Sun. Feb 21st, 2021
Fighting childhood cancer with education: Russian Federation’s experience

Photo courtesy of the Rogachev Center press service

Artists of the Bolshoi Theater perform for child cancer patients of the Rogachev National Medical Centre
On International Childhood Cancer Day 2021, WHO/Europe highlights progressive ways to achieve better outcomes for children with cancer in the WHO European Region. The Russian Federation’s steps to merge paediatric haematology and paediatric oncology into one medical specialty is an inspiring example of how countries’ health and education systems can adapt to new methods and save children’s lives.

Childhood cancer: a different disease

Childhood cancers have fundamentally different characteristics and are being treated in different ways compared to “grown-up” oncological diseases. These cancer types are much more likely to be genetic and can develop before the child is even born.

More than half of childhood malignant neoplasms are haemoblastoses that damage the blood-forming immune system, the other 25% of cases damage patients’ nervous systems (central, peripheral or sympathetic). Most of these cancer types can be treated well with drugs and do not need any type of surgery.

“If I needed to treat cancer in my child, I wouldn’t allow a surgical oncologist to take the lead on the case. I would call a paediatric specialist who had enough experience and knowledge to establish a correct diagnosis and choose the correct therapy. Such a professional would be able to control all medication and, if needed, surgical operations,” explained Professor Aleksander Rumyantsev, President of the Dmitry Rogachev National Medical Research Centre of Paediatric Haematology, Oncology and Immunology, and Chief Paediatric Oncologist-Haematologist of the Ministry of Health of the Russian Federation.

Merging haematology and oncology for the benefit of patients

To train professionals of such quality, the authorities of the Russian Federation registered a new medical specialty in February 2021 that merges paediatric haematology and oncology. Until recently, these two specialties were separate in the country. A paediatric haematology-oncology course will become available in medical universities in the Russian Federation in 2022.

The medical specialty “paediatric haematologist/oncologist” was first introduced in the United States of America almost half a century ago. When the effectiveness of the system became evident, the same process was started in Europe and this specialty was broadly adopted in 2004. The Russian Federation has been moving in the same direction since the 1990s.

Importantly, a sufficient number of cases are required to gain expertise and allow health professionals to rapidly resolve crucial prognostic and therapeutic challenges in children with cancers. In a statistically average region of the Russian Federation, with a population of 1.5–2.0 million, paediatric oncologists used to treat around 30 children a year. Yet paediatric haematologists of the same region have 300 or 400 new child patients annually – with haemophilia, many other genetic blood disorders and immunodeficiency diseases. Most of them can be classified as premalignant conditions.

“Paediatric oncologists and haematologists often use the same methods, technologies and – what is even more important – the same base of medical knowledge. By merging these specialties, health professionals get an opportunity to easily share their experience for the benefit of patients,” says Dr Marilys Corbex, Senior Technical Officer on noncommunicable diseases, WHO/Europe.

Fighting cancer with Chekhov’s help

The Dmitry Rogachev Centre, with the help of the Russian Federation authorities, has been collaborating with WHO/Europe and Member States of the WHO European Region, adapting, promoting and developing modern childhood cancer treatment guidelines. The work has resulted in an improvement of survival from acute lymphoblastic leukaemia in those countries from 30–40% to 75–80%. Today, the survival rate in the Russian Federation is above 80%.

Introducing the paediatric haematology-oncology specialty, and improving the quality of diagnostic and clinical expertise, is an important step on the way to achieving one of the major goals of the WHO Global Initiative for Childhood Cancer – to reach at least a 60% survival rate for all children with cancer globally by 2030.

Another useful tool in this context is the Eurasian Alliance in Paediatric Oncology (EurADO), an association of paediatric oncological physicians and nurses, organized with the support of the Dmitry Rogachev Centre and St. Jude Children’s Research Hospital, United States of America. The alliance is aiming to improve the survival rate of children with oncological diseases across Eurasia. EurADO currently unites 13 countries and has a common database on cancer patients that can be used for medical practice and longitudinal scientific research.

“We need to remember, as Russian playwright and doctor Anton Chekhov said, ‘there is no national science, just as there is no national multiplication table’. Sharing knowledge is crucial for fighting cancer,” added Professor Rumyantsev.

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