Oncologist

, who was in charge of the Children's Oncology, Hematology and Immunology Department of the RNPC, resigned in the fall of 2020 in protest when the management was changed at the RNPC against the will of the staff.

Now Nadzeya works as an oncologist in Cesky Krumlov.

• Patients with the same oncological diagnosis and even stage may receive different treatment due to different molecular and genetic features of the tumor.

• The mass departure of doctors from the country affected the quality of care, including diagnostics, but it will affect the mortality rate rather than the number of registered oncological diseases.

• Repressions, war and occupation of Belarus, sanctions from the West as a result very painfully hit the most vulnerable population groups, patients.

• Now, unfortunately, most high-tech industries, including oncology, are condemned in Belarus to return to the 50s of the last century.

• Health should not be taken as a given, illness should not be taken as a punishment.

  Work on your health, as people work on their appearance or prestige, as a result, it will provide you with both.

"A cancer diagnosis is no longer a death sentence in the minds of most people"

— On February 4, the world celebrates World Cancer Day.

If we talk about trends in Belarus and the world in the fight against this disease, what would be the most important thing you would point out?

- An important positive change that we can observe in Belarusian society is that a cancer diagnosis has ceased to be a death sentence in the minds of most people.

In Western countries, this happened much earlier, now there are changes in public consciousness here as well.

From a professional point of view, it can be noted that the trend of improvement and detailing of diagnostics and thus personalization of treatment continues.

This means that patients with the same oncological diagnosis and even stage may receive different treatment due to different molecular and genetic features of the tumor.

The percentage of preventive interventions based on diagnosed genetic changes has increased.

For example, removal of mammary glands with plastic implants or removal of ovaries in the presence of a mutation in the BRCA 1 or 2 genes.

From the socio-economic point of view, it is worth noting the gradual "aging" of the population and the associated increase in morbidity, which, of course, will require changes in approaches to financing this branch of health care.

It is also possible to note the well-known "rejuvenation" of cancer, that is, an increase in the number of diseases among relatively young, able-bodied age groups.

Oncologists have come to use the term "financial toxicity", which means expenses not only for cancer treatment, but also for the rehabilitation of its consequences, for transport, for temporary incapacity for work and much more.

It also requires a review of the forms of financing we are used to.

"There is progress in almost all areas of oncology"

- What is the good news in the development of methods of treatment of oncological diseases?

- There is progress in almost all areas of oncology.

Methods of surgical treatment are being improved, robotic surgery, minimally invasive and endoscopic interventions are being developed.

Radiotherapy actively uses methods that preserve healthy tissues, such as proton therapy, stereotaxis.

Of course, a significant breakthrough can be noted in the drug treatment of cancer.

These are immunotherapy, targeted (targeted), and antiangiogenic (directed at the blood supply to the tumor) therapy.

The emergence of generics (biological analogues) of these drugs makes them more affordable financially.

"Unfortunately, pancreatic and biliary tract cancer has a poor prognosis"

— According to the latest trends, what types of oncological diseases are the most common in the world and in Belarus?

And what types of cancer are best detected in the early stages and, accordingly, treated?

And which ones have a bad prognosis?

- I have already mentioned more than once the importance of screening programs aimed at early detection of the most common tumors.

It is a mammogram in women after 45 to detect breast cancer at an early stage, it is a colonoscopy after 50 to detect the beginning of changes in the colon and prevent the transformation into cancer.

In addition to this, women are required to have annual examinations with a gynecologist for cervical cancer screening.

In these diseases, the prognosis is favorable with timely detection.

Unfortunately, cancer of the pancreas and biliary tract has a poor prognosis.

There is no screening for these diseases yet.

Lung cancer is still a serious problem.

But tactics in relation to prostate cancer have changed a little.

In a number of cases, dynamic observation, hormonal therapy, rather than aggressive approaches, are appropriate.

"Incidence figures in Belarus as a whole reflect the general trend of a decrease during the pandemic and an increase after it"

— When talking about the Belarusian situation in the field of oncology.

The other day, the management of the Russian National Center for Oncology and Medical Radiology announced figures according to which 50,400 new cases of malignant tumors will be registered in 2022.

For comparison, there were 45,600 new cases in 2021, and 54,800 before the pandemic in 2019. How would you analyze these numbers?

— The incidence figures in Belarus in general reflect the general trend of a decrease during the pandemic and an increase after it.

Just like in the Czech Republic and in other EU countries.

— The decrease in the number of newly diagnosed cancer cases during the covid pandemic is associated with a decrease in visits to health care institutions for professional examinations, screening and appeals for medical assistance in the presence of minimal complaints.

Undoubtedly, the mass departure of doctors from the country affected the quality of care, including diagnostics, but it will have an impact on the mortality rate.

In a totalitarian state, statistics are rarely honest, but it is difficult to hide excessive mortality figures, and in Belarus it was high during the pandemic.

What the indicator is now, I can't say, but I assume that it is still high.

"Doctors manage only thanks to enthusiasm, but the human resource is not infinite"

- Name the main problems faced by oncologists and the oncology industry in Belarus over the past three years.

- The last three years were truly catastrophic for the whole of Belarus, not only for certain spheres of life.

The pandemic demonstrated the failure of management in the health care system and, on the other hand, the solidarity of civil society.

Protests against falsification of elections in 2020 finally severed the connection between society and the state.

In the end, the repressions, the war and the occupation of Belarus, the sanctions from the West, as a result, hit the most vulnerable population groups, the patients, very painfully.

Medics manage only thanks to enthusiasm, but the human resource is not infinite.

Now, unfortunately, most high-tech industries, including oncology, are doomed to return to the 50s of the last century.

- You work as an oncologist in the Czech Republic.

If we compare the systems, what is common with Belarus, and what is the difference?

— The systems are fundamentally different, each has its advantages and disadvantages, but, certainly, cancer patients in the Czech Republic are more socially protected and provided with a higher level of medical care.

But the level of burnout among medics here is very close to our Belarusian one.

"Take care, folks"

- What advice as an oncologist would you give to people to protect themselves from cancer if possible?

- It's hard to refrain from banalities, but that's the way of doctors.

Repeat a hundred times a day the well-known truths that everyone knows.

Health should not be taken as a given, illness should not be taken as a punishment.

Work on your health, as people work on their appearance or prestige, as a result, it will provide you with both.

Early detection of the disease is the common responsibility of the doctor and the patient.

Competent communication is a very useful tool in the fight against an oncological diagnosis.

Once again, I express my admiration for my colleagues who, despite the crazy pressure, are doing their job.

Take care, family.

• Anna Sous

  Radio Svaboda journalist

  Editor of the "Only women" community on Facebook 

  sousa@rferl.org

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