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EF: Regarding the evolution of healthcare, are you anticipating challenges or an opportunity in 2024?
MK: I will start with challenges since I firmly believe that considering the circumstances around a step forward is necessary if you wish to advance. First, there are a lot of cancer patients in our country; 180,000 people received a cancer diagnosis last year, and the annual death rate is roughly 100,000. This is the first challenge. The introduction of a comprehensive model of anti-cancer management with multidisciplinary decision-making is, in my opinion, the main challenge not only in treatment but also in the processes involved in diagnosis. Cancer patients in my country are seen by medical, surgical, and radiation oncologists, among other oncologists, but numerous additional specialists also treat them.
For instance, thoracic surgeons or chest physicians are primarily responsible for diagnosing lung cancer and continuing patient therapy. Urologists treat prostate cancer patients; however, in Poland, non-oncologists do not always embrace a multidisciplinary approach. As a result, patients with prostate cancer are often undertreated, receive only chemotherapy, and do not receive innovative new-generation hormonal or BRCA-targeted therapies. Creating a holistic care model is a challenge. In my opinion, the best approach to make things better is to establish cancer units, such as those for lung, breast, prostate, and other cancers.
An additional challenge facing the country is the need to expedite the diagnosis phase of anti-cancer management due to persistent barriers in acquiring reports such as pathology, radiology, or molecular in a reasonable time. For instance, the European Society of Medical Oncology states that the molecular profile should be received in 10 to 14 days, but in my country, it takes much longer. This presents a challenge for introducing the most effective modern systemic therapies.
I believe there are numerous reasons why there are delays. First, there are far too few certified laboratories in the country, and their distribution is uneven. There are facilities with excellent access to molecular testing and centres with extremely poor access. There are only 150 medical genetics specialists in our field; some are professors and not accustomed to working at the front lines. This is the cause of our lack of easy access to molecular testing, which is necessary for both radical and palliative treatment. For example, immunotherapy or targeted therapy is used in adjuvant or neoadjuvant methods for non-small-cell lung cancer, which is why having adequate access to molecular testing is essential.
I mentioned a few topics regarding non-oncologists who treat a sizable number of cancer patients. Cooperation with radiation therapy specialists is necessary for an optimal outcome for patients. The fact that collaboration is not always acceptable by non-oncologists and is not always smooth or adequate presents another challenge for the country. The relationship between applying equality control in oncology and imperative action presents another challenge. It is crucial to remember that without quality assessment, we cannot achieve the best possible outcomes. A national anti-cancer system is being proposed in my country, and effective anti-cancer measures are a key component.
Since prevention is the most economical and effective anti-cancer measure, it presents another challenge. Currently, Poland has four screening programs in place: one for cervical cancer screening, one for breast mammography screening, one for colorectal cancer screening using a colonoscopy, and a fourth for early detection of lung cancer using low-dose computed tomography. For instance, 20% of people participate in lung cancer screening and 40% in breast cancer screening. That is incredibly low, as we know that participation rates should be between 70% and 80% of what they are in Scandinavian countries to reap the benefits of a screening program. As a result, increasing participation in screening programs is needed.
For example, in the case of lung cancer, it is necessary to persuade individuals that a low-dose computed tomography is not just for cancer detection because they fear stigmatization. It should be noted that some cardiovascular diseases can also be detected by low-dose computed tomography. As a result, we must rationally and sensibly encourage the nation's preventative screening initiatives.
We need to work with oncologists because we don't have enough staff. For instance, there are 1,500 licensed medical oncologists among the 10 million people in the Czech Republic and just 1,300 among the 38 million people in Poland. As a result, we must work together while imparting knowledge on developing a comprehensive framework. We wouldn't be able to treat every patient without medical oncologists; in Poland, for instance, there are currently 23,000 newly diagnosed cases of lung cancer; as a result, we must work with other physicians.
EF: In Poland, how accessible are oncological medicines currently? What more needs to be done to improve access?
MK: In Poland, anti-cancer agents come in a variety of forms. Most of these agents are older and include hormone and cytotoxic agents – both are available from a so-called catalogue of anti-cancer substances. Therapeutic programs also provide anti-cancer therapy as a secondary source. Novel agents – immune checkpoint inhibitors and molecular targeted agents – are available within therapeutic programs. The Ministry of Public Health finances and reimburses them. While some of those therapeutic programs have well-equipped structures, others do not. For instance, we have access to all medications approved by science for treating melanoma, including immunotherapy and molecular targeted therapy. As such, Poland is not different, for instance, from Germany and the Netherlands.
Similar circumstances exist in the case of lung cancer, as patients treated for lung cancer and carcinoma are prescribed 17 agents, anti-EGFR, anti-ALK, anti-ROS1, and immunotherapy in addition to chemotherapy or as a monotherapy. Although several programs are currently insufficient, we are still satisfied. Both prostate and bladder cancer patients require better access to medication. Second, the country's therapeutic programs do not always use the contracted agents; in certain areas, patients only receive 80% of the contracted agents, as there is insufficient access to molecular testing. This is what is wrong with molecular diagnosis. While things are improving overall, there are still certain internal insufficiencies.
In Poland, cancer ranks second in terms of illness burden and causes of death. Cardiovascular diseases rank highest on the list, but compared to ten years ago, cancer diseases are far closer now. Not us, but the cardiologists are the ones who have improved. When it comes to oncology results, we are still roughly 10% below the norm for the European Union.
EF: What role do you think public-private partnerships will play in improving patient outcomes in Poland, and how do you anticipate this role developing?
MK: The private sector plays a significant role in education, not only in society at large but also in the education of specific professions like nurses, who are vital partners in the treatment of patients. Better-educated nurses help to produce better outcomes. I started the oncology nurse education program two or three years ago, and the pharmaceutical firms supported us because they saw the value of educating nurses. Most nurses are female, and because of their positive interactions with patients, those patients are more willing to open up to them about their issues. The private sector plays an important role in education.
EF: Since the general public is ultimately the most impacted, how can we raise awareness among them of the significance of illness prevention?
MK: Early health education about leading an ideal lifestyle is vital. Young people are the targets because, once they are aware of the issue, they may persuade their parents and grandparents about the risks associated with certain behaviours, like smoking, for example. Prevention is crucial, and early education is important at that point. Second, our goal is not to instil fear in people about diseases. For instance, I've learned via the Internet that King Charles' diagnosis in the United Kingdom has led to a rise in the number of individuals beginning prostate-specific antigen testing. Having well-known individuals exhibit exemplary behaviour is one strategy to boost involvement in preventive programs. We need to speed up the primary preventive actions.
EF: We understand that your responsibility as a physician is to optimize and improve patient outcomes. What is your perspective on the funding and implementation mechanisms for new therapies like gene therapies?
MK: As soon as possible, any innovative medications, including immunotherapy and molecular targeted therapy, should be included in the radical treatment. Being a national country consultant, I consistently advise the ministry that immunotherapy and targeted therapy belong in the radical treatment group alongside radiation therapy and surgery, as well as in the future of all these novel agents. Early application of innovative medicines will yield the best results.
EF: Regarding oncology in Poland, what message would you like to share with other influential opinion leaders reading this article from around Europe or the world?
MK: Provide a framework for conducting clinical trials across Europe accessible to all countries. Second, we occasionally run out of some agents. To address this, the European Union must establish an independent system to manufacture anti-cancer agents in Europe, and all member states must be supported. It's critical to establish a shared biobank for molecular testing. The French system for biobanking results from molecular pathology is a good example; the pan-European Biobank will be highly beneficial.
When I attended the conference in Romania two years ago, I was taken aback by a few of the simple agent problems. Another instance was when young oncologists participated in a session at the most recent European Lung Cancer Conference in Copenhagen, where my department's assistant took part in the conversation. Three women: a Mexican, an Italian, and my departmental assistant. For instance, an anti-cancer agent known for many years is not available in Mexico. Some agents can only be obtained in Poland, while others can only be obtained in Italy. The variations are unacceptable.
