The National Oncology Network - what benefits will the patient gain? Episode 36

Monika Rachtan
Hi, I would like to welcome you very warmly to another episode of the programme "Patient First". Today we are going to talk about oncology patient care and how experts plan and implement their strategies. Our guest is Professor Piotr Rutkowski. Good morning, Professor. I was wondering how best to introduce you, as you are involved in many areas.

Piotr Rutkowski
Good morning. Indeed, I am involved in two main things. Firstly, I am a surgical oncologist and head of the Department of Soft Tissue, Bone and Melanoma Tumours, specialising in rare cancers such as sarcomas and common skin cancers at the National Cancer Institute in Warsaw. Secondly, I am socially active in the Polish Oncology Society, where I am chairman, and I also chair the Minister of Health's team for the national oncology strategy. This links in with the activities of the Polish Cancer Society, i.e. implementing and coordinating the national oncology strategy, which is crucial for the health of Polish citizens.

Monika Rachtan
The professor also ensures that oncology patients have a better diagnostic and treatment pathway. It is important that it is clear and transparent so that patients can go through it smoothly.

Piotr Rutkowski
It is true. Cancer treatment is complex and not always successful. We are trying to improve cure rates, quality of treatment and patients' lives. Although it is not easy, the system is becoming more patient-friendly. Our data from the National Cancer Institute show that in some cancers, such as lung cancer in men, the upward trend in incidence has halted.

Monika Rachtan
And what does it look like for women?

Piotr Rutkowski
Unfortunately, there is an increase in the incidence in women, which is linked to the increase in the number of female smokers.

Monika Rachtan
This is very worrying.

Piotr Rutkowski
Indeed. New tobacco products with attractive names that introduce young people to smoking are also a problem.

Monika Rachtan
What do you think of quitting smoking as a New Year's resolution?

Piotr Rutkowski
Smoking should be passe. We know that around 50% cancers can be avoided by a healthy lifestyle. Smoking is still popular in Poland and has a direct impact on cancer incidence. We have a helpline and smoking counselling centres in Poland that can help people to quit smoking. It is not an easy process, but it is very important for our health.

Monika Rachtan
This is true.
Piotr Rutkowski
Indeed, smoking is a very dangerous habit. If we eliminated it, we would have much healthier citizens in our country.

Monika Rachtan
Thank you very much for these words, Professor. Although we did not plan to talk about it, I think it is important to keep reminding about the problem of smoking in our country, which affects everyone's health. Let's now return to the evaluation of oncological care in Poland. How would you, as in school, give an assessment of oncological care in our country, taking into account the different types of cancer?

Piotr Rutkowski
I have been working in this field for 25 years and have seen improvements. Initially, I would have rated it at 3 minus. Now we are at 4 minus, which is significant progress. We have achieved a lot in the meantime. However, the situation is not uniform across the country, differences are visible. Patients see how oncology care is implemented. Nevertheless, Poles are still not adequately active in oncology prevention, which is worrying. Compared to other countries, such as Hungary or the Czech Republic, we still have a lot to do in terms of prevention. Therefore, it is important that we provide information and encourage screening.

Monika Rachtan
There are some tests available without queues, right?

Piotr Rutkowski
Yes, we have screening tests such as mammography, cytology and colonoscopy available to insured patients. The availability of these tests is better than many people think. We have recently made significant advances in the quality of these tests, especially in the case of mammography, which is now digital and available nationwide.

Monika Rachtan
So the activities you carry out directly affect patients?

Piotr Rutkowski
Yes, these measures have an impact on the number of people receiving screening. For cytology, about 50% of Polish women get screened, while it should be 70-80%. For mammography, it is about 40%, which is still a low number.

Monika Rachtan
Yes, around 36%, as we checked today.

Piotr Rutkowski
Yes, about 36-40%. This is a really low number given the availability of research and specialists.
Piotr Rutkowski
Really, this is due to two things. Firstly, we are paying more and more attention to the state of our skin, and secondly, we have access to new therapies. Skin cancer care is now good. For breast cancer and lung cancer, we are also seeing improved survival rates. While this may not be impressive, it shows that the situation is changing. However, in some cancers we are beginning to approach the average results in the European Union.

Monika Rachtan
But only in some cases?

Piotr Rutkowski
Yes, only in some cases. This shows that it is not yet an ideal system, but there are countries that perform better. These countries rely on the public health system, such as Norway, the Netherlands and Sweden. They are leaders in oncology because they monitor their healthcare systems and invest more resources.

Piotr Rutkowski
It cannot be ignored that money does indeed affect outcomes in oncology, but it must also be used effectively. It is important that the system is coordinated. For example, some centres in the Netherlands specialise in treating certain types of cancer, which reduces waiting times and increases the effectiveness of treatment.

Monika Rachtan
You mean this is similar to what we have in Poland?

Piotr Rutkowski
Yes, this is similar to what we have in Poland, especially within the National Oncology Network. All these systems are based on networks, where the patient is referred to a specialist centre, but some treatment may be provided closer to where the patient lives. The Netherlands, Norway and Sweden monitor their healthcare systems, which allows for accurate assessments of treatment quality and overall healthcare indicators. These are elements that will soon be introduced in Poland and, in my opinion, this will be a huge advance for oncology patients.

Piotr Rutkowski
However, it is also important that we take advantage of existing opportunities and prevention programmes. An example is the lung cancer screening programme, which will soon be introduced. Although not yet available, there has already been a pilot of this programme in Poland.

Monika Rachtan
I can share a personal experience of this programme. My father was randomly qualified for this programme, even though he had never smoked. His primary care physician recommended that he take part in the pilot because of his cancer history. I am not sure what the eligibility criteria were.

Piotr Rutkowski
I do not know the exact eligibility criteria, as this is decided by medical history.

Monika Rachtan
But the important thing is that, after enrolling in the programme, the father was invited for a CT scan after only 2-3 days, which is incredibly fast in Poland. The result showed some changes, which turned out to be probably inflammatory changes after pneumonia. Nevertheless, he was monitored and had the support of an oncologist. This shows that the system works in Poland and that the results in oncology are not as bad as they might seem.

Piotr Rutkowski
Compared to other countries in our region, Poland fares better. Even the Baltic States and Slovakia do not perform as well as we do. It is also worth noting that in the European Union not everything is reimbursed for drug therapies everywhere. In Poland, we have access to many basic therapies, and our National Oncology Strategy assumes even greater access to innovative therapies by 2030.

Piotr Rutkowski
Despite some challenges, I believe we have made significant progress in oncology care in Poland in recent years,
Monika Rachtan
In our programme, we meet doctors who usually speak about a specific area of oncology and so far none of them have complained about drug programmes in Poland. On the contrary, they all say that different treatments are available and alternative therapies can be used if needed. I would now like to return to the National Oncology Network. This concept can be confusing for many patients. Could you, Professor, explain in simple terms what will change when the National Oncology Network is introduced?

Piotr Rutkowski
The National Cancer Network is an attempt to bring order to the system. At the moment we have about a thousand medical facilities that diagnose and treat cancer. However, this is too high a number in relation to the number of patients who develop cancer in Poland each year - around 170,000 cases. We are talking about a million patients who are living with a history of cancer or are actively being treated. Some of them do not need treatment in cancer centres, but regular check-ups. As a result, the number of facilities is too high. In addition, there is chaos, patients do not have a clear pathway, they do not know where to report and what steps to take. Although the system is improving, we still have room for improvement.

Piotr Rutkowski
Patients need a fast and clear pathway from diagnosis to treatment. The DILO (Diagnosis and Oncology Treatment) card is a step forward, but it is not always used properly and GPs are not always involved. We need coordinators to help patients find the right diagnostic and treatment pathway and put them in touch with the right specialists. Today, most cancers are treated interdisciplinarily, by different doctors, so coordination is key.

Monika Rachtan
Does this mean that patients can get confused?

Piotr Rutkowski
Yes, this is possible, which is why the introduction of coordinators is important. Another issue is the levels of reference, which determine where and what treatment is available in a centre. Not every centre has all the specialists and resources. Some cancers can be treated closer to where the patient lives, but there are also super-competent centres, for example those specialising in breast cancer. Teams of specialists, including rehabilitation therapists and psycho-cologists, work there. It is worthwhile for patients to go to these centres because the treatment results are better there.

Piotr Rutkowski
It is also crucial for patients to be aware that there are Specialised Oncology Treatment Centres (SOLOs) with different levels. Not all patients need to be treated at Level 3, some can be treated closer to their home if their case requires it.
Monika Rachtan
Is there a certain level for melanoma as well?

Piotr Rutkowski
As such, this centre provides this. Of course, in the case of early melanoma, it is not always necessary to be treated at a Solo 3 centre, because that would be absurd. It is sufficient if it is diagnosed and removed and then followed up at the Solo 1 level, which is how it works. However, advanced melanoma usually requires treatment at Solo 3 level. There are cancers that a priori require this focus.

Piotr Rutkowski
This applies to pancreatic cancer, oesophageal cancer and hepatocellular carcinoma. In these cases, there is no doubt. This is very important, but it is not the end for us, for any potential patient. We are currently monitoring this system for the first time. This is the first time in Polish healthcare, in Polish healthcare, when the system is monitored.

Monika Rachtan
What does it consist of?

Piotr Rutkowski
Firstly, there are indicators and metrics and guidelines. Currently, as a National Monitoring Centre, together with a huge team of experts, we are preparing most of the cancer guidelines. These guidelines will go directly to the National Cancer Council under the new system. However, we are already publishing them on the website of the National Monitoring Centre, the National Institute of Ecology. They are already available, and in the future they will be placed on an aggregated site called the National Cancer Portal, which will contain all the information on cancer, guidelines and the possibility of preventive examinations, etc.

Piotr Rutkowski
It will be such a compendium of knowledge.

Piotr Rutkowski
A compendium in one place. This will be very important, in my opinion, for every Pole. But what else does this monitoring provide? First and foremost, it allows us to assess whether a given centre meets certain criteria, i.e. whether it provides an appropriate level of treatment. Thanks to this, every patient in Poland should have access to the same standard of treatment, regardless of whether they live in Hajnówka, Szczecin or Warsaw.

Monika Rachtan
Will treatment results be available to patients? Will I be able to see how long patients live?

Piotr Rutkowski
Yes, but it is not as simple as that, because if we were to rely on just one indicator, we could conclude that, for example, we are treated badly because patients live shorter at the National Cancer Institute than at the Solo 1 centre, which deals with simple cancer cases. Of course, this will be a possibility, but many factors will have to be taken into account, such as the stage, complexity of treatment, etc. It will not be a clear-cut answer.

Monika Rachtan
Of course, but I understand that this will be carefully worked out so that these results can be accurately compared.

Piotr Rutkowski
Yes, exactly. That is our objective. We, as the National Monitoring Centre, are only responsible for analysing the data and reporting it. We do not evaluate the data, to make that clear. This is very important. We now have a team of analysts in our department who are very well equipped for this task and work with the Health Centre, which collects this data in Poland. Now there is also a new option that the pathomorphological, or histopathological, results are standardised. This is a new element of our work, but it is not over yet.
Monika Rachtan
I would still like to ask about this standardisation. What does it mean for patients? What is the relevance of the histopathology result?

Piotr Rutkowski
When a patient receives a histopathology result, they were often previously told by their doctor that certain data were missing or that the description was inadequate. Now, thanks to the National Cancer Network, teams of pathomorphologists describe exactly what should be included in the histopathology report. Firstly, this helps to make an accurate diagnosis, and secondly, it enables the appropriate treatment to be tailored. The histopathology report also includes information on additional techniques, such as molecular tests, which are available in Poland but have not always been fully used by all centres. However, this is not the end of the changes that await patients. It is also the coordination of prevention and the possibility of introducing new indicators. Even if we start with a certain number of indicators, e.g. 40, monitoring systems in other countries, such as Scotland or the Netherlands, already have around 200 such indicators. The Dutch system monitors around 160 indicators. However, this expansion does not take place immediately and allows the performance of each centre to be assessed, for example on the basis of the number of patients readmitted to hospital or the rate of complications after operations, as complications after operations always occur, especially in more complex cases. Therefore, it is necessary to have a thorough understanding of the data and take many factors into account. This is truly a revolution in healthcare.

Monika Rachtan
This sounds fascinating.

Piotr Rutkowski
Yes, this is fascinating and I hope it will be fully implemented. There is one other point I would like to mention. It is the patient helpline.

Monika Rachtan
This is very important.

Piotr Rutkowski
Yes, this is very important, and it is scheduled to be launched in the second quarter of this year.

Monika Rachtan
What information will be available on this hotline?

Piotr Rutkowski
First and foremost, the helpline will be able to assist the patient in directing them to the appropriate treatment centre for their particular cancer and making appointments. This is the first important function. The second thing is. This is the oncology care coordinator. And indeed this has already appeared in many centres.

Monika Rachtan
How does this work precisely?

Piotr Rutkowski
We have had a coordinator for a long time, and now we just have more coordinators who help us at different stages of both diagnosis and treatment. And I think it works very well, because I can't imagine working without a coordinator, because it's not the doctor's job, and besides, the patient has a clear contact. He receives information after the consilium. These are things that are very important. There is also, for the first time, the possibility of contact between centres using ICT systems.

Monika Rachtan
Seemingly so simple.

Piotr Rutkowski
Well, yes, but so far, ladies and gentlemen, in order to contact each other, we use various systems, but they are all cottage industries, so to speak. That is, we talk to each other by phone, zoom, email, so to speak, but it's never been formalised, that an official consultation is formed from this. And that's very important for those centres that are less referential, that is Solo 1, and Solo 2 or 3 that have to work together. Because this is also very important. If the state thought that everyone had to go to one central hospital, that would be pointless. That is precisely not the point. The point is that in many places, the Mazowieckie province also has quite a few hospitals. It has a very good centre in Plock, for example, in Siedlce.
Monika Rachtan
Do all patients have to be treated in Warsaw, or are there cases where other centres can be chosen?

Piotr Rutkowski
Of course, not all patients need to be treated in Warsaw. The choice of centre depends on the individual case. It is important that the treatment pathway is personalised and tailored to the needs of the patient. In some cases, treatment in centres other than Warsaw can be just as effective. Therefore, there is a need to standardise the patient pathway to help make the best decisions. Guidelines play a key role in ensuring consistent care and helping patients achieve better treatment outcomes. Some of these guidelines have been adapted from the US NCCN (National Comprehensive Cancer Network) and adapted to Polish conditions by Polish experts.

Monika Rachtan
This means that it was realised quite quickly, it seems.

Piotr Rutkowski
Yes, this has been implemented relatively quickly, but full implementation requires financial support from the National Monitoring Centre. The application for this has been submitted, and I hope that we will be able to continue this process. For every patient, this is a significant quality change, because we all want them to be treated at the highest level, according to the latest guidelines. And that doesn't mean that everyone has to be treated in one place. The National Cancer Network is designed to ensure access to high quality oncology care across multiple centres.

Monika Rachtan
What does this mean for patients? Could we discuss the specific benefits of these changes?

Piotr Rutkowski
For patients, these changes mean access to personalised care and treatment according to the latest standards. It also means being able to benefit from a national network of centres, which can significantly reduce waiting times for appointments or tests. Patients will have the reassurance that they are being treated according to best practice, resulting in better patient outcomes and quality of care. It is important that every patient has access to personalised care, regardless of where they live.

Monika Rachtan
I am sure this is very important for many patients.

Piotr Rutkowski
Yes, this is important for every patient. We want oncology care to be accessible and personalised for everyone, regardless of where they live. This is our goal and the premise of the national oncology network.

Monika Rachtan
What about oncology treatment coordinators? What skills and qualities should set them apart? For those listening to this podcast and wondering if this is the job for them, can you list any specific qualifications?

Piotr Rutkowski
The role of oncology treatment coordinator is an important function that does not necessarily have to be performed by a person with a medical background. In Poland, they are often people with a variety of educational backgrounds who have received appropriate training and understand the healthcare system. It is crucial that they have good interpersonal skills and can communicate effectively with patients and collaborate with the medical team. It's a job that can be learned, but it requires an understanding of the healthcare system and the ability to work within it. Each hospital is organised slightly differently, so the role of coordinator may look slightly different in different places. It's a job that helps to provide comprehensive and personalised oncology care, and facilitates communication between the patient and the medical team.

Monika Rachtan
This sounds like an important role.

Piotr Rutkowski
Yes, this is a very important role that contributes to better patient care and faster response times. The coordinator can, for example, help make appointments or provide information if a patient has questions. This is an important function that helps to provide comprehensive and effective oncology care.

Monika Rachtan
We talked about infrastructure problems and the importance of access to comfortable and modern hospital buildings. This certainly contributes to patient comfort. But there are also issues such as signage and navigation in hospitals that can make it difficult for patients. I can imagine the situation of an elderly person receiving a piece of paper telling them that they need to find building C, room 327, on the third floor in the DCO. Do such problems really affect the experience of oncology patients?

Piotr Rutkowski
Yes, signage and navigation in hospitals are important issues that affect the patient experience. Modern and clear signage can make it much easier for patients to navigate the hospital. For older patients who do not always feel confident in a new place, this is particularly important. Hospital infrastructure should be designed in such a way that patients can easily find the places and rooms they need. This is not a mundane issue, but it affects patients' daily lives.

Monika Rachtan
I understand that this is also factored into plans to build new hospitals such as the one in Warsaw and Wrocław.

Piotr Rutkowski
Yes, the construction plans for the new hospitals also include signage and navigation aspects to ensure that patients are comfortable and easy to navigate in the new buildings. This is an important part of comprehensive oncology care.

Monika Rachtan
Let us return to the National Cancer Network. At what stage is work on its implementation currently underway? Are some of the solutions already in place, or do decisions still need to be taken to start the full functioning of the NSO?

Piotr Rutkowski
Currently, work on the National Cancer Network is in various stages. Some of the solutions are already being implemented, but much depends on the KSO implementation team and the National Cancer Council. Our task as the National Cancer Institute is to monitor oncology care quality indicators and guidelines. Implementing a full oncology network is a complex process, but the deadline for full operation is the end of March, three months from now. This is one of the key points in the National Cancer Strategy and we will monitor progress.

Piotr Rutkowski
Other important elements of KSO are education and prevention. Improving medical information about cancer, education in schools and access to prevention information are crucial for patients and the public. Through education, we can raise awareness and understanding of cancer and promote health-promoting behaviour. In addition, new preventive tests, such as low-dose CT scans for diagnosing lung cancer and modern methods of detecting pre-cancerous conditions, such as HPV infections, are also planned for next year. The importance of HPV vaccination for young people is also worth highlighting.

Monika Rachtan
These are important steps towards improving prevention and diagnosis. I hope that patients will take advantage of these opportunities.

Piotr Rutkowski
Yes, these steps are aimed at improving prevention, early diagnosis and medical information, which will contribute to lowering the incidence and improving cancer outcomes. All this is for the benefit of patients and society.
Monika Rachtan
Are we again failing to take care of prevention?

Piotr Rutkowski
We all fought for unlimited access to vaccines. There are two vaccines available. Today I checked, asking the Ministry of Health, and there are more than 5,000 vaccination points at POZ level.

Monika Rachtan
And a lack of patients.

Piotr Rutkowski
No patients and vaccines are available. Currently, around 200 000 HPV vaccines have been secured in Poland. Therefore, we benefit, but we also pay attention to other aspects, such as improving the availability of tests for colorectal cancer. An alternative is the fit test, which is a test for occult blood in the stool. Once the Prevention 40+ programme is completed, this is to be introduced. I hope this will happen.

Monika Rachtan
Many people avoid colonoscopy, fearing it.

Piotr Rutkowski
It is therefore worth considering alternatives. Another important issue is the creation of a breast cancer competence centre, which we have discussed. It is already two years in the making, but the regulation has been submitted for consultation. The competence centre for the diagnosis and treatment of lung cancer, the LAN Cancer Unit, is also important because, as I said, lung cancer is our main problem. A pilot on prostate cancer screening is also being launched. The possibilities in Poland are great, but they are not always used. The most important thing is information, hence the Internet Patient Account and the National Oncology Portal. Many elements of the National Oncology Strategy are going according to plan, and we have already introduced some things, in cooperation with the Medical Research Agency. Science in oncology in Poland is developing dynamically.

Monika Rachtan
This is true.

Piotr Rutkowski
We are the only agency in this part of Europe that has copied Western models and provides non-commercial trials for Polish patients. We have access to new therapies at the clinical trial stage, publicly funded. This is something unique. I observe similar situations in Germany, France or Italy, where I evaluate grant competitions. These trials introduce new therapies, optimise treatment, which improves the quality of public health and can reduce the cost of treatment, benefiting patients. This is a success story. The quality of education in oncology has also improved, although still few graduates choose a career path in this field. In oncology, scientific and financial successes come with time. This is more complicated than in other specialities, such as aesthetic medicine or family medicine. But given the satisfaction and advances in treatment, it is worth the commitment. For example, the radiotherapy equipment in Poland is one of the most modern in Europe.

Monika Rachtan
I recently toured the National Institute of Oncology in Gliwice and saw this equipment.

Piotr Rutkowski
But it is not just Gliwice. We have many such places in Poland. But if we don't have radiotherapy specialists, who will operate the equipment? There is a lot of work to be done. Most graduates don't know radiotherapy, which is a problem.

Monika Rachtan
After 6 years at the Medical University, can they not know radiotherapy?

Piotr Rutkowski
They can.
Monika Rachtan
How is that possible? It is amazing what the professor says.

Piotr Rutkowski
Oncology in some places is fragmented and not concentrated as a single field of medical science and practice. I graduated from the Medical University of Lodz, where oncology was clearly separate. This made it easier for doctors graduating from this university to choose a career path in oncology. However, there are centres where teaching is fragmented and inferior. In such places, the choice to specialise in oncology is more difficult for doctors. It is a shortage specialty, and yet I believe resident rates should be even higher. Fortunately, many of the activities in the National Cancer Strategy are going according to plan, including support in many areas of medicine.

Piotr Rutkowski
Prevention programmes have been successfully launched, so there are many successes. This all translates into visible results, as I said, next year and in 2025.

Monika Rachtan
We have a new health minister. Are you worried that projects from the previous government will be rejected?

Piotr Rutkowski
I believe that continuity in oncology is natural. The National Oncology Strategy was prepared by a broad team of experts, not by a particular political party. Politicians need to appreciate that what is good should continue. Oncology is not a short-term game. We already have progress and something visible for everyone. I hope the new Health Minister will continue to do this because it is rational. The National Oncology Strategy programme is spread over 10 years and its implementation contributes to the health of our society.

Piotr Rutkowski
There is an opportunity to accelerate the implementation of the National Cancer Strategy. Elements of the strategy are already prepared and are just waiting to be implemented.

Monika Rachtan
They are waiting for the Minister's signature.

Piotr Rutkowski
Exactly.

Monika Rachtan
So we appeal to the Minister for her signature. What two more pieces of advice do you have for the new Minister?

Piotr Rutkowski
I may not be in the business of giving advice, but if the Minister asks me, I am happy to share my thoughts. I hope to attend the ministerial team meeting. It is crucial for oncology to improve prevention and outreach to the public and to implement a National Cancer Network with appropriate indicators and metrics. The third important thing is proper funding and coordination of the public oncology system. Our team from the National Cancer Institute is there to support the Ministry and patients.

Piotr Rutkowski
We have a good team of analysts and people involved in the coordination of the National Cancer Strategy. We help with monitoring and coordination, which is important for an objective view of the implementation of the strategy.

Monika Rachtan
Why?

Piotr Rutkowski
This gives us an external mechanism to check progress. This is a new situation for the Ministry of Health, but it is needed so that oncology is prioritised.

Monika Rachtan
The Institute for Patients' Rights and Health Education is a partner of the programme, which talks about the humanisation of medicine. What does this mean for you?

Piotr Rutkowski
Above all, it is more patient participation in choosing a treatment pathway, but in an educated way. We are trying to provide more information to patients and are working with patient organisations. Artificial intelligence can help humanise, providing objective information and supporting doctors in their decisions. The amount of medical knowledge has increased tremendously and treatment methods have changed dramatically.

Monika Rachtan
Yes, they have changed.

Piotr Rutkowski
There has been a revolution in oncology over the last 25 years. I remember the results of treatment 20 years ago and now there is a huge difference. Early melanoma is now relatively easy to treat. The humanisation of medicine is all about the knowledge of the patients, who are our partners.

Monika Rachtan
So education, education, education. We appeal to the public.

Piotr Rutkowski
Yes, education is key, including for children. The Ministry of Education has a role to play here, because lack of education affects low health awareness. This determines our future.

Monika Rachtan
We encourage education from reliable sources. Listen to experts and clinicians who are willing to share knowledge.