treatment process was transferred online and these were mainly educational teleconsultations, preparing patients for the remaining stages of radiotherapy, as well as consultations and teleconsultations. For maximum patient safety, Amethyst has acquired a UVD Robot - the most modern device for disinfection and decontamination of rooms (only 8 centers in Poland have identical equipment), which eliminates 10% of bacteria, viruses and fungi in rooms such as patient rooms or wards in just 99,99 minutes. operational.

Marcin Hetnał, MD, PhD, Head of the Radiotherapy Department of the Rydygiera Hospital and Medical Director of the Amethyst Radiotherapy Center:
“Approximately 170 patients undergo therapy at Amethysta every day; in pandemic In 2020, over 2900 patients completed the full course of treatment with us. This proves that patients simply trusted us. They saw that despite the threat of COVID  zwe do everything to maintain the efficiency and effectiveness of therapeutic cycles. Any delay in the start of treatment increases both the risk of death and the burdensomeness of subsequent therapy. When it comes to rapidly growing cancers around the head, neck, lungs or cervix, every day is important. Therefore, for greater patient safety while maintaining precise radiation doses, we have introduced shorter therapy cycles. And just a week ago, one more thing - system for positioning and monitoring the patient's position
during radiotherapy, enabling the maximum safe administration of high doses of radiation. Even if the patient moves, the system will interrupt the therapeutic beam and the staff will immediately correct the position so that the dose of rays reaches the designated place. AlignRT (VisionRT) is actually the latest medical technology, available to patients from Krakow and Małopolska from September. No queues and under National Health Fund insurance.”

Against the spread fake news and negative stereotypes, this last piece of information is particularly important. Therefore, it is worth reminding - every insured patient diagnosed with cancer at the Rydygiera Hospital and the Amethyst Radiotherapy Center is treated free of charge! They can use the Fast Oncology Path (DILO), which is implemented at the Rydygiera Hospital as part of the Oncology Package of the Ministry of Health and allows for highly specialized diagnostics of patients in the field of cancers of the gastrointestinal tract, head and neck, skin, breasts, lungs, brain, urology, gynecology, hematology and musculoskeletal systems.

Due to its multi-profile nature, the hospital is able to cover every stage of the diagnostic path, both in outpatient and inpatient treatment. The Departments of General Surgery, Oncology, Radiotherapy, Oncology and Hematology employ an experienced nursing team and a total of 95 doctors, half of whom specialize in oncology. This also allows for the development of the educational activities of the hospital, which is a training base for other facilities in the region. On the initiative of the Marshal of Małopolska, Witold Kozłowski, the Rydygiera Hospital actively participates in the project of the Consortium "Oncology Małopolska".

The Amethyst Radiotherapy Center (connected to Rydygier by a small internal corridor) employs almost 100 people, including high-class doctors, medical physicists, technicians and nurses (most of them with specialized training in Poland and abroad), without whom even the most advanced medical equipment could prove ineffective. useless. The center cooperates with AGH and leading international medical centers specializing in the latest oncological therapies, especially radiotherapy. Each patient who is referred for therapy here in the process of oncological treatment, after approximately 2 weeks of extended diagnostics and preparation, begins the first cycles of radiation.

The entire oncology supplement to Gazeta Krakowska and Dziennik Polski can be read here  Dziennik_Polski_dodat_specjalny_1_27_10_2021

The association "AMAZONEK" and people with cancer in Zgorzelec is collecting signatures for a petition to the president of the National Health Fund and the Minister of Health to enable the operation of the newly built radiotherapy center there. Over 8,3 thousand people have already expressed their support. people.

The stalemate situation of the newly established Amethyst Radiotherapy Center in Zgorzelec continues - the National Health Fund still does not agree to sign a contract for the provision of medical services. Cancer patients and their families started collecting signatures for a petition to the National Health Fund. The authorities of Zgorzelec, as well as the city and commune of Bogatynia, as well as various organizations operating in the area, also joined the initiative - the petition can be signed, among others: at the Customer Service Point of the Zgorzelec Municipal Office, at the City and Commune Office in Bogatynia and with volunteers. It is also available online at Petycjeonline.com. Local media also write about the action.

Currently, a total of 17.10.2018 people have signed the petition (as of October 8319, 7,5). The vast majority, almost 800 thousand. participants of the campaign, decided to sign the paper lists in person, but the initiative was also supported by over XNUMX Internet users from all over Poland. The collection of signatures is still ongoing - you can sign it online here.

Five resident doctors are preparing for specialization at the Amethyst Radiotherapy Center. This is a response to the growing shortage of doctors in Poland.

There are 160 cases reported annually in Poland. new cancer cases. Meanwhile, the shortage of specialized doctors is growing. There are only about 600 radiation oncology specialists practicing in Poland.

The Krakow Amethyst Radiotherapy Center is currently the only non-public center offering postgraduate training for doctors. At the Krakow facility, they take care of patients under the supervision of more experienced colleagues, learn to cooperate with medical physicists, and learn about the latest technologies used in radiotherapy and combined treatment. And in two years, fourth-year medical students of the Krakow Academy. Andrzej Frycz Modrzewski will participate in classes prepared by the medical team of the Amethyst Radiotherapy Center.

September 15 is European Prostate Day, which was announced to remind people about prevention, perform check-ups and promote knowledge about this disease. Prostate cancer is currently the cause of nearly 10 percent. deaths among men.

Globally, prostate cancer is the second most common cancer. Deaths due to prostate cancer are recorded as the sixth cause of all deaths due to malignant diseases. It is estimated that 899 men worldwide are diagnosed with prostate cancer each year, and the number of deaths reaches 000 cases. By 258, these numbers may increase to 000 diagnosed cases and 2030 deaths, mainly due to the increasing average life expectancy.

Prostate cancer may be asymptomatic, and its early detection gives a good chance of cure. Therefore, for men over 50, check-ups with a primary care physician or a urologist are important. Determining the PSA level and a transrectal manual examination performed by a doctor are usually a sufficient test to determine the risk of cancer.

The basic treatment for prostate cancer is surgical removal of the tumor, now increasingly used in combination with radiotherapy and hormone therapy. However, many patients are afraid of complications related to surgery. The Amethyst Radiotherapy Center uses brachytherapy, which can be an alternative to surgery in many cases. Brachytherapy is a type of radiation therapy in which a radiation source is placed directly into the cancerous lesion. This is done by installing special applicators.

Advantages of using brachytherapy in the treatment of prostate cancer:

1. possibility of administering a high dose of radiation directly to the prostate gland,
2. due to the rapid dose drop outside the radiation source (except for the applicators), a minimal dose of radiation reaches healthy tissues outside the prostate gland,
3. short treatment time compared to teleradiotherapy,
4. treatment that is better tolerated from the patient's point of view compared to radical prostatectomy (surgical excision),
5. high treatment effectiveness due to the biological features of prostate cancer (characterized by a low alpha/beta ratio, which means that we expect the best treatment results when using high fractional doses, such as in brachytherapy),
6. high treatment effectiveness compared to other treatment methods, lower rate of impotence and urinary incontinence as complications after therapy compared to other methods.