MIL OSI Translation. Region: Russian Federation –
The new standard of care allows you to reduce the time of making a diagnosis, increase its accuracy and prescribe therapy taking into account all the characteristics of the patient.
Moscow was able to increase the volume of specialized oncological care by more than 40 percent in 2020. Sergei Sobyanin told about this during a visit to the center of pathological diagnostics and molecular genetics of the city clinical oncological hospital No. 1, which is located on Zagorodnoye highway (house 18a).
“Moscow health care, despite the problems associated with the pandemic, throughout this period of time did not reduce the volume of planned assistance. And one of the most important areas is cancer care. During this period, we not only did not reduce, but increased the volume of oncological care, in particular, chemotherapy, radiation therapy, ”said the Moscow Mayor.
According to him, this became possible thanks to the new standard of work of specialized clinics. “In recent years, we have created six powerful oncological centers that carry out dispensary records, perform surgical interventions, and, most importantly, they have powerful pathomorphological laboratories that allow us to accurately diagnose the disease, accurately determine targeted therapy and dosage for each patient,” added Sergei Sobyanin.
For eight months of this year, 222 thousand hospitalizations of patients with cancer were carried out for treatment in round-the-clock and day hospitals. This is 42 percent more than in the same period in 2019. The number of courses of radiation therapy increased by 21 percent (from 5.3 to 6.4 thousand), and chemotherapy – by 51 percent (from 109 thousand to 164 thousand).
Today, modern immune and targeted drug therapy is provided to patients with six types of cancer: breast, prostate, kidney, rectal (colorectal), bronchial (lung) and melanoma. They account for about 80 percent of all cases of cancer.
The improvement in the quality of cancer treatment was ensured by the introduction of a new standard of oncological care. On the basis of the largest city hospitals – GKB No. 57 named after D.D. Pletnev, Moscow Clinical Scientific Center (MKSC) named after A.S. Loginov, MGOB No. 62, State Clinical Hospital named after S.P. Botkin, GKB No. 40 and GKOB No. 1 – six multidisciplinary oncological centers were organized. They have a full range of clinical capabilities – they carry out diagnostics, surgical treatment, drug therapy, and dispensary observation.
Each center has a population of one or two Moscow districts. Thus, specialized care at all stages – examination, treatment and dispensary observation of patients – is carried out in the structure of one medical organization. This approach allows you to shorten the time of making a diagnosis, increase its accuracy and start treatment faster. To prescribe therapy, taking into account all the individual characteristics of the patient’s body, a modern pathomorphological laboratory operates in each oncology center.
Thanks to the new standard, the average duration of research has been significantly reduced – more than 70 percent of patients are diagnosed earlier than it is determined by the terms established by state standards and programs, said Nikita Savelov, chief freelance specialist. Moscow Department of Healthon pathological anatomy in oncology. “All these studies can be performed in six supporting oncological hospitals, and the patient does not need to go anywhere to pass the material, and all this is done absolutely within the framework of the compulsory medical insurance,” added Nikita Savelov.
He stressed that all six cancer centers and their laboratories follow a single standard. “We have launched a huge program of digitalization of pathological anatomy, which we plan to complete next year, as a result, a single digital platform will be created,” Nikita Savelov said. – Descriptions of all cases of the disease will be digitized and entered into a single database, and it will not be necessary to have a full set of specialists in each institution. If lung cancer specialists are concentrated in one institution, they take these descriptions from the system with complete clinical information (CT, MRI, access to all examinations) and conduct qualified diagnostics, in another – breast cancer specialists, they take case descriptions from the system their profile. That is, there will be a single digital circuit. ” According to Nikita Savelov, among other things, new technologies can reduce the number of personnel by automating many processes.
A large-scale refurbishment of six multidisciplinary cancer centers was carried out in 2019-2020. In total, more than 300 units of medical devices were purchased. Today, doctors and laboratory assistants have at their disposal such high-performance modern devices as:
– automatic immunostainer Ventana Benchmark XT with accessories, station of immunohistochemical staining Autostainer Link 48. These are automated systems for carrying out immunohistochemical reactions. When examining tumor tissues, one can find out not only about the benignity or malignancy of the tumor, but also determine (if the tumor is cancerous) its histological type, which affects the choice of treatment methods;
– a doctor’s table with the ePath software and hardware complex for working with autopsy material, which allows macro- and microscopic recording of clippings, digitizing and archiving images. Unique design protects the pathologist from biological fluids, cutting aerosols and microorganisms
– automated workstation of a medical worker Acer Veriton Z4820G, DQ. VNAER.075, Zebra ZD620t-HC label printer, AutoWrite Next Cassette Printer for histological cassettes with accessories, which allows each biosample to be assigned a unique number and control sample routing, providing electronic document flow;
– cryoconsole Tissue-Tek TEC 5 CC, which allows deep freezing of tissues for preparation of a section and effectively eliminate pathological foci. The technique is successfully applied for research, as well as during operations;
– apparatus for packaging biological samples Tissue Safe. It packs the histological material in a vacuum to transport fresh specimens from the operating room to the laboratory;
– microscopes: scanning for laboratory research Pannoramic Midi, biomedical Nikon Eclipse Ci, biological for laboratory research Axio Imager.A2 with a system for optical analysis of tissues, cells, chromosomes. They allow you to see a micro-object by scanning its surface.
Re-equipment of morphological and genetic laboratories made it possible to increase the accuracy of diagnosis and definition of treatment methods, including targeted drug therapy. Modern devices help specialists to determine the nature of a tumor cell and choose the right treatment, in which the tumor is perceived as a target and only it is affected, and neighboring healthy cells remain unaffected.
Thanks to the increase in equipment productivity, the number of immunohistological studies in 2020 increased by five percent (up to 85.4 thousand), molecular genetic studies – by 73 percent (up to 8.6 thousand), and histological studies – by 23 percent (up to 598 thousand) …
The use of the polymerase chain reaction (PCR) technique in real time makes it possible to determine key mutations in genes in non-small cell lung cancer, bowel cancer, breast and ovarian tumors, and metastatic melanoma – to prescribe targeted therapy and determine the predisposition to diseases. As a result, the time for making a diagnosis and prescribing treatment for patients was significantly reduced, therefore, the prognosis of the course of the disease and the quality of life improved.
In addition, the re-equipment of laboratories made it possible to reduce the time for conducting pathomorphological studies, significantly increase the efficiency of diagnostics and treatment of oncological diseases, automate the process of processing diagnostic material as much as possible, digitize images with the possibility of archiving them, conduct consultations on complex and controversial cases with experts from six basic oncological hospitals. as well as provide consultations to doctors from other regions and exchange experience with colleagues from Europe and the United States.
“We have also reached the federal standards laid down in the federal law on the prescription of chemotherapy according to a single principle, on the prescription of certain drugs. These are great opportunities not only to spend money and overfeed patients with pills, but to accurately determine the diagnosis and dosage. Then there will be an effect, ”said Sergei Sobyanin.
According to Nikita Savelov, Moscow healthcare can now completely independently resolve issues related to the treatment of cancer patients. “We have a different problem now. Since we can do all this here, on board, federal centers are already complaining that we do not send patients to them. And we have no need for this. We in six centers are able to do everything now, ”he added.
Center for Pathomorphological Diagnostics and Molecular Genetics
One of the six new laboratories – the center of pathological diagnostics and molecular genetics – was created in the city clinical oncological hospital No. 1. In a two-story building built in 2005, an updated pathological department, a genetics laboratory, a cytological laboratory and a clinical base of the Department of Pathological Anatomy of the Russian Medical Academy of Continuous Professional education. The total area of the center is 3.5 thousand square meters.
In 2019–2020, 32 units of modern equipment were delivered to the center, which made it possible to significantly increase the laboratory’s capacity. Before that, biomaterials of 12 thousand patients were examined here a year, and now more than 20 thousand.
More than 150 thousand studies are carried out in the laboratory annually. Among them are morphological, immunohistochemical and molecular genetic studies for the diagnosis of precancerous conditions and various tumors, as well as for determining the sensitivity to chemotherapy and targeted therapy.
Laboratory assistants can make about 400 immunohistochemical slides per day – before that, with the manual method, they made about 60 slides in two working shifts.
The center employs 22 doctors (including two doctors of medical sciences and two candidates of medical sciences), 16 nursing staff and four nursing staff.
The oldest cancer hospital in Moscow
City Clinical Oncological Hospital No. 1 is one of the oldest specialized Moscow clinics. In 1946, on the territory of the present Basmanny District, an oncological hospital was organized, which became the main oncological institution in Moscow (oncological dispensary No. 1). Outstanding oncologists Samuil Lvovich Mints, Boris Vasilievich Petrovsky, Yuri Yakovlevich Gritsman and others worked here. In November 2018, the institution was renamed the City Clinical Oncological Hospital No. 1.
Now the medical facility has 270 beds. Here they provide assistance in the main areas of oncological profile: oncogynecology, treatment of skin cancer, breast, esophagus, stomach, liver, pancreas, small and large intestine, lungs and mediastinum (organs located in the pleural region).
The hospital performs unique operations on patients with one of the most severe forms of oncological diseases – head and neck tumors, followed by reconstruction of the facial skeleton, which is necessary to preserve the quality of life. Surgical operations are performed both in the traditional way and using minimally invasive methods of laparoscopy.
In total, the hospital employs 916 employees, including 294 doctors (17 doctors of medical sciences and 34 candidates of medical sciences), 342 nursing staff, 11 nursing staff and 269 more employees.
Every year the hospital performs about seven thousand operations to remove cancerous tumors. 31.4 thousand people are registered in the clinic. In 2019, it was visited 197.2 thousand times, of which 124.8 thousand visits were for patients with malignant neoplasms. During the year, patients were hospitalized 26.2 thousand times.
In 2019, overhaul and re-equipment of building No. 8 on Zagorodnoye Highway was completed, on the basis of which a new center for oncosurgery was created. His key specialization is microsurgical operations, including for the most dangerous malignant tumors of the head and neck, which previously did not leave a chance for recovery.
In 2020, a major overhaul of building No. 7 has begun, where the departments of chemotherapy, oncourology, coloproctology, an angiographic operating room, as well as an operating unit and intensive care unit will be located. The renovation work is scheduled to be completed in autumn 2021.
In another building on the territory of the hospital, which is undergoing major repairs, it is planned to open a new center for outpatient oncological care for residents of the Central Administrative District.
Cancer care during the COVID-19 pandemic
During the COVID-19 pandemic, all types of medical care in the “oncology” profile were provided in full. Patients received surgical treatment, chemotherapy and radiation therapy, they were provided with all the necessary drugs.
From January to August 2020, within the framework of specialized medical care in the “oncology” profile (treatment in a round-the-clock and day hospital), 222 thousand hospitalizations were carried out, which is 42 percent more than in the same period in 2019. The number of courses of radiation therapy increased from 5.3 thousand to 6.4 thousand (an increase of 21 percent), chemotherapy – from 109 thousand to 164 thousand (an increase of 51 percent).
Due to the fact that a number of city and federal hospitals were redesigned for the treatment of patients with coronavirus, on the basis of the city Institute of Otorhinolaryngology named after L.I. Sverzhevsky, an additional 100 beds were deployed to treat patients with oncological diseases. They were housed in two or three local wards, fully complying with the epidemiological requirements.
For patients with tumors of the prostate and mammary glands, hormone therapy was organized at home. A doctor and a nurse visited them and, in the absence of contraindications, administered the necessary drug. 248 patients received such treatment during the period of self-isolation.
For those with a cancer diagnosis, doctors could prescribe drugs in solid dosage forms for the maximum possible period, but no more than 180 days, taking into account medical indications.
Measures to prevent the spread of COVID-19 have been and continue to be in place in all medical organizations oncological profile.
EDITOR’S NOTE: This article is a translation. Apologies should the grammar and or sentence structure not be perfect.