Oncology passport - a tool for more efficient cancer care. Episode 75

Monika Rachtan
Good morning Monika Rachtan I would like to welcome you to another episode of the Po Pierwsze Pacjent programme. It turns out that up to one million people in Poland currently suffer from cancer. Importantly, people with cancer may also develop other diseases and require treatment and care from doctors of various specialties. This is what we are going to talk about today. On my programme, and my guest, but above all your guest, is Professor Bożena Cybulska. Good morning, Professor.

Bożena Cybulska
Warm welcome.

Monika Rachtan
And Professor Marcin Ziętek Good morning, Professor.

Marcin Ziętek
Good morning, thank you for the invitation.

Monika Rachtan
Let me start with you, Professor. How often does it happen that oncology patients come to you with problems such as varicose veins, for example, or hypertension, or some other conditions that simply affect Polish people?

Bożena Cybulska
I would go back to that introduction you made about the fact that we have a million people with cancer. I would say that we have a million people with cancer or post-cancer. And this is also the clue that we are going to talk about today, which is that those patients who are once in active treatment have an active cancer process, but those who are already recovered have gone through a cancer process and all these patients also have other disease processes. This population risk of developing, for example, ischaemic heart disease or diabetes in these cancer patients is similar to or even higher than in the general population, because these patients have already been treated with chemotherapy, radiotherapy or have had surgery and may also develop other disease processes.

Monika Rachtan
Because the cancer treatment you mentioned is not indifferent to the patient's body. Even if the patient no longer has cancer, the traces that remain in the body after chemotherapy or immunotherapy sometimes remain with the patient for the rest of his or her life.

Bożena Cybulska
Yes, that's right, they stay for the rest of their lives. What is more, some patients will have an increased atherosclerotic process, for example, and these patients will require additional, more frequent cardiological care and additional examinations. Therefore, such an oncology patient is not a patient who has to go only to an oncologist, but is a patient who has to undergo all other preventive examinations, all other laboratory tests and diagnostic tests, just like any other person who does not have cancer. Please also remember that we often still have the perception that cancer is a sentence. We have a huge number of healers who no longer have cancer, or who are living with cancer and will live for many, many years because the cancer is standing.

Monika Rachtan
It is a chronic disease in many cases. Professor, but I will still ask and come back to those oncology patients who are undergoing treatment, Because I have this impression that many oncology patients treat the oncologist as that doctor who either keeps them alive or has allowed them to win their battle with cancer or to complete their oncology treatment, because every patient will probably talk about themselves differently. So do you also feel that all these health problems that the patient has at the moment are your oncologists' problems, at least in the patient's mind? Well, sure.

Marcin Ziętek
It does happen. It also depends on the speciality, because oncology is quite a broad field and I am a surgeon and the contact with the patient is much shorter, because it is the preparation, the operation and it usually ends positively like that. Whereas systemic treatment is a significantly longer treatment. In the complementary option it's usually about a year, but in the palliative option it's a very long time, so it's a big attachment.

Monika Rachtan
But when does a patient have this worse prognosis?

Marcin Ziętek
This is when there is spread of the disease and when there is no cure. But it is increasingly possible to significantly prolong the life and comfort of these patients.

Bożena Cybulska
Let's put it this way, because it's the term palliative treatment, it's not quite right. We have had palliative patients for 15 years. Well, it may be a term which arouses negative emotions, but what we mean here is that this patient cannot be cured of the cancer process itself, as, for example, a patient with diabetes can be cured, so the patient lives with diabetes and functions quite well. He gets the right medication, he gets insulin for example. And he functions many, many years with this disease. This is also the case with cancer, but in addition here there may be another disease process that we will not address.

Marcin Ziętek
We are witnessing a breakthrough and a revolution in oncology. And just as in the not-so-distant past, 10 to 15 years ago, it was difficult to achieve such long survivals in those patients who had metastasised as a result of the duration of the cancer. At the moment, indeed in many situations these patients live for long years. Therefore, in fact, malignant tumours are becoming, for the most part, chronic diseases. But let us also bear in mind the very large group of cancer patients who are already cured at the very beginning of their treatment. We are talking about these early stages. About those situations where the patient is aware of and sees the oncologist quickly, so we have a good chance that this surgical treatment will be the only treatment without the need for follow-up. And we have more and more of these patients because the largest group of malignancies are skin cancers, including the rare still melanoma, which are the easiest to identify because they are mainly on the skin, so they are easy to just see, they are also easy to treat because it is mostly a simple surgical removal and that is the end of it. So we will have an increasing number of patients. And our intention is also to reassure and disenchant this notion of malignant tumour, which is very often associated with a short life, with death, which is not true, because, first of all, the earlier we come forward, the greater the chance that we will cure the cancer at all and be completely healthy people.

Marcin Ziętek
On the other hand, if the patient comes in late, we really have more and more modern therapy that extends the life of these patients a lot. That is, we will have on the one hand more and more cancers and on the other hand more and more cured patients or chronically treated patients. And this is the group in which we will have to take care of the various other conditions that accompany as in any healthy person.

Monika Rachtan
That's right. And these conditions, as the professor mentioned, they can run a little differently in these patients after Oncology treatment because of these traces that. Oncological treatment has left and so have we. We meet today on the occasion of the congress of the Polish Oncological Society. This congress every three years, once every four, four.

Bożena Cybulska
Years, for four.

Monika Rachtan
Years, because I remember the last time I was there, but it's been so long.

Bożena Cybulska
But that's because there was a covid and that's why then the congress was in the fifth year and now it's sort of in the third year. On the other hand, every four years there is a congress of the Polish Cancer Society.

Monika Rachtan
And during this congress, during this congress, there are very important deliberations and a new project that you are creating, which is the oncology passport. It will be a document, something along the lines of. It's hard to call it, to imagine it, because it will be a kind of box in which there will be answers to all the questions related to what to do with the oncology patient when he is cured, how he can function In the world and the medical world. I know there are questions like, for example, can I play tennis after a melanoma resection?

Marcin Ziętek
That is to say, yes, this passport is a finished document that has been created within the section dealing in general with the oncology patient after treatment. We must also say that, in general, the last two years of the Polish Cancer Society have resulted in the creation of several different sections. You are the chairman of one of them. I deal with just such a patient at the end of treatment. And this passport is one of the ideas, one of the activities of the section, which brings together not only oncology specialities, but various others. In order to discuss among experts how to improve the patient's follow-up. Because we have more and more of them. We also have to face different problems. The oncology passport is, in principle, intended to be such a document for every patient who has completed oncological treatment, irrespective of the type of cancer, in which there will be, on the one hand, a summary of what happened, at what stage it was, and, on the other hand, there will be a whole range of recommendations as to what check-ups to do, at what frequency. And there will also be a lot of interesting information about rehabilitation, the possibility of different forms of activity for this patient, the possibility of doing immunizations and many issues.

Marcin Ziętek
It will be a single document, which will be called a passport, because with this, with this document, the patient can move all over the country to different centres, But above all, we want to move a large group of healthy, cured patients to family doctors, because we want to free up space for new patients, because we know.

Monika Rachtan
That they will.

Marcin Ziętek
Coming. They have, they clash a little with the problem of queues, waiting times. And knowing that malignant tumours are on the increase in terms of new cases, well, we have to prepare for this new group of cancers. And it is not a matter of getting rid of patients, but of redirecting some of them to centres in a very safe way, but a very important element is that we also want, and we also have representatives of the Polish Society of Family Medicine in our section. We want to prepare and secure family doctors so that this takeover of patients is safe both for patients and for doctors.

Bożena Cybulska
Because this passport is not just for the patient, it is also for the doctor. It is a guide and an aid for the doctor, who will guide the patient, be it a doctor of another speciality or a general practitioner, so that he or she will also have an easier time and will receive a certain amount of knowledge from the patient and will know how to guide him or her.

Marcin Ziętek
Yes, this is patient ownership. It increases awareness. It can structure very nicely what has happened and what lies ahead. On the other hand, it is a very valuable document for GPs and for doctors in general dealing with the various other conditions of these patients, because, as we know, as they live longer, new and different conditions will arrive and this will facilitate communication between specialists.

Monika Rachtan
On the form of this document, whether it's going to be some kind of app or whether it's going to be an A4 sheet of paper that the patient is going to be.

Marcin Ziętek
Initially, it will be a similar existing document to the DiLO card, the so-called Green Card, which facilitates the first contact with the cancer centre when cancer is suspected or diagnosed. So, on the one hand, it will be such a paper document in the patient's hand, but, above all, it will be an electronic document visible in the various centres, so that by the card number it will be possible to read these recommendations, which will be entered electronically.

Bożena Cybulska
On an individual patient account. We would like this document to be suspended.

Marcin Ziętek
At a very early stage. This document has already, after many discussions and meetings, emerged as a ready-made file for further procedure, because now we have meetings ahead of us at the Ministry of Health where this will be discussed, and next year we hope to implement it, because it is known that what is new can be met with different comments. These will not always be positive, but we know that the goal is a good one, that it is to improve the patient pathway between the cancer centre and the so-called region, while not overburdening the region. We also want to show on the figures that GPs must also be armed with the financial means to perform these tests if the patient is to move away from the cancer centre.

Monika Rachtan
I think that if this were the case, if, in fact, such a card were to be included in the IkP, it would be of great benefit to patients, because thanks to this, their family would also be able to familiarise themselves with it, and it would never be lost or misplaced by the patient, so I think it is worth striving to make the Internet Patient Account the place where such information would be available. Professor, does it happen often? Because you treat patients systemically. That an oncology patient comes to you and says that he has been to the doctor somewhere, that the doctor has given him some medicines, but he does not remember. And do situations like this happen right in the office, that for example a patient goes to consult a cardiologist for some reason, because he has another co-morbid disease. And that's fine, because he goes to the right specialist, but then he goes back to the professor. And so it is not really clear what to do with all this.

Bożena Cybulska
It varies a lot, because it depends on who the patient goes to, which doctor. We have a number of specialists, other than oncology specialists, who are excellent at dealing with various problems in oncology patients. However, some doctors are afraid to take care of these patients, and we want to reach this part, this part of doctors. We want to help them and show them that this patient is actually no different from any other patient. Of course, he requires additional, special examinations or special supervision. Nevertheless, he is ill in the same way as any other patient who does not have a cancerous process and should be diagnosed and treated in the same way as any other patient. It is, of course, necessary to check whether there is any coincidence between oncological drugs and the prescribed therapy. It needs to be checked too. This is a big problem sometimes of this polypragmasy, that many drugs are ordered for the patient from different specialists. And there has to be one person who will review these drugs and see that they do not repeat the same drugs under different trade names.

Monika Rachtan
Professor, but I think it's important to you when a patient comes in that they just bring all these cards from the different specialists they go to you and then there it is. By prescribing oncology treatment, you are able to safely decide what the patient will be given. Because if you don't have this knowledge from all these other specialists who are taking care of the patient, then de facto this oncological treatment may be. Its efficacy may be less, or there may simply be some drug interactions. And this knowledge, because I want to convince our viewers here that they should work with this oncologist and be open to the fact that, if they already go to another doctor, that the professor has to get this knowledge from the patient, because we don't have these passports yet and the professor doesn't always know, for example, the patient will go privately, well she is not able to guess what drug the cardiologist has prescribed.

Bożena Cybulska
We would like to receive information from doctors of other specialities. In many cases, such a patient comes to us with an information sheet from a cardiology, diabetes, nephrology or other outpatient clinic, where I can see what conditions the patient has. This is extremely important when qualifying for oncological treatment. I can see what medications he or she is taking, this makes it very easy for me. If such a patient does not have a consultation and I have to review what the patient has. Either he brings boxes of medications or he brings a list of medications that he is taking. Well, it is both time-consuming and very difficult for us. Often we can miss a medication or the patient doesn't bring it with them or they don't remember taking something. It just gets dangerous. We have to require the doctor who has the patient from another specialist to provide us with this information. In most cases, we get these information sheets. If we do not get them, the patient has to come back for this information.

Monika Rachtan
Often I also think that here the appeal to our viewers is that it is not the oncologist who has to demand from the doctor of another speciality, but that it is the patient who seeks to provide his doctor, who is giving him systemic treatment. All the necessary information that affects his health and precisely the health of the patients. Especially now, at a time when we have an increased incidence of various diseases, we can vaccinate. And can oncology patients, Professor, because I know that in this passport also the provisions for vaccination will appear, can safely receive the vaccination against influenza whooping cough.

Marcin Ziętek
In most situations, absolutely yes. In some it is even recommended, so this cancer is not a contraindication at all. Only the patient's current local condition, any high fever. That, which can occur rapidly, can be a contraindication, but the cancer itself is not a contraindication. And this will be one of the permanent records in the oncology chart to facilitate further management. We have a lot of visits from patients who come to our centre just to get an answer to the question, can they do rehabilitation, can they go to the spa, can they get vaccinated? These are mostly questions where the answer is yes without a problem, but it turns out that this patient was ill, for example, 10 20 years ago with cancer. He's had many, many other illnesses along the way, and he's still associated with this malignant cancer. And there is also the problem of those centres, such as sanatoria and some rehabilitation clinics, which are afraid and, upon hearing a cancer diagnosis, are afraid that they may harm the patient. So it's also about streamlining that pathway so that the patient doesn't have to come in for that. And in most situations, it will be the oncologists finishing the oncology treatment who will be able to write briefly if there are any contraindications, because if there are any, we will also list them in this card, but this can significantly reduce the number of questions and make the patient's pathway back to normal functioning easier.

Marcin Ziętek
Because, as we said at the beginning, the vast majority of cancers are early stage, they are fully curable, so these are patients who will have had cancer and other adventures along the way, so we don't want to stigmatise them. We want to free the cancer patient as much as possible from that association with something difficult, hard and deadly. These are really people who can get into super good activities. What's more, we also have various ideas to talk about facts and myths in oncology on our oncology pages in order to disenchant it, to correct certain misconceptions, based on scientific knowledge and speaking in the voice of experts so that it rings clear and inspires confidence in our patients.

Monika Rachtan
We are constantly seeing that this central system is lacking, and that there is no such thing as a cumulative system of information about the patient which could be used by all doctors who later encounter the patient. But you said a very important thing about listening to experts. And I would also like to emphasise this, and I emphasise it many times in this programme, that in the programme, first of all, the patient on the couches. There are doctors, specialists, pharmacists, people who have medical training and who are allowed to talk about medicine. Unfortunately, there is a lot of misinformation in the media space today. Very often medical topics are spoken about by influencers or people who would like to become an authority in a certain field, who have read something, thought something and pass on this medical knowledge. This obviously harms the patient who listens to such a person, but it also harms you in your work, because then you have to deal with these, excuse me, stupid things that the patient has heard somewhere on the Internet, and you often have to react, which causes various health problems and facts and myths concerning oncological treatment. What do you, Professor, hear most often when it comes to oncology therapies, to cancer treatment, when it comes to such myths, such a classic myth from the oncology department.

Bożena Cybulska
Don't move, don't move, because there's bound to be something wrong. It's the surgeons who usually have this.

Marcin Ziętek
The biggest myth that is passed on by mainly older, less informed patients is that if the tumour is removed, the patient may die because of it. Consequently, it is better not to move this growing tumour. And this is indeed what happens, because this patient eventually ends up on the operating table anyway because of bleeding pain. Only too late. When distant metastasis occurs, he dies in a short time and the message to his surroundings, to his village or environment, is that if he had not undergone the treatment, he might have lived longer. And this myth is reproduced. And in the meantime, in oncology, nothing works more for the effectiveness of treatment than for a patient to come in early with as small a tumour as possible with as early as possible this disease, because that's how we can improve the cure. That's what's happening in modern systemic therapy, which you, Professor here, represent. And this is a breakthrough in oncology. But we won't go any further with it if we don't make our patients, our young patients, our listeners as well, aware so that they know that it's important to come in earlier, better unnecessarily than too late, because that thickness of the tumour at the time of detection maximally affects the patient's subsequent fate and prognosis.

Marcin Ziętek
And no modern therapy can replace this. So our role is also to convince patients that it's not our disease, that it's a challenge for doctors, it's the patient's disease and if they don't take care of it, nobody will do it for them. So it's this kind of late reporting that is the problem for the patient. Later on, we can treat anyone, it's just a pity about the pain, the suffering. I am already overlooking the costs generated by this modern therapy, because it is indeed effective, but it is also expensive.

Bożena Cybulska
Here it should also be added that often people do not know where to look for certain information, and this information is there. There is such a tab on the NFZ website called Where to Treat. There is information on all centres, not only oncology centres, but also hospitals and clinics. There is also information on preventive examinations. If you go to the tab Where to get treatment, you can go one by one as it is, and there is a tree which develops, where you select your own. For example, you select a prevention programme. We choose our voivodeship, the programme is displayed, we click on it and all the units which carry out particular preventive examinations or particular units which deal with a particular disease process are displayed. Whether they are surgical, dermatological, oncological or various types of wards. This is also very well-structured information that is very good for patients, so that they know where to turn, so that they do not look for charlatans or someone else, as you said, but instead seek the source of their knowledge, where to find a doctor, where the doctor is located.

Bożena Cybulska
Because, in fact, such a dispensary can be very close to where you live.

Marcin Ziętek
And it's very good that you're talking about this, because we've just put this information on our website of the Polish Cancer Society. This is the ptmed.pl website, where there is a tab for patients. And following questions and requests from patients, we have identified these very psychological counselling centres, which psychology works very well within the Oncology Centre. But once the patient leaves the hospital walls, well they collide with a wall of waiting queues. So that is one solution. The other is, for example, the dermatology outpatient clinics, where we refer most of our skin cancer patients to the region, because they don't require oncological treatment, but they do require at least once a year such, such a prophylactic dermatoscopic examination, and on this page there is a tab where we just enter which specialist we are waiting for, where we live. And there it is displayed momentarily. First of all, the nearest clinic. The telephone number to register, opening hours, address. And, most importantly, all these clinics are covered by the National Health Fund, so they are free of charge.

Monika Rachtan
Still being responsible for the health education of the public, I think the professor mentioned the prevention programmes that are being carried out and we have such a programme at the moment in breast cancer, which is dedicated especially we are, It's October, so this prevention of breast cancer has to be talked about. And here we invite all ladies. 4575 I remember well. This is the new framework where women can just come forward for free mammography. But also if you are younger, there is nothing wrong. You can have a breast ultrasound just for yourself. Just once in a while, every year. As the professor said.

Bożena Cybulska
It all depends on what kind of breasts a woman has, whether there are any changes there, whether something has been detected, whether she herself senses something in her breasts or has found something. But certainly these examinations are highly recommended.

Marcin Ziętek
Very important family history, i.e. among immediate family members parents, siblings, children. If there is a confirmed malignant neoplasm. This also makes it necessary for the patient to report about 10 years earlier than the healthy population. So in the case of breast cancer, we are already reporting from this new barrier of 45, only 35, for example. So this genetic burden is also important when it comes to such earlier control.

Monika Rachtan
And then, of course, there is lung cancer. What does it look like at the moment as far as lung cancer and the prevention programme is concerned, because we know that there were some problems with this programme. It was a bit of a pandemic, and I know that not all the centres that were supposed to be running it were either. Is it now possible to do screening in lung cancer?

Bożena Cybulska
Not all centres have screening, the kind of population-based screening we have at the moment. It's for cervical cancer, breast cancer and colorectal cancer. And this is the kind of screening that we do, as it were, in specific age groups. You can find this just on the NFZ u websites, where such examinations can be performed. In the case of smokers, low-dose tomography can also be found on the NHF's website, and the centres where such examinations can be carried out are listed there, as this is not contracted everywhere. This is an examination that requires the right equipment and staff to carry out this examination and make a good diagnosis.

Marcin Ziętek
Well, and here the big problem in our country is the reporting of such tests, which are free of charge. They detect cancer at an early stage, giving new life, actually saving lives. The enrolment is very low in mammography it is about between 30 and 40% only. But the 40+ programme, for example. In the first year of operation I had data that it was 2% reporting. Just where? In neighbouring countries, not some more developed countries, it's at 70%. So our Polish patients have a problem identifying the risk with. Perhaps this is due to some fear, to a lack of awareness, but there is still a very low reporting rate for tests that are free, that are dedicated to address this group of patients at risk of developing cancer. Because it is not to.

Bożena Cybulska
All of them, because they are laboratory tests, stool tests, urine tests.

Marcin Ziętek
And minimally invasive.

Monika Rachtan
Yes, I would also like to emphasise that we very often, as a nation, as Poles, complain about the health service, because we say doctors do not want to treat us, that treatment is ineffective, while in fact, in most cases, it was enough simply to carry out preventive examinations earlier, and thanks to this, the doctor may not have had to apply that dreadful systemic treatment that he could have had in an outpatient clinic. In fact, the professor would have cut out the skin lesion, had it tested. And there wouldn't have been this whole, just this whole consequence of this patient oncology pathway. If we were more responsible for our health by implementing preventive examinations.

Marcin Ziętek
You make a good point with a simple example from our cancer that we deal with most often with Professor Melanoma is a skin cancer that is easy to find because it is mainly on the skin not only, but mainly using a dermatoscope. If the patient comes in early enough and prophylactically, that is, not when something is suspicious and large, visible to the naked eye, but is small. If we are able to find the pre-invasive form as a small nevus on dermatoscopy, we identify the suspicion of such a melanoma. If we cut it out, it is in the pre-invasive stage. This is the only stage that is 100 per cent curable. There is no future risk of this Monster tumour spreading, of distant metastasis. There may, of course, be another outbreak, but it is so characteristic of this cancer that early detection gives a full cure. Late detection results in 800 deaths from melanoma every year in Poland, most of which could have been definitely avoided, already overlooking this expensive and lengthy treatment.

Monika Rachtan
Professor, what are the problems facing oncologists in our country today? Those that affect the quality of their work. That they are perhaps sometimes just burnt out, overtired. What are the problems that most often affect you?

Bożena Cybulska
In fact, the biggest problem is a staffing problem, because as of today, over 100 places for clinical oncology, we had probably 30 or 40 applications for specialisation. Also this staffing problem is very.

Monika Rachtan
Young people don't want to be oncologists, no.

Bożena Cybulska
They are afraid of this speciality, just as society as a whole is afraid of cancer, afraid of the word cancer. And we have therapeutic possibilities. This is one of the most and fastest growing specialities. We have patients who used to live 3 6 months for lung cancer at the diagnosis of even advanced disease, and now we are able to manage them for up to 10 years, because we have such drugs that help in longer survival in therapy. On the other hand, staff shortages mean that we cannot take care of everything either. We want to treat patients as well as possible, as effectively as possible. We want to make time for them, but we also cannot take care of all patients. We cannot take care of all the recovering patients. That's why we try to redirect some of the patients to smaller centres, to GPs, to other specialists, so that they can help us with things that they can take care of in peace and don't have to burden us with, for example, prescribing cardiovascular drugs. Sometimes patients treat us like a GP and will ask us to extend their medication. Of course, when such a patient comes in, most oncologists will do so, they will extend these drugs because the patient is running out of them.

Bożena Cybulska
Nevertheless, we cannot allow ourselves to be burdened with such tasks, because this means that we then have no time for that patient who is undergoing treatment or who comes to us with toxicity after therapy, we have to have time for them. Hence the whole post-treatment oncology surveillance section, so that we can safely redirect patients to other specialists and so that these other specialists can help us and give us this space to treat new patients and apply these modern therapies.

Marcin Ziętek
Well, let's also say that this passport too, so as not to frighten our patients. It's not that those who have a difficult, serious illness, we're going to send them away.

Bożena Cybulska
We are, of course, talking about ornithologists.

Marcin Ziętek
Those diseases that are chronically treated or with a high risk of recurrence. Absolutely standard is a five-year follow-up in a cancer centre. We are talking more about a group of cured patients with a very low risk of recurrence. And this is the group that can safely, with good recommendations, go to another centre. But these complicated cases are absolutely that. We don't even want to let these patients go outside. And going back to that staffing, I absolutely agree. In surgery it's just as evident not only in oncology surgery, but in the surgical fields, because there's a very long learning curve there, because it's standing, physical work, well it's actually a very big problem for us today is the lack of young staff, staff who would be willing to learn and then take us out in the future. The question is who will treat us?

Monika Rachtan
Well, I think that here a competitor and a big problem is also aesthetic medicine, which is very often chosen by doctors today because it is nice, profitable and makes people happy. So I think it may also be the case that it is really worth appealing to young doctors to choose the more difficult specialisations, such as oncology or surgery, because someone has to treat us, too. And Professor, do you have the impression that these other specialities, these other doctors, dermatologists, cardiologists? Surgeons, but not oncology surgeons, just general surgeons, are a little afraid of these oncology patients, that they are a little angry that these oncology patients have to return to the region. I am talking about the recovering patients.

Marcin Ziętek
I think it is not so much that they are afraid, but that the coexistence of the cancer means that there is a certain perhaps lack of knowledge as to what is more important at that point in the treatment and they require such a consultation. On the other hand, if you are talking about different specialties in general. It seems to me that it is very diverse and, for example, we know that in cardiology there are a lot of applicants for this specialisation. On dermatology it's hard to get in, isn't it? So it's varied oncology is aggravating because it's treating difficult patients. These are the situations where there are a lot of deaths because of it, which we fight all the time, but nevertheless psychologically it is very taxing if we have to deal with someone's misfortune every day, and nobody prepares us for it and nobody supports us so that we relieve this chronic stress somehow, we have to cope by playing tennis, for example.

Monika Rachtan
And how is your professor doing?

Bożena Cybulska
And well, I generally run the garden.

Monika Rachtan
And it is indeed the case that this stress is being managed, because I think every time in this programme we talk about the fact that doctors are human beings, and what the professor said is such a beautiful testimony to the fact that you too are affected by these stresses. We mainly talk about patients in this programme, but we also need to be aware that each of us will be a patient to a greater or lesser extent one day. And the medical profession does not protect you from getting the flu or from getting cancer. So you should be aware that you also have to deal with these stresses, with this difficult work, because the work of an oncologist or surgical oncologist is one of the most difficult jobs you can choose for your professional path.

Marcin Ziętek
That's why all the things you pointed out that we are people by the way.

Bożena Cybulska
But that's also what we're doing to build this simple, easy path, so that if we need help, we can also get on exactly that path and be guided by colleagues well, quickly, safely, through the whole disease process. Well, that is also our goal. I would just like to say that it is not so bad that we do not have this help from these other specialties. A cardio oncology section has been established within the Polish Cardiac Society. Cardio-oncology clinics are being set up, which are helping us a great deal with our patients. And these patients hopefully we will get funding for that, because that is what we are fighting for now. But these patients are to have priority access to a cardiologist if they also have a diagnosis of CT, or cancer, in their diagnosis.

Marcin Ziętek
This also needs to be explained, because modern therapy, which has super-extended the lives of our oncology patients, unfortunately also has its complications, including cardiac complications. The point is that while saving the patient, but generating some complications, it is also important to have safeguards to detect and protect them quickly, and therefore to simply treat these complications. Hence these measures.

Monika Rachtan
And that's when this group of specialists comes in to take care of the patient. And often patients who are treated with immunotherapy, for example. They see an endocrinologist, a cardiologist and many other doctors, who all work as a team to ensure that this patient can continue to receive this treatment and, in fact, help prolong the life of this patient. But you, as the Polish Cancer Society, by creating various recommendations, documents, including the patient's oncology passport, are also, in a way, decision-makers, because you decide what this patient pathway will look like. But if you could make three demands to the Ministry of Health to make it easier for clinical oncologists to work, to make it easier for surgeons, oncologists, where would you start?

Bożena Cybulska
From reducing the amount of medical documentation which, unfortunately, is still hanging over us, colloquially speaking. The second thing is that we have already succeeded a little, as professions or functions of coordinators have been created. They relieve us of a lot of the paperwork, but they also lead the patient by the hand. It is already the case that if we establish a treatment plan at a consortium and we know that a patient requires a tomography scan, scintigraphy or a date for some kind of consultation, an oncology treatment coordinator is able to take the patient with him or her, set appropriate dates and arrange for the patient to come back to us so that we can read the results and make further therapeutic decisions. And that we have an oncology network and the implementation of this network as soon as possible. We hope that it will help us a lot and also improve the quality of patients.

Monika Rachtan
Before I ask the Professor further, I would just like to add that. The coordinators that the Professor was talking about really do exist, because under some of them. Under some of the people who watch our programme under the episode where the coordinators just appeared. They wrote that they don't exist at their place. I would like to say that in Wrocław, at the Lower Silesian Centre for Oncology, Pulmonology and Haematology, these coordinators were guests on my programme. You can watch this programme. It aired in February, and they are not only in the programme, but they are really there, because I had the opportunity to accompany an oncology patient who was just going through the eco pathway, and they are really there. We hit it off brilliantly.

Marcin Ziętek
Institution. It has existed since the introduction of the DiLO card and today I cannot imagine working with a patient without such a coordinator. She gets the recommendations printed out by the doctor and takes care of the whole diagnostic pathway and after the consultation. She also guides the patient throughout the treatment, so it's a super support for. Oncologists and we are really already such a team that I can't imagine without it. Without this effective work, because it shortens us a lot. They make a lot of calls. To speed up certain tests, to get them in the right order, they react to certain situations that a patient gets sick. To move something or that someone drops out of one examination and we put another patient waiting in that. So it's really a living tissue that's functioning all the time. And it's already such a strong link in this whole chain that it's a great thing that has come about with this card. DiLO.

Monika Rachtan
And what message is the professor sending to the Ministry of Health today?

Marcin Ziętek
I hope that the Ministry will look favourably on this oncology passport project of ours and help us to implement it. Because, in fact, we already know after many discussions that this card will incredibly Simplify the functioning of the oncology patient in this sphere, outside oncology centres in this period of so-called control tests. So I hope that this card will find recognition and there will be support for it to actually find its way into our lives.

Monika Rachtan
And I would like to make an appeal that, not only in October, we should remember prevention, not only breast cancer prevention. Let us remember, but let us also remember that many other cancers really can be treated effectively and minimally invasively if they are detected at an early stage. Today, my guest, but above all your guest, was Professor Bożena Cybulska, Foot. Thank you very much, Professor and Professor Marcin Ziętek. Thank you very much. Thank you, Professor, that was the programme first of all. Patient. My name is Monika Rachtan and I invite you to subscribe to my channel. See you next Wednesday.