The influence of accessibility of anticancer drug therapy on the target indicators of the oncological service

Introduction. Main oncologic indicators such as morbidity, mortality, early detection of malignant tumors, one-year mortality rate, noticeably differ not only among the countries but also among the regions of one country, and even more among the territories of one region. Oncological service informatization let us evaluate the target indicators in each territory unit of the region at any given time and to reveal the actual problems.

The object of the work was to find out the differences in one-year oncological mortality rate among the territories of Sverdlovsk Region and to reveal the relation of it with the distribution of stages of detected oncological cases and with the availability of anticancer drug therapy (ADT).

Materials and methods. Indicators of one-year mortality rate, distribution of stages of new cases, specialized treatment performed, were received from the regional oncological informational system ONCOR. The analysis of data on 32758 ADT courses conducted to patients from 60 districts of the Sverdlovsk region in the first 6 months of 2020 was carried out.

Results and discussion. The number of courses held varied from 33 to 1 213, unique schemes – from 9 to 267. We analyzed the accessibility of ADT based on the relative indicators such as density of ADT (the ratio of the number of courses carried out to patients from a given territory to those registered in each territory) and diversity of ADT (the ratio of unique patterns of ADT in patients from a given territory to the number of registered patients in each territory). The density of ADT ranged from 11,8 to 108,3 courses per 100 registered patients, the variety of PLL – from 0,7 to 10 schemes per 100 registered patients. A relationship was revealed between the distribution by stages of detected cases of malignant neoplasms and one-year mortality, between the percentage of stage IV and the density of ADT. The density of ADT influenced the one-year mortality rate even with the leveling of the effect of the proportion of stage IV.

Conclusion. The regional oncological system allows to demonstrate territorial differences in the indicators of the oncological service and the availability of specialized treatment. The density of ADT influenced the one-year mortality rate. The received information about the fulfillment in medical organizations at the place of patient’s residence the oncological dispensary appointments should be considered when making changes to regional orders for routing patients with malignant tumors. 

1. Chissov V.I., Starinskiy V.V., Kovalev B.N. (eds.). Organization of the oncological service in Russia. Part 2. Moscow: MNIOI named after P.A. Gercen Rosmedtechnology; 2007. 663 p. (In Russ.) Available at: http://www.oncology.ru/service/organization/oncoservice.pdf.

2. Tyulyandin S.A., Zhukov N.V. (eds.). The truth about Russian oncology: problems and possible solutions. Moscow: Russian Society of Clinical Oncology; 2018. 28 p. (In Russ.) Available at: https://rosoncoweb.ru/library/ patient/002/index.pdf.

3. Kaprin A.D., Starinskiy V.V., Petrova G.V. (eds.) Malignant neoplasms in Russia in 2019 (morbidity and mortality). Moscow: P. Hertsen Moscow Oncology Research Institute –Branch of National Medical Research Radiological Centre of Ministry of Health of Russia; 2019. 250 p. (In Russ.) Available at: https://glavonco.ru/cancer_register/%D0%97%D0%B0%D0%B1%D0%BE% D0%BB_2019_%D0%AD%D0%BB%D0%B5%D0%BA%D1%82%D1%80.pdf.

4. Davydov M.I., Gorbunova V.A. (eds.). Rational Pharmacotherapy in Oncology: A Guide for Practitioners. Moscow: Litterra; 2017. 880 p. (In Russ.) Available at: https://www.rosmedlib.ru/book/ISB.

5. Wilking N., Bucsics A., Kandolf Sekulovic L., Kobelt G., Laslop A., Makaroff L. et al. Achieving equal and timely access to innovative anticancer drugs in the European Union (EU): summary of a multidisciplinary CECOG- driven roundtable discussion with a focus on Eastern and South-Eastern EU countries. ESMO Open. 2019;4(6):e000550. doi: 10.1136/esmoopen-2019-000550.

6. Antipova T.V., Melnik M.V., Nechaeva O.B., Shikina I.B., Vechorko V.I., Lutseva E.M. Assessing effectiveness of cancer care. Sotsialnye aspekty zdorovya naseleniya = Social Aspects of Population Health. 2016;(1):3. (In Russ.) doi: 10.21045/2071-5021-2016-47-1-3.

7. Pavlysh A.V. Cost-effectivness analysis in oncology. Klinicheskaya farmakologiya i terapiya = Clinical Pharmacology and Therapy. 2015;24(5):75–80. (In Russ.) Available at: https://elibrary.ru/download/elibrary_25664723_45216348.pdf.

8. Avxentyeva M.V., Omelyanovskiy V.V., Petrovskiy A.V., Davydov M.I., Zheleznyakova I.A., Tyulyandin S.A. et al. New approaches to the development of diagnostic related groups for cancer pharmacotherapy in Russian Federation. Meditsinskie tekhnologii. Otsenka i vybor = Medical Technology. Assessment and Choice. 2018;32(2):8–23. (In Russ.) doi: 10.31556/22190678.2018.32.2.008-022.

9. Gantsev Sh.Kh., Starinskiy V.V., Rakhmatullina I.R., Kudryashova L.N., Sultanov R.Z. (eds.). Outpatient Polyclinic Oncology. Moscow: GEOTARMedia; 2012. 448 p. (In Russ.) Available at: https://www.rosmedlib.ru/ book/ISBN9785970428757.html.

10. Grebenkina E.V., Gur’yanova A.V., Ushakova M.S., Belova S.V., Tereshkin D.V., Maslagin A.S., Gamayunov S.V. The first results of the work of the outpatient oncological care center in the Nizhny Novgorod region. In: White Nights 2020. Theses of the VI St. Petersburg International Oncological Forum. St Peterburg: Voprosy onkologii; 2020. 426 p. (In Russ.) Available at: https://forum-onco.ru/upload/unsorted/forum_tezis_2020.pdf.

11. Murashko R.A., Stepanova L.L., Teslenko L.G. The experience of organizing the outpatient oncological care center within the framework of the project “Fight against cancer” in the Krasnodar region. In: White Nights 2020. Theses of the VI St. Petersburg International Oncological Forum. St Peterburg: Voprosy onkologii; 2020, pp. 360–361. (In Russ.) Available at: https://forum-onco.ru/upload/unsorted/forum_tezis_2020.pdf.

12. Kaprin A.D., Starinskiy V.V., Haylova Zh.V., Shahzadova A.O. The comparative analysis of achieving the indicators of the regional projects «Control of oncological diseases» based on the real-time monitoring data in January – May 2018–2019. Vestnik Roszdravnadzora. 2019;(4):64–71. (In Russ.) doi: 10.35576/article_5d651dbc693279.10409311.