Representatives of the World Health Organization’s International Agency for Research on Cancer (IARC), the Organization of European Cancer Institutes (OECI) and ERASMUS University Medical Center (EMC) are involved in the project as experts.
The project “Improving cancer care coordination and screening in Latvia and Slovakia – ICCCS” has been running since the beginning of 2022 at the initiative of the Institute of Clinical and Preventive Medicine of the University of Latvia (LU KPMI). The goal of the project in Latvia is to promote equal access to health care for cancer patients, and its expertise is divided into three areas – cancer screening, cancer registry and the creation of a comprehensive cancer center and cancer care network. The idea of the project arose based on the recommendations of the Council of the EU Cancer Mission.
The results will help to organize the system
The project is also led by Professor Mārcis Leja, Director of the Institute of Clinical and Preventive Medicine (KPMI) of the University of Latvia (LU) and Rolands Lappuķe, Advisor to the President on Smart Technologies. The project management model was approved by the Ministries of Health and Finance.
“Essentially, we will gain a set of proven experience, knowledge and opinion, which will provide opportunities to avoid failures and predictable mistakes in arranging the care of cancer patients and creating its future,” sums up Mārcis Leja.
With this project, we are moving towards a more thoughtful, modern and efficient care of cancer patients. “We will get a set of recommendations tested in practice, and we just need the political determination to implement them,” says the professor.
According to him, the results of the project should be evaluated as a technical support tool, but political support is also needed so that Latvia can implement and implement everything necessary.
Three directions for improving care
The main areas were identified in which the experience gained abroad is very important, and they are – improving and organizing the cancer registry, planning cancer screening to comply with the concepts and principles of European countries, and moving towards the European Commission’s setting that every member state should have a comprehensive cancer center .
Working groups have worked in all the mentioned directions, experts have visited several times, got acquainted with the work of health organizers, as well as processes in medical institutions and research organizations, including universities. There have also been meetings in which not only Riga specialists were involved, but also from other places, explains Mārcis Leja. The involvement of organizations representing patients was essential.
The recommendations will in a sense be a guide on how to do what is necessary, what steps to take in order to reach the best possible result. Therefore, the presentation of the results will largely be the central event of the entire project. After that, they may be polished and formalized until they are presented to policy makers and decision makers, specifically the Ministry of Health.
The opportunity to work at a global level
“It is also of great importance that, in our opinion, the best experts with relevant experience, knowledge and opinion are involved in the working groups. In this case, it will be an opportunity to exchange opinions, not only with specialists, but also with representatives of society and patients, who were not present during the project implementation process,” emphasizes Mārcis Leja.
He emphasizes that the summary of results will not contain recommendations for all life situations, but they will be about the most important areas, the most essential that the experts have found.
In connection with a system, including a cancer registry, often everyone understands something of their own, however, there are internationally necessary principles that are the absolute minimum, and the rest could be regional needs. “In the context of this project, we pragmatically try to stick to the fact that we should be guided by international experience and standards. And that is exactly what the experts involved in the project can bring to us,” emphasizes M. Leja.
Among the experts, Andre Carvalho, senior scientist of the International Cancer Research Agency, has assumed the international management of the project, and Simon Oberst, director of quality and accreditation of the European Cancer Institutes Organization, is also an active participant. For many, a “new world” was opened in Latvia by ERASMUS University Medical Center (Erasmus University Medical Center) Professor Iris Lansdorp-Vogelaar on cost and effectiveness modeling of cancer screening.
Well thought out and properly organized cancer screening can be and is cost effective. She has also outlined the essential prerequisites for cost-effective cancer screening. She is one of the world’s leading experts in this field, and her methodology has been used in many countries, including Europe and the United States.
State, regional and local policy makers will be provided with knowledge and the opportunity to systematically evaluate and quantify benefits and losses in breast, cervical and colorectal cancer programs with a special tool, outlining the most important economic benefits from effective cancer screening, prerequisites for ensuring effective cancer screening. It is important that in the future the European Commission also foresees the introduction of prostate, lung and stomach cancer screening. It should be noted that in the field of gastric cancer prevention, the performance of Latvian specialists plays a significant role in the creation of the entire European program.
Extensive and comprehensive expertise
The total field of work is quite wide. Marcis Leja lists examples: “There are genetics and diagnostics, clinical trials, radiotherapy, palliative care, human resources, digitization, multidisciplinary teams, patient involvement and the move towards comprehensive cancer networks”.
“They have identified and analyzed each area in detail, there are appropriate assessments of the situation we are in. For example, sometimes the hardware is at a very good level for us, but gaps or faulty solutions cause problems in organizational matters. In addition, as we know, there is a threat that our good specialists may go to work abroad,” explains the professor.
“And if otherwise we would have to pay for them separately, then in this case their work was fully paid for by the European Commission, and the experts were present and participated. We would like to hope that it will have a real effect already,” says M. Leja.
He explains that the screening platform as such in Latvia was not even included in the digitization plans for the next few years, but it will have moved thanks to communication with experts and a very positive attitude from state structures – the Ministry of Health, the Center for Disease Prevention and Control (SPKC), the National Health Service.
Currently, Latvia has formally moved ahead of the European recommendations in the field of screening, screening for four types of cancer is considered to be implemented in Latvia – breast cancer, cervical cancer, colorectal cancer and prostate cancer, although the implementation of the latter was not recommended by the EU until now. However, in reality, we do not reach the mandatory minimum indicators for any of the above-mentioned tumors, which shows that the screening organization does not work in the current model. We are not even able to record the minimum quality indicators that are a prerequisite for organized cancer screening.
The expert report will cover a very wide area, it also includes recommendations, the implementation of which would also improve the future, for example, modern diagnostics, molecular councils and similar things.
A similarly positive collaboration applies to the issue of comprehensive cancer centers. With the support of the Ministry of Health, the Riga Eastern Clinical University Hospital has started the path to the creation of an internationally accredited cancer center, but EU recommendations oblige each member state to go much further, creating a “comprehensive center”, which means excellence not only in clinical medicine, but also in research and in education, explains Marcis Leja.
Cancer Center Levels of Excellence
A cancer center, a comprehensive cancer center and a comprehensive cancer network are three different things, but very closely related. Mārcis Leja explains that the basis of the comprehensive cancer center must be a structure built in a specific place – a cancer center, and currently Latvia is going to this cancer center as the first stage. It is a specific institution, but it should be taken into account that now not only a cancer center as a structure is required from each member state of the European Union, but a comprehensive cancer center and a comprehensive cancer network, which is included in the conditions of the European plan to defeat cancer.
Only the cancer center means excellence in clinical medicine, treatment, diagnostics, cooperation with family doctors. Conceptually, it is excellence in medical care within one center, it is one institution.
A comprehensive cancer network, not a center, would mean that Latvian residents would receive high-quality treatment not only in the Riga East Hospital, but also in Liepāja, Daugavpils or other hospitals, and this already means many institutions.
On the other hand, the comprehensive cancer center, along with excellence in the clinic, also includes excellence in research and also in education. “Currently, none of the hospitals in Latvia can really achieve this. At least because, while in some countries all research is done through hospitals, we don’t have it. Our hospital does not meet the status of a research organization, research is not directly funded in the hospital, except for drug research clinical trials. But we have institutions that carry out very high-level clinical research in oncology, for example, the Latvian Biomedical Research and Study Center, the Latvian Institute of Organic Synthesis, as well as universities – UL and Rīga Stradiņš University. How much more comprehensive would we get if we united these forces – not only artificially on paper, but they should be jointly planned, organized, involved. For example, in state research programs, these institutions already work together, but it is for a specific project,” explains Mārcis Leja.
“For us to talk about a comprehensive cancer center, there must be a stable, well-defined and organized collaboration between all institutions operating in the relevant field. Then we would come very close to meeting the criteria required for a comprehensive cancer center. We are at the beginning of the road, and it will not be easy for us to achieve the accreditation of the cancer center, but we have other institutions and research organizations that are very competent. Perhaps Latvia could serve as a model for other European countries, how it is possible to reach comprehensive cancer centers, because there are still many countries in the process of the next level,” summarizes the professor.
Cross-sectoral cooperation is necessary
“What the experts will expect from Latvia will be the implementation of these recommendations. It also has certain deadlines – the next year and a half, when there should already be some results. But I think we can be quite calm, because the results of the recommendations given by the experts are already here, before the end of the project. But for us to be successful, it is essential that the implementation process does not stop,” says Mārcis Leja.
He informs that, based on the advice of international experts, the Steering Committee of the project was established, which included representatives of several ministries – Ministry of Health, Education and Science, Ministry of Finance, Environmental Protection and Regional Development (VARAM) – and their subordinate institutions. , as well as representatives of patients and other institutions. The monitoring committee is supervised by the Minister of Health Līga Menľelsone.
The involvement of several ministries and institutions is necessary, because, for example, research is under the auspices of the Ministry of Education and Science, cancer survivors are under the supervision of the Ministry of Welfare, cancer registry and screening – it is digitization, data exchange, which is under the supervision of VARAM, and similar with other competences.
“Going a step further, I would like to emphasize what the international experts also recommended in their report, that in order to achieve the comprehensive cancer infrastructure, representatives from different hospitals, different universities, different ministries, different research organizations should come together first informally and then formally. And it should become a structure where everyone participates in planning how to better arrive at the result. Currently, at the European level, there is talk of centers, cells, or hubs, in which people who want to act are represented from all institutions,” emphasizes Mārcis Leja.
The project “Improving cancer care coordination and screening in Latvia and Slovakia” is financed by the Directorate General for Structural Reform Support of the European Commission (DG REFORM).