Andrey Chernichenko, Doctor of Medical Sciences, Professor, President of RATRO

In Russia, 300 thousand patients die from cancer every year, but until recently there was no strategic plan for the development of radiation therapy. For comparison: 30-35 thousand people die on Russian roads every year, and the state is concerned about this fact, increasing fines and toughening punishments.

Actually, today a malignant tumor is not a sentence, but only a diagnosis. Diagnosis of a serious but treatable disease - also thanks to the development of radiotherapy. At stages I - II of the tumor process, the five-year relapse-free survival rate is 80-90%. But in Russia, in 60% of cases, cancer was diagnosed at stages III - IV, when hopes for a quick cure were practically lost. Every year, about 200 thousand cancer patients are recognized as disabled, and 40% of them are of working age.

In the United States, there is one linear accelerator for every 70 thousand population, and what is even more important, the level of equipment of the oncology center does not depend on geography - whether it is Alaska or the outskirts of Washington, the patient can always count on timely and qualified radiation care.

In Russia, until recently, the ratio looked like this: 1.42 million people per unit of equipment. And to make matters worse, modern accelerators were concentrated mainly in research institutes and large cancer centers. The results of treatment in these institutions are comparable to world statistics - and in most regions the effectiveness of radiotherapy differs by more than an order of magnitude.

The radiation fund of peripheral institutions consists of worn-out and outdated equipment. 80% of remote radiotherapy devices date back to the 1960-1970s and have long since expired. The error in dispensing doses on worn-out devices reaches 30%. Under-irradiation of the tumor leads to relapse, and over-irradiation leads to the development of severe radiation complications. Inadequate use has discredited radiation therapy methods in Russia.

In 2006, the Russian Association of Therapeutic Radiation Oncologists (RATRO) began developing a program for the development of radiotherapy services. According to the most conservative estimates, 300 billion rubles were required to equip Russia with modern equipment.

The national oncology program consists of two main parts. The first, most significant, is organizational: strengthening primary care and creating a vertical of oncological power, patient routing in each specific region, developing treatment standards, regulatory documents, personnel training, etc. The second is the technical re-equipment of oncology dispensaries and federal cancer centers.

The program had opponents, and not only among financial officials. “How can you buy equipment if there is no one to work on it,” colleagues were indignant. But the majority of oncologists are confident: the training of personnel and the creation of the necessary base must develop in parallel - plus the training of teaching staff abroad, the integration of foreign experience, and the creation of appropriate departments in medical institutes. (The first department was already opened in May of this year - at the Sechenov First Medical University on the basis of the Herzen Moscow Scientific Research Institute.)

And the program was adopted by the government in March 2009 (resolution N189). Its undoubted advantage is funding from two sources at once: state and regional. Acting as both a customer and an investor, the regions are more responsible when it comes to choosing equipment, and the state, seeing local interest and control, can more easily part with budget rubles.

The first positive results include equipping more than 30 oncology clinics in the country with the most modern equipment. In 2009-2010, 12.672 billion rubles were spent on equipping 21 regions of Russia with modern equipment. In 2011, it is planned that another 14 regions will receive the necessary equipment.

So far, there are no manufacturers of accelerators and other complex equipment in Russia, so there is no market for service support. All equipment comes and will come from abroad, but where and how the imported devices will undergo technical inspection is a question. If the device breaks down, it will take a lot of time to transport the required part, go through customs, and so on.

For the first time in the Russian oncology program, considerable funds will be focused on the early detection of cancer. A regular therapist in a regular examination room can detect a tumor and make a diagnosis. But until recently, non-oncologists did not have oncological alertness. To reverse the sad statistics, it is planned to open primary oncology rooms in every medical institution. In some regions, therapists already receive cash bonuses for detecting cancer in the early stages.

Thanks to the active work of representatives of RATRO and the Association of Oncologists of Russia, orders of the Ministry of Health and Social Development were signed on the procedure for providing medical care to cancer patients; for the first time in Russian history, a new medical specialty “radiotherapy” appeared, as well as the positions of a medical physicist and equipment operation engineer.

All this is just the beginning of the creation of a fundamentally new oncological and radiological service in Russia that meets international standards; there is still a long and difficult path ahead to overcome the more than 30-year backlog. But in 20 years, Russia will be able to significantly improve the quality of medical radiological care for patients in all regions, which will, in particular, reduce mortality from severe diseases by 30%. It will also increase the efficiency of using expensive radiological equipment and the return on investment from its acquisition by 8-10 times.

Recorded by Olga Demyanova

Russia has to overcome a 30-year lag in oncological and radiotherapy