On April 10 2008 members of the European Parliament (EP) passed a resolution on combating cancer in the enlarged European Union . Through this resolution they draw attention to the dramatic rise in incidence of this illness in Europe. The European parliamentarians consider prevention to be the best combat strategy and ask the Commission to allocate finances in the 7th Framework Programme for the support of research and innovation in the area of primary prevention, screening and timely diagnosis of cancer and new medicines and treatment. The Czech Oncological Society (COS) is providing information on the current situation in the Czech Republic in this statement
In the Czech Republic three screening programmes aimed at early diagnosis of breast, cervical and colorectal cancers are currently in place. Vaccination against human papillomaviruses (HPV) that protects young women from cervical cancer is also accessible. Men over 50 years of age pass standard procedures for establishment of the level of prostate specific antigen (PSA). An elevated level of this substance in the blood leads to further detailed diagnosis of the prostate gland. COS supports all screening programmes and other activities contributing to early detection of tumour illnesses. It identifies with the EP’s call for the introduction of further techniques of early diagnosis as soon as they are scientifically confirmed. At the moment this is true especially for colorectal carcinoma diagnostics. COS is preparing together with Gastroenterological Society of the Czech Medical Society of Jan Evangelista Purkyně a proposal for preventive examination that should include in addition to detection of concealed haemorrhage in the stool (haemoccult) also endoscopic examination of the colon (colonoscopy) in the 50th year of age.
Members of the EP call for the establishment of oncological registries in the Member States in order for the elaboration of a Union-wide study of the incidence of cancer and the differing survival prospects for people diagnosed with the disease. The Czech Republic possesses a unique instrument in this field that can serve as a model to other EU Member States. For several decades now the Czech Republic has had the National Oncological Registry (NOR). Data collection in favour of this registry is obligatory by statutory instrument and at the same time absolutely essential for the planning of the needs of oncological care and the evaluation of its impact. The collection of data, its verification and storage currently cost around 10 million CZK yearly. A presentation of epidemiology of malignant tumours in the Czech Republic is available to every citizen through the interactive national portal www.svod.cz. In close connection to this national population registry the COS ensures the running of other clinical registries following mainly the most expensive anti-tumour treatment and its results. In individual complex oncological centres registries following the quality of provided care are also being established.
The EP is appealing to the Member States to ensure that all over their territory multidisciplinary oncological teams will be available so that all patients can be provided with optimal individual treatment. As far as it concerns the COS also this point is solved in our country. The Czech Oncological Society has since January 1 2006 accredited a network of 18 workplaces, in which the patients are guaranteed complex care in the field of diagnostics and treatment of tumour illnesses. It consists of medical facilities bearing the status of complex oncological centre (KOC) or complex oncological group (KOS). There is room for improvement in the area of education of oncologists and medical personnel so that they can identify in time the psychological and social needs of patients in the interest of improving quality of life and alleviation of the patients’ distress and depression. Most of the KOCs do not have their own psychologist and in the social area the oncological patients still do not receive proper information of the type: how to apply for disability pension, where to seek assistance in case of lack of financial resources, etc.
The EP in its Resolution urges the Commission and the Member States to acknowledge oncology as medical specialization and ensure life-long learning for oncologists in line with the agreed guidelines. In the Czech Republic oncologist prepare themselves for two years in the area of internal medicine, after which attestation follows in the area of radiotherapy or clinical oncology. Czech oncologists can also take advantage of continuous life-long learning. Medical doctors from other fields (ORL, surgery, stomatology, etc.) can supplement their education with institute study, but only in their field of original expertise. The EP is calling on the Member States to support and promote palliative care - that is care for the incurably ill - and to elaborate guidelines for its employment. In the Czech Republic palliative medicine is established as an independent field. There are 12 hospices on the territory; medical doctors devoted to the problematic have 2 monographs as text books at their disposal and for practitioners there is a manual on how to approach patients that are being provided palliative care.
The EP calls for the securing of distribution of best practices in treatment and care through networks of medical workers so to ensure that citizens have access to the best available treatment. This demand is in the Czech Republic supported by the internet site www.linkos.cz. The web is designed for professional public but also - in a special section - to people diagnosed with oncological illness, their friends and family. The web is regularly updated with new information. Its visit rate is approaching 30 000 unique accesses monthly. Further, the “National Oncological Programme On-line” is aimed more at professional public. At www.onconet.cz the network of complex oncological centres is presented, their equipment and projects in progress.
From the patients’ point of view the availability of anti-cancer drugs if important. COS has a detailed overview of the availability of different oncological medicines in our country. It shows that the availability of medicines for the moment exceeds the current demands of doctors working throughout the country. Nevertheless, this disparity is relative as the most demanding oncological treatment is available only in the Complex Oncological Centres and it still remains to be resolved whether all patients are properly directed for treatment to oncological centres. For final resolution of this question cooperation between the KOCs and regional oncologists must be improved, but so must the medical literacy of the Czech public. Only a well informed patient can actively contribute to decisions taken in the course of his or her own treatment. The web www.linkos.cz/pacienti serves this purpose; it is an open and guaranteed source of information about oncology for everyone.
The EP encourages the Commission and the Member States to investigate in the framework of a high-level pharmaceutical forum the ways to provide patients with access to innovative and life-saving anti-cancer medicines. It sees the solution in their faster introduction to the market and more rapid approval through a centralized EU procedure. A conditional process is to be considered while data is collected on the drugs’ value to the patients in real application. This is assured by newly set-up system of price generation and coverage in the Czech Republic. The EP is calling on the Member States to adopt in line with European guidelines national charters of patients’ rights and to include the patients and their views in the formulation of health policies. In the Czech Republic we do not have a charter of patients’ rights. There is however a set of rights of the patients and it is displayed at every medical facility. We have the National Oncological Programme that was elaborated to match the conditions and needs of the Czech Republic and in conformity with the conclusions of the World Health Organization (WHO) adopted on the control of tumour illnesses. The Czech Republic’s National Oncological Programme aims at reduction of incidence of tumour diseases and lower mortality rate, at improvement of quality of life of cancer patients and at rationalization of expenses for diagnostics and treatment of tumour illnesses in the Czech Republic.
Not unimportantly the EP also urges the governments of the Czech Republic and Italy, which have not done so to this day, to ratify the Framework Agreement on Tobacco Control that came into force in February 2005. COS repeatedly urged the lawmakers to ratify the Framework Agreement.