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Russia - Patient organizations and insurers call for elimination of violations of the rights of cancer patients

Russia (bbabo.net), - Clinical guidelines for the treatment of various nosological forms of cancer contain provisions that violate the rights of cancer patients to timely and high-quality medical care. Participants of the All-Russian XII Forum "Movement Against Cancer" spoke about this. Based on the results, at the initiative of patient organizations and the medical insurance community, a letter will be sent to the Ministry of Health and the government with specific proposals for finalizing the document.

“It is worrying that certain clinical guidelines for the treatment of cancer contain norms that allow for the possibility of violating the rights of patients to receive affordable and high-quality care, which may interfere with the achievement of the targets of the federal project “Fight against Cancer,” believes the chairman of the coordinating council of the Interregional Public Movement "Movement against cancer" Nikolay Dronov.

As an example, the expert cited the document "Practical recommendations of the Russian Society of Clinical Oncology (RUSSCO)", in which a new section appeared: "General principles of antitumor therapy". "This section includes an unlimited range of assumptions for shifting the dates of the start of the next cycle of chemotherapy and targeted therapy without medical reasons - it is allowed to start a course of treatment three days earlier or later than the planned date due to production needs, public holidays, "for family reasons" and and so on," Dronov explained.

He noted that because of this assumption, other important documents began to change, not for the better for the patients. For example, last year the Russian Association of Oncologists also allowed in its clinical guidelines the possibility of deviating from the timely chemotherapy cycle in women with breast cancer. Although previously adopted by the same RUSSCO "Practical Guidelines for therapy of Breast Cancer" actually forbade increasing the intervals between chemotherapy cycles.

According to insurers and patient organizations, such a relaxation of the norms protects the interests of medical organizations, but not cancer patients. As part of the national project "Fight against cancer", insurance medical organizations check how optimal treatment regimens are observed in medical organizations, and in case of violations, doctors have to pay fines.

"These changes were made in order to be able to shift the terms, but at the same time avoid financial responsibility for these serious violations of the rights of citizens to timely chemotherapy. No "production needs" can be the reason for the violation of the rights of oncologists. Chemotherapy must be carried out in a timely manner, exactly according to the scheme provided for by the instructions for the medical use of the drug, with observance of dosages and intervals when administering the drug.The same fully applies to the use of other drugs, including expensive targeted drugs.Shifting the terms in one direction or another, even by three days - this is a gross violation of the patient's rights to timely and high-quality therapy," Alexei Starchenko, doctor of medical sciences, member of the Council of Public Organizations for the Protection of Patients' Rights under Roszdravnadzor, adviser to the insurance medical organization Capital MS, explained to Rossiyskaya Gazeta.

The expert emphasized that the order of the Ministry of Health No. 203 "Criteria for assessing the quality of medical care" clearly states that the refusal to comply with the requirements of the instructions for the use of a medicinal product is a gross violation. “The order is valid, the use of drugs is possible only in accordance with the instructions, violation of the requirements specified in it, including changing the duration of the intervals between courses of treatment without medical indications, is clearly a criterion of inadequate quality,” Starchenko insists, because otherwise the risk increases disease progression.

“Any “productive interests” that are not aimed at respecting the interests and legitimate rights of the patient are illegal and unlawful. In addition, even the very thought of neglecting the interests of the patient and creating a risk of progression of a malignant neoplasm in him can cause serious psychological harm to the patient, and this is doubly unacceptable," the expert emphasizes.

Another negative point that advocates of patients' rights discussed concerns the experiment, which began in January 2022 in Moscow. The project itself is excellent: at the initiative of the Moscow Oncological Society, Moscow oncologists are to conduct "observational studies" during which they will evaluate the effectiveness of new cancer drugs "in real clinical practice". It would seem that cancer patients will have the opportunity to be treated with the most modern, latest medicines. But there is a significant "but".“For drugs that are not included in the list of vital and essential drugs, the medical commission makes a decision, and taking into account the verification of the property security of the patient who will be prescribed these drugs,” Starchenko explained. “The criteria for this property security, in accordance with which these drugs can be given to the patient - the ownership of no more than two residential premises and the availability of funds in the bank account: an amount that does not cover the funds for oncological drugs, which the patient claims to receive.

But such an approach will inevitably divide patients into those who can receive treatment for free, and those who will have to pay for it. “According to Article 19 of the Constitution of the Russian Federation, the state guarantees the equality of human and civil rights and freedoms, regardless of gender, race, nationality, language, origin, property and official status. The introduction of a property security check is discrimination against patients,” said Alexei Starchenko.

He also warned that such a "dual" approach in the choice of drug therapy will certainly lead to serious conflicts and litigation.

In the All-Russian Union of Insurers, in turn, they say that they will protect cancer patients in case of violation of their rights.

"We are ready to reach the Supreme Court on the appeals of patients, if they apply for compensation for moral and material damage," Starchenko stressed.

Russia - Patient organizations and insurers call for elimination of violations of the rights of cancer patients