Interview with Dr. n. pharm. Leszek Borkowski on the situation of Polish prostate cancer patients:
Prostate cancer has taken the infamous first place on the most common male cancers for several years. What does this mean? Have men suddenly become more ill or have we improved diagnosis?
The increased morbidity recorded statistically is the result of better diagnosis, patient provision and record keeping. As we know, registers used to be kept separately in each treatment unit. Now it is organised differently and therefore we have better data. On the other hand, we see a lot of men starting to get sick. In the past, it used to be said that prostate cancer was a disease of pensioners and senior citizens, so it is worrying that today it is being contracted by active men who are just approaching senior age.
What is the treatment of prostate cancer like in the world and in Poland?
It varies enormously around the world because of therapeutic doctrine and the financial capacity of a country. The best example is treatment in Poland and our immediate neighbours, because then we are comparing countries of similar wealth with similar epidemiology. The treatment of prostate cancer has taken a huge leap forward over the past 10 years in Poland. Here it is important to emphasise the recognition of this problem on the part of the Ministry of Health. But this ten-year step requires further steps. Because today, in 2021, we are starting to diverge from our neighbours, our therapeutic and reimbursement doctrine assumes a different treatment for patients who have non-metastatic prostate cancer. It seems to me (I say this based on numerous publications in reputable scientific journals) that medicinal products attributed to treatment at the time of metastasis can be used in patients who do not have such metastasis (thanks to the drug, the patient has an increased comfort of life related to its extension). It seems to me that enzalutamide, for example, should be allowed in the drug programme before the appearance of metastases, because positive effects of its use can be seen in patients both without and with metastases. And in cancer, there is a rule of thumb to treat it as soon as possible, because a disseminated tumour is definitely a more difficult opponent than one organised in a single site. With cancer in one place, surgical techniques can be used. But they do not always help, because excision does not mean that the cancer is no longer there. And patients often think so. I myself often try to guide them out of this mistake. Because while it is important to have faith and hope, they need to remember that there are so-called cancer stem cells that circulate in the bloodstream, but you cannot see them. If they could be seen, we would catch them. Surgery therefore does not always give a cure for cancer. But as in everything, massiveness is important. That is why I believe that the fewer cancer cells there are, because there is a tumour excised, sometimes it is easier to fight the cancer cells that remain. To support such treatments, drugs are used in various therapies to destroy cancer cells that have not yet become established, that cannot be seen. In some simplification, we can say, that enzalutamide is the right drug to pursue such a therapeutic concept. This is confirmed by numerous publications in reputable scientific journals.
Does a Polish prostate cancer patient have the same access to therapy at every stage of treatment as a patient in other EU countries?
It depends on the system for measuring access. The Polish health service is not the best organised, but it is not my role to review this. That's what competent bodies are for, and they should deal with it effectively - organise it better. This doesn't require money, just a cool-headed view of the patient's journey from family doctor to expert cancer treatment. We are not a land of eternal happiness for patients who are treated for prostate cancer. On the one hand, there is an organisational, technical problem, which I think should be solved quite quickly, and on the other hand, the availability of certain therapies. There are also restrictions on approved molecules. I once met at a conference in Brussels with one of our deputy health ministers, who said there that, after all, we have these molecules reimbursed. He did not tell the whole truth, which I resented and which I tried to explain in the conversation, that, yes, the molecule is there, but it has such restrictive criteria for the inclusion of patients in the drug programme that only 10 per cent of those in need benefit from it. This is not a situation that, as a simple doctor, I accept.
How important is the form of administration of this medicine to the patient?
The form of the drug is important from the point of view of patient comfort and assimilation, absorption of the active substance, and may also be important for the pathway of the substance to a specific receptor. With regard to the aforementioned enzalutamide, the answer to this question is the pandemic, i.e. the time of limited access to the doctor (2.5 million fewer hospital admissions than before the pandemic). With such difficulties, the easier the drug is to administer, the easier it is for the patient to get to grips with the maze of recommendations and advice. And we can already see that enzalutamide has won out over other active substances not only for its therapeutic efficacy, but also for its easy application. All that seems trivial on the ward, in a situation where the patient is at home alone or with a terrified family, takes on a different status.
The latest data show that the pandemic has stunted cancer detection in 2021 due to patients dropping out of outpatient clinics. Have you also observed such a trend? Are the patients now turning up at more advanced stages of cancer?
Patients were cancelling their appointments for several reasons, including fear of the hospital where they could be infected with SARS-CoV-2, but also because many wards were closed. They called my foundation Together In Sickness and complained that there was not even any information on the door as to what they should do with themselves. This organisational problem puts the onus on the animators of our health service. To return to the question - all oncologists speak with one voice that they have not seen such advanced cancers as today for a long time. And cancer develops by leaps and bounds. In the beginning, not much changes, but after crossing a certain demarcation line, its growth is dynamic and frightening.
Source: medexpress.co.uk