In Bulgaria there is an opportunity for comprehensive and avant-garde therapy, says prof. Assen Dudov, medical director of “City Clinic – cancer center"
Prof.. Dudov, at what level is medical oncology in our country compared to that in the EU? Can it be argued, that the patient here gets that, which you would get in Germany for example?
In terms of knowledge and therapeutic possibilities, medical oncology in Bulgaria definitely approaches the highest European and world standards. Of course, questions about diagnostic possibilities come, as well as for some types of treatment, related to the need for state-of-the-art equipment. In this sense, purely medical oncology (chemotherapy) of solid tumors is at a very high level, but until now there have been difficulties in optimal diagnosis and concomitant or subsequent radiation or nuclear treatment.
In Germany, a quick and effective diagnosis of malignant tumors is carried out in a short time and in one place. In a short period of time, the patient is examined by an oncology committee, which in our country is called a tumor board. Chemotherapy treatment is then started, radiation therapy or a combination of both. This is a huge advantage, because it is timely treatment that guarantees better results. To start it though, perfect timely diagnosis in all its aspects is required. This applies from the simple X-ray examination through the computed tomography, SPEKT/CT other scintigraphic studies, positron emission tomography (PET/CT) etc.
What is missing in the organization and therapeutic manuals in our country, to be at the highest level?
Therapeutic guidelines in medical oncology or, as it is accepted to be called – pharmaco-therapeutic manuals (FTR), are an exceptional success in Bulgarian medicine.
The decision to have such mandatory documents standardizes care, as for cancer patients in the country, as well as for treatment in various other specialties. Many specialties have not yet submitted their projects to the FTR for consideration. Our guidance has been submitted to and accepted by the National Drug Pricing and Reimbursement Council (NSCRLP). The project was developed by the Bulgarian Oncological Scientific Society (BOND) on the basis of. the sun. gold standards, accepted by ESMO (European Society of Medical Oncology) and disgust (American Society of Clinical Oncology). Their work recommendations were also reflected in our manuals, as well as in the project, which we handed over to the NSCRLP. After working in the said council, the guide was accepted, after which it was published on the council's website and is now a mandatory element of treatment. In this sense, the therapeutic guide in medical oncology is state-of-the-art and comprehensive. Annual updates will be submitted to the committee.
Why, with prescribed excellent treatment rules and registered representatives of the main pharmacological classes, there is still a lack of good enough results?
First of all, the reason for this is the fragmentation of diagnostics in different medical facilities. And now we are witnessing how in most places patients are sent away on principle: "Go there and have your heart checked", "Do a scan or PET/CT at this or that hospital" etc. This also demotivates the sick, and staff, leads to chaotic movement of patients between different medical facilities. Often interpretation is by staff, who does not specialize in oncology and the patient receives inadequate, and sometimes even crazy advice, with the best of intentions. It is no coincidence that the "conductor" of diagnostics, the treatment and follow-up of cancer patients in the civilized world is the medical oncologist (chemotherapist). This change of roles in our country unfortunately plays a bad joke on patients as well, and on staff. As long as there are no clear rules, which must be strictly observed, and closed loop treatment at one location, will always introduce "noise into the system". However, this noise can be fatal for some due to the tearing of the method.
The lack of study of medical oncology during medical training also played an endlessly bad joke! Many colleagues graduate, then specialize, but they remain with insufficient knowledge or complete absence of such knowledge. They become wonderful specialists in their field, but their meeting with cancer patients is often associated with not very clear ideas of where to be directed. It's not their fault though, and is the deeply flawed medical education system in our country. In Europe and North America, people get sick and die most often from 2 causes - vascular diseases (heart attacks, strokes) and cancer. In order not to study cancer as the second cause of death in man, it's obvious, that there are gross omissions. This is why some majors accept, that they can do chemotherapy, which is so absurd, as much as if the chemotherapists decide to operate. So we have good therapy guides, but we have no universally observed effective doctrine. Most places lack the complexity of diagnosis and treatment.
The oncology section of "City Clinic" opens on Wednesday. Why did you set out to lead it? – what else is there?
My transition to work at City Clinic – "Oncology Center" was a big challenge, which I have rarely had. After 23 r. work in the former Capital Oncology Dispensary and 5 r. in UMBAL "Queen Joanna – ISUL" came the offer to work in an environment, completely in line with the ideas of the most modern oncological treatment, diagnostics and follow-up with super modern and unprecedented possibilities in Bulgaria. It engages me so strongly, because everyone, who knows me, knows, that the main thing in my life is modern and understanding treatment in the field of medical oncology. In this unique hospital of the future, patients can find the entire range of specific diagnostics, through which to achieve a complete outcome of their disease. Where is the tumor located?, what are its histological characteristics, what are the results of his immunohistochemistry, genetic study of tumors, studies at the level of metabolism through skillfully selected isotopes for the specific patient, which in the conditions of PET/CT and some other similar methods give unique information, which serves for the further construction of a diagnostic and treatment algorithm, individualized and refined for each specific patient.
The radiation treatment options are also unique. They include 3 state-of-the-art linear accelerators, which have not only the best hardware, but also unique software. Two of the devices are capable of performing stereotaxic radiosurgery, for which Bulgarians now travel to Western European countries or Turkey, because there is no such type of radiation surgery in our country. They will be able to quickly and efficiently, in just minutes, to perform radiation operations on primary brain tumors or metastases from other sites; radiation operations of primary and metastatic tumors in the lungs, pancreas, the liver, lymph nodes in the retroperitoneum and a number of other hard-to-reach places. All this is completely new for Bulgaria and repeatedly increases the chances of cure and long-term extension of life.
The equipment for brachytherapy will also be unique - application of local radiation therapy for localizations such as cervical cancer, prostate cancer and, I want to emphasize - head and neck tumors, where this method is not applied in the country. This will not only extend the lives of many patients, but surgical interventions carried out so far will be avoided, that mutilate – for example removing part or all of the language, salivary glands, parts of the cheek, etc.
The combination of radiotherapy with chemotherapy will be one of the leading prospects. The lead will be the organ-preserving approach. This method, used, for example, in rectal cancer (the lowest part of the large intestine), provides an opportunity for an excellent healing effect and in most cases helps to prevent the so-called. artificial anus on the abdominal wall.
What medical oncology will offer?
It will enable treatment with all classic antitumor drugs and with biological therapy, targeting specific genetic characteristics (targets). Medicinal products will be used, which directly attack tumor cells and this is the so-called. target (target) therapy. These targets will be detectable here as well, for which we have a state-of-the-art genetics laboratory. There are other unique methods, which the hospital has, to prescribe the right drugs for the right patient at the right time. Everything is so well maintained and at such a level, that presents a challenge for any clinician, who works oncology. Of course, purely domestic conditions are also important, which are in the highest standards for the construction of a medical facility as they are intertwined with the most modern medical technologies. The hospital was designed by leading US companies.
Can the flow of patients to Turkish oncology clinics really decrease??
The availability of state-of-the-art treatment options will sharply reduce the flow of patients from Bulgaria to the countries of Europe or Turkey. Moreover, we will have such a base, that the opposite is very likely to happen - patients from Europe or Turkey, who wish to have their treatment at our place. This is quite possible, because patients in these countries are well informed and will quickly find out where cutting-edge treatment is available. Unfortunately, Bulgarians are not well informed about the treatment options in the country and abroad. In this regard, the new hospital will also offer them a patient center, in which such information will be provided, so that they can make a decision under conditions of unbiased informed choice.
