Index – Belföld – Csaba Polgár: The National Institute of Oncology is at the forefront of cancer treatment in Central and Eastern Europe
The Minister of Human Resources of the previous government, Miklós Kásler, treated oncology as a priority area of health care, as a result of which HUF 10 billion in development resources were received by the National Oncology Institute between 2018 and 2022. Now that there is no independent health ministry, do they expect that the situation of the institution?
It is true that the national institutes, such as the oncology institute, have benefited from several important European Union and domestic sources of development in the past period, some of which are still ongoing. There was a change in the person of the minister, but for the last two years Sándor Pintér has been overseeing the health sector as the operational chief, so we do not expect a serious change of direction. The minister also said in the parliament that the new health management will continue the six public health programs, including the National Cancer Program.
On April 1 this year, the foundation stone of the one-day oncodiagnostic center was laid on the premises of the hospital, when it was said that the 12,000-square-meter, four-story building is expected to be completed in 2024. Construction has already started, where is this project now?
Two-thirds of the 31 billion construction investment of our new diagnostic block would be realized from EU funds withheld by Brussels. For the time being, we believe that the implementation plans have been completed, but the bidding process is delayed due to a lack of financial resources. We hope that Minister Navracsics will be successful in the negotiations with the European Commission, depending on this, further developments can continue. According to the news, negotiations are progressing well, and an agreement may be expected by autumn. We are confident that the given investment can be completed by 2026, even with a slight delay.
What are the benefits for patients if the institution is expanded with such a complex?
The institution has developed, but since the last expansion, the construction of the cancer center in 2010, it has been very busy, we treat patients every year, and we have more and more international and educational obligations.
The number of people treated at the institute is constantly increasing, each year around half a million people receive outpatient care, 20 thousand receive treatment-like treatment, and 16 thousand receive inpatient care.
Fortunately, the number of cured patients who are constantly coming for check-ups is also increasing, so the care of outpatients also requires more and more space. package, there are serious parking problems around the institute, as well as in the whole city center, the solution would be the two-story underground garage of the new building, our invasive gastroenterology, our endoscopy lab and our long-awaited PET-CT equipment will move to the next level. Our pathology and molecular pathology departments in the old barracks could move to the second and third levels, which would finally give them a place worthy of their quality work. At the very least, a national telemedicine center would be established, which would connect the 19 county and Budapest oncology centers and thus enable virtual oncoteams, without having to carry patients’ histology blocks or MR and CT images on CD from one institution. in the other, the entire Hungarian oncology network could be connected here with digital developments. This would reduce the time it takes to make an accurate diagnosis, and the patient could be sent to the appropriate institution sooner for the most effective treatment. With the digital connection of domestic cancer centers and the intensive exchange of scientific information, new working methods could be adopted more quickly.
The Czech Republic took over the presidency of the Council of the European Union on July 1, and the government considers the fight against cancer to be of prime importance. One of their important goals is to establish a comprehensive cancer center in each member within the next three years. In Hungary, the National Oncology Institute has had such accreditation since 2008. What is the advantage of the comprehensive cancer center?
There are cancer centers in every country in the European Union, but comprehensive accreditation has very serious criteria. Not only the complete therapeutic (radiation, chemo, drug treatment and surgical procedures) and drug treatment and surgical procedures) and the palette should be covered, but also in education, clinical and basic research, as well as in the treatment of rare diseases must go to such an institution, which is why yes. it must also function as an epidemiologic-methodological center and maintain a national cancer registry.
In this seven-year cycle, the EU is now allocating substantial sums of money to the “Europe defeats cancer” EU plan. After 205, they want2 to connect the comprehensive cancer centers of the countries at the European level, thereby ensuring the fastest possible flow of research, development, therapeutic and diagnostic knowledge. The accreditation has serious requirements, which the Association of European Cancer Institutes renews with an on-site inspection, we have already renewed it twice, so it is now valid until 2023 for the National Oncology Institute.
Ten European countries do not yet have an institution with this title, but for example, the Karolinska Institute in Sweden, one of the world’s best medical research centers, received this title only a few years ago. And in Central and Eastern Europe, Hungary is the only Oncology Institute accredited as a comprehensive cancer center.
The way forward is also in Hungarian, that regional oncology institutions such as Szeged, Pécs, Debrecen and Szombathely could be accredited at the cancer center level, or it would be even more ambitious if the oncology network were fully accredited. OOI can provide professional assistance in this, since several of our colleagues also participate in the European accreditation teams.
How does Hungary stand in terms of screenings, in addition to cervical, then breast and, more recently, colon cancer screenings, will new types of tumors be included in the public health program?
What the Union has noticed is that the participation rate in the various screenings is not the same, from which they conclude that the license needs to be improved. In our country, it would also be good to improve the willingness to participate in the free cervical, breast and colon cancer screenings provided by us. For lung cancer, it would be important to screen heavy smokers from the age of 50. we have passed the HUNCHEST 2 implementation cancer screening program in Hungary, in the Pull year, under the leadership of the National Institute of Germology, we screened more than a thousand heavy smokers aged 50-74 in 16 cities with the low-dose CT scan in the past 2 years, and we are now in the follow-up phase. So far, we have screened 61 cases of asymptomatic lung cancer patients, and in 48 of them (i.e. 79 percent), the lesion was discovered at an early, operable stage. With this, discovered lung cancers can be operated on by screening only 15 eyes. That is why we will continue the program in our country. According to the results of HUNCEST 2, we found 61 cases of malignant tumors among 4215 patients, all of whom were heavy smokers who had smoked one pack of cigarettes a day for more than 20 years. That is why it is important to emphasize that 95 percent of lung cancer is related to smoking. In Hungary, lung cancer accounts for a quarter of fatal cancer cases.
What else can we do besides not smoking to avoid malignant diseases?
Smoking is not only responsible for the development of lung cancer, it is also associated with many other malignant changes, such as kidney, colon, cervical, head and neck, bladder, oral cavity or even pancreatic tumors. But in the USA, where the vast majority of the population has given up cigarettes, the data can prove that the main risk factor there is no longer smoking, but obesity, which also plays a greater role in the development of cancer.
Unfortunately, the statistics in Hungary are not good from this point of view either, a large proportion of the older population – who are also at risk due to chronic diseases – suffer from being overweight. This is also why it is important that, in addition to quitting smoking, we pay special attention to achieving and maintaining an ideal body weight.
With 20 minutes of regular exercise a day, we can prevent the development of many diseases. In order to avoid tumors, we should try to eat as little smoked and red meat as possible in addition to a healthy diet, vegetables, vegetables and fiber intake.
Although there are many therapeutic options in Hungary, the KSH data show that since 1990, there has been little change in cancer-related deaths, with 30,000 people losing their lives every year. What is the reason of this?
Although the number of new cancers discovered annually has increased by more than 10 deaths in the last 15 years, or the stagnation of cancer deaths, it does not increase, which means that the chance of a patient’s recovery at home has improved by 1 percent in the last 15 years. The reason for this is the introduction of screenings, early detection, better diagnostic and therapeutic options. The fact that, unfortunately, the number of cancerous diseases is increasing is, on the one hand, related to the fact that, as in the whole of Europe, our society is also aging. product, the lifespan at birth has increased by 7 years since the system change. As we age and our cells age, more and more organ problems, chronic diseases or even cancerous lesions develop. Despite the rising number of cases, the objective of the National Cancer Program is to reduce the number of cancer deaths by 10% by 2030.
Which therapies are currently the most modern and showing the best results at the National Oncology Institute?
He participates in several targeted and immunotherapy clinical trials at the institution. In some respects, immunotherapy represented a paradigm shift and a new point of view, as the method tries to strengthen the body’s own defense against the tumor. In the last ten years, this type of treatment has really shown breakthroughs in certain areas, for example in melanoma, and many patients with advanced, distant metastases can be made completely tumor-free for several years. The way of the future also means individualized therapy in antitumor drug treatments, multigene tests can be used to determine antitumor targets. Serious progress has also been made in Hungary in recent years, the national molecular oncoteam was set up at the OOI, and with their cooperation, we are now able to carry out molecular pathology tests of 300-500 genes locally and at Semmelweis University with NEAK funding. However, the procedure is expensive and extensive, which is why it is only performed in the case of tumor types where it can have a real therapeutic benefit. In the area of minimally invasive surgeries, we have also caught up with Western European countries with the Da Vinci robotic surgery machine that arrived this year, and since 2018, we have been able to reduce the required radiation therapy time with the CyberKnife imaging radiation device.
To what extent has the shortage of healthcare professionals in Hungary affected your institution?
This is not so typical of national institutions. In the past three years, the number of our employees has increased in all areas. The best reason for this is that the Institute of Oncology has great appeal professionally, in terms of people, and in terms of infrastructure, and we can give the impression that it is still beyond us next year.
(Cover photo: Csaba Polgár. Photo: Réka Szabó / Index)