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06.02.08
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United To Fight Cancer
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Comment by Vladimir Frolov
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When Antonina Gromova, a slender, 34-year-old computer engineer from Moscow, first felt a lump in her left breast two years ago, she did not think much of it and did not go to a doctor. Two years later, she woke up with horrible pain in her back. For several months, she was treated for all kinds of back pain, until a tomography scan revealed major damage to her spine from metastatic breast cancer. She was given a wheelchair and a few months to live. Her only stroke of luck was to enroll into a clinical trial of innovative anti-tumor drugs at the Russian Cancer Research Center in Moscow. Today, she drives a car and is writing a book about battling her cancer.
Natalia Shestakova, a warm and energetic woman in her early fifties, had been feeling sick for almost seven years, all the while being brushed off by her local doctor in Moscow, until July 2003, when she was diagnosed with advanced breast cancer that had already spread to her liver. She was told she had three months to live. She, too, was lucky enough to be admitted into clinical trials for a new anti-tumor drug – herceptin (trastuzumab) –a monoclonal antibody that is the latest and most advanced oncology weapon in the fight against breast cancer. She is now a walking miracle, with her cancer, which was deemed incurable, gone completely.
When last year, at the age of 33, Anna Larionova, a pretty and boisterous woman from St.Petersburg, was told she had an aggressive form of breast cancer, she felt the world was crushing down on her. A mother of a six-year-old girl, she decided to give cancer, which had already metastasized to her spine and her left hip causing enormous pain, the fight of her life. Her only chance of survival was herceptin and another innovative drug to combat bone metastasis with an overall price tag for treatment exceeding $150,000 a year. She did not have that kind of money. She got some of the drugs under the Federal Drug Reimbursement Program for people with disability status (DLO). But soon the money in the program dried up and she was left without the medicine that could save her life. She was fortunate to be enrolled into a clinical trial in which Western pharmaceutical companies provided free drugs. She now goes to a dance class with her daughter despite the fact that the cancer destroyed one of her vertebrae.
I came across these courageous women last Monday at the first forum of the Movement Against Cancer, a patients advocacy group recently set up to fight for the right of cancer patients in Russia to have access to innovative treatment and new cancer drugs. They have a long road ahead.
Cancer is the third largest killer in Russia, after heart disease and alcohol poisoning. Every year, more than 300,000 people die of cancer. Another 150,000 become invalids. There are 450,000 new cancer diagnoses each year, 50,000 of these are breast cancer, the largest killer among women. The number of cases is projected to increase as the Russian population ages.
Cancer survival rates in Russia are the worst in Europe. The five-year survival rate from all types of cancer in Russia is at a dismal 43 percent. In France and Austria it is 61 percent; in Sweden – 62 percent. In large measure, such high cancer mortality rates in Russia are due to the lack of guaranteed access of cancer patients in our country to innovative methods for cancer prevention and treatment.
Russia’s spending on oncology care and particularly on cancer drugs is inadequate. In 2006, Russia spent about 570 million euro ($845 million) or 4 euro ($6) per capita on cancer drugs. By comparison, per capita spending on cancer drugs in the United States in 2006 amounted to 38 euro ($56), in Canada – 28 euro ($41), in France – 22 euro ($32.5), in Italy – 19 euro ($28), even in Poland it was 9 euro ($13).
Since 1971, the arsenal of cancer drugs has tripled. Expediting access of cancer patients to innovative cancer drugs has become a standard policy for medical authorities in most developed nations. In the United States and in the EU between 1995 and 2003, better access to innovative drugs helped reduce overall cancer death rates by 30 percent.
Treating cancer with innovative anti-tumor agents is very expensive. Most cancer patients cannot afford to cover such expenses out of their own pocket.
Many countries have introduced special government reimbursement programs for innovative drugs to reduce the financial burden on cancer patients (which can run between $30,000 and $70,000 a year for a treatment program). Croatia, a country with population of 4.3 million – similar to the Russian Republic of Tatarstan – allocated $40 million for innovative oncology drugs in 2007, more than the entire 2007 DLO budget for Tatarstan, which totaled $26.7 million.
In 2005-2006, for the first time, the federal drug reimbursement program for people with disabilities (DLO) gave many cancer patients an opportunity to receive treatment that included modern effective medicines. In part due to this, mortality rates in Russia dropped for the first time in 2006.
However, it was a mistake not to allocate funding for innovative anti-cancer drugs into a separate federal program. Voluntary withdrawals of participants from the DLO have severely affected the access of cancer patients to expensive medicines. Due to diminished funding for the DLO in 2007, procurement of anti-cancer drugs was cut in half – 6.4 billion rubles in 2007 compared with 12.3 billion in 2006.
Regional drug reimbursement programs cover a much smaller number of eligible patients. Cancer patients enrolled in these programs get access to innovative cancer drugs only at advanced stages of the disease when chances for survival are low. And even then, getting the drugs is always a challenge since it requires fighting bureaucracy every step of the way. The system does not cover patients at early stages of the disease whose chances for survival and even complete recovery are much higher.
For example, about 50,000 women in Russia have a highly aggressive type of breast cancer. They all need at least a year-long course of treatment with herceptin, which is the only effective treatment for this type of breast cancer. Without this drug, they will all die within a year or two. The drug costs about $6,000 per month. In the first half 2008, the Russian federal and regional health agencies purchased enough herceptin to treat 359 patients.
Ilona Vasileva from St. Petersburg, another founding member of the Movement Against Cancer, knows well what it is like to be denied the medicine that provides the only hope for survival. Last year, at the age of 35, she was diagnosed with an aggressive form of breast cancer, which, as her doctor correctly informed her, could only be treated with herceptin.
She received treatment for one month with this drug before being told that the money in the federal drug reimbursement program that covered her drugs had run out. There was money in the regional drug program, but as a cancer patient she was eligible for drug coverage only in the federal program and the city of St. Petersburg could not cover her. She was desperate. If the treatment were interrupted, her cancer would stop reacting to the drug and spread. Her doctor provided her with leftovers of herceptin from other patients and pushed her to fight for her rights. She appealed to the regional health agency – only to be rebuffed. She wrote letters to members of the city legislature. Only one of them agreed to help and advised her to file a legal claim against the city authorities. She finally got her next regimen of medicine under the regional drug program. After living through this experience, Vasileva realized that she had to help other patients fight for their right to live.
“The Russian state on paper guarantees cancer patients free access to effective anti-cancer treatment,” saidVasilieva, “but in reality, many patients are denied innovative and expensive drugs that have made a difference in cancer care around the world. In Denmark, a friend of mine, a breast cancer patient, has been doing her third consecutive year of herceptin therapy (with very good results) with all drug costs covered by a special government program. Why should Russian women be worse off than women in Denmark? Our politicians are talking about raising birth rates and paying money to women for a second child. Well, why don’t they pay for my treatment so that I could live to raise my daughter?”
She will not find answers to her questions from any of the men running for president of Russia. |
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