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Stucturing Cancer Care in Kazakhstan

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Stucturing Cancer Care in Kazakhstan
Primary – Secondary – Tertiary Care
Alexander Eggermont
ASTANA, 22 May, 2014
Cancer Worldwide Burden (2008 пѓ 2030)
12.4 million new cases
7.6 million deaths
28 million living with cancer
26.4 million new cases
17 million deaths
82 million living with cancer
Courtesy of Peter Boyle. IARC
2
Cancer the leading cause of death
Global and premature mortality rates in France in 2005
DonnГ©es de mortalitГ© globale et prГ©maturГ©e sur 2005 en fonction des causes
155 407
149 839
160 000
120 000
80 000
43 962
40 000
37 805
35 056
14 425
17 526
2 627
0
Tumeurs
CANCER
Maladies de
Maladie
de l'appareil Causes
externes
de
External
causes
Cardiovascular
Respiratory
l'appareil
circulatoire
respiratoire
blessuresuicide…)
et
(injuries,
disease
disease
d’empoisonnement
Global mortality rate
MortalitГ© Totale
Premature mortality rate
MortalitГ© prГ©maturГ©e
Source : CépiDc Database – 2005
LUNG CANCER
CANCER
France
Europe
World
Incidence
Mortality
Prevalence
320 000
144 000
800 000
2 600 000
1 600 000
8 000 000
12 000 000
7 600 000
28 000 000
Current smokers in France
15 Millions people
Males
Females
32%
21%
IARC 2008; INSERM 2007
Sturcturing Cancer Care in Kazakhstan
пѓ 0 LEVEL: PUBLIC HEALTH ACTIONS
• Public Health: understand demographics
• Start Cancer Registries
• Information Campaigns /Education / Awareness
пѓ 1ST LEVEL PRIMARY CARE/DIAGNOSTIC CENTERS
• Basic/ Early Diagnosis Campaigns (Breast, Colorectal, Cervix)
• Education, Awareness
• Screening programs (Breast, Cervix, Colorectal, Lung, Prostate(?))
пѓ 2ND LEVEL REGIONAL CANCER CARE CENTERS
• Multidisciplinary care of patients
• Develop INTEGRATED Surgery, Radiotherapy, Cancer Medicine
пѓ 3RD LEVEL COMPREHENSIVE CANCER CENTERS
•
•
•
•
TERTIARY TOP-NOTCH COMPLEX MULTIDISCIPLINARY CARE
RARE TUMORS
GENETIC COUNSELING
RESEARCH, RESEARCH / INTEGRATED WITH CLINICAL RESEARCH
Sturcturing Cancer Care in Kazakhstan
0 LEVEL: Public Health Campaigns
пЃ¶ Create Awareness:
пѓ Education / Information Campaigns
пЃ¶ Create Demographic Knowledge
пѓ Cancer REGISTRIES
пЃ¶ Install IT infrastructure at Levels 1-2-3
пЃ¶ Institute of Public Health
пѓ Cancer ,Cardiovascular, Infectious diseases, Obesity and
Diabetes, etc
PREVENTION and EARLY DIAGNOSIS
0 + 1 LEVEL
Tumors
Cause
Prevention Early Diagnosis
Lung
Head and Neck
Tobacco
Tobacco
Alcohol
Tobacco
Diet
Diet
campaign
campaign
campaign
campaign
campaign
campaign
Endoscopy
Vaccines
campaign
Vaccine
PAPsmear
campaign
CT screen
?
PSA screen ?
Esophagus/Stomach
Colorectal
Liver
Cervix
Hepatitis B/C
Alcohol
HPV infection
Breast
Lifestyle
BRCA1/2
Prostate
Age
(Barret) endoscopy
Stool / Endoscopy
PAPsmear
Mammography screen
Self Examination
Sturcturing Cancer Care in Kazakhstan
2ND LEVEL CITY /REGIONAL CANCER CARE CENTERS
пѓ MULTIDISCIPLINARY CARE SYSTEM
• Multidisciplinary Tumor Board structure
– Pathology, Radiodiagnostics,
– Surgery, Radiation Therapy, Medical Oncology
• Develop INTEGRATED care pathways
• All tumors except for:
– Very complex
В» Head and Neck/Esophagus/Pancreas
– Very rare tumors
В» Osteosarcomas, neuroendocrine tumors, paediatric
Sturcturing Cancer Care in Kazakhstan
3RD LEVEL COMPREHENSIVE CANCER CENTERS
пѓ CARE – RESEARCH - TRAINING
• Tertiary Care – Clinical/Translational/Basic Research – Training
пѓ TERTIARY TOP-NOTCH COMPLEX MULTIDISCIPLINARY CARE:
• Complex surgery + high precision radiotherapy + induction
chemotherapy
–
–
–
–
–
–
–
Neurosurgery of tumors
Neuroendocrine tumors
Head&Neck / reconstructive surgery
Esophagus
Pancreas
Locally advanced rectal cancer
Paediatric tumors
Comprehensive Cancer Center
Towards a Cancer Campus
Alexander EGGERMONT. MD, PhD
Gustave Roussy Comprehensive Cancer Center
Cancer Campus Grand Paris,
France
Premier Comprehensive Cancer Center in Europe
пЃ¶
пЃ¶
пЃ¶
пЃ¶
пЃ¶
+ 12000 new patients /yr
+ 50.000 treatments/yr
>10.000 surgical interventions/yr
>250.000 chemotherapies/yr
> 200.000 outpatient visits
Per January 2015
пЃ¶ 560 beds (including 90 outpatient beds/chairs)
пЃ¶ Expansion with 110 beds in 2015
пЃ¶ 230 FTspecialists + 200 PartTimeSpecialists
пЃ¶ Employees + 2800
пЃ¶ Budget:
пЃ¶ Research:
300 millions Euros
70 millions Euros
Key Missions
пЃ¶ Tertiary / Highly Complex Medicine
пѓ Complex Surgery/reconstructive surgery/stereotactiv RTX/ induction
radiochemotherapy, bone marrow transplantation etc..
пЃ¶ Rare Tumors ( > 20%)
пЃ¶ Care integrated with Clinical Research (36000 pts/yr in Clinical
Trials)
пЃ¶ Early Drug Development
пѓ (680 pts included in 2013 : >20% of CR program)
INTEGRATION of RESEARCH and CARE to
create TOMORROWS MEDICINE
50 000 Treatments per year
Spectrum of Cancer Treatments
Patients hospitalisГ©s avec localisation tumorale maligne
Neurologie
Essais prГ©coces
Sarcomes et t. 2,0%
1,3%
mГ©senchym.
Autres
4,1%
0,7%
PГ©diatrie
5,3%
Sein
24,1%
ThyroГЇde
5,2%
Poumon
6,5%
Dermatologie
6,5%
ORL
12,3%
HГ©matologie
6,9%
Urologie
6,7%
GynГ©cologie
8,0%
Digestif
10,4%
13
Clinical RESEARCH
пЃ¶ 3600 patients / year in clinical trials in 2013
пѓ 2010: 2160 pts – 2013: 3600
пЃ¶ 24% of new patients in clinical trials
пѓ 1/3 Pharma; 1/3 GR- led multicenter ; 1/3 IGR- single institution
пЃ¶ Drug Development Phase I/II # 1 in Europe
in Europe in Phase I
пѓ 2013 Creation of Department of Drug Development
• In 2010: 226 pts – 2013 : 680
BASIC + TRANSLATIONAL RESEARCH
CREATING A CONTINUUM FOR
Basic-Translational-Clinical RESEARCH
35 Research Groups: 450 Researchers, 240 Technicians
пЃ¶ Basic Research
пѓ Research Building 1 and 2 (each 5000 M2)
пЃ¶ Translational Research
пѓ Research Building 3 (6000 M2
пѓ Additional Laboratories in Hospital Building
пЃ¶ Clinical Research
пѓ Specialists, Research Nurses
пѓ Trial Office with 150 persons
Comprehensive Cancer Center
Towards a Cancer Campus
Alexander EGGERMONT. MD, PhD
Gustave Roussy Comprehensive Cancer Center
Cancer Campus Grand Paris,
France
Comprehensive Cancer Center
Towards a Cancer Campus
Alexander EGGERMONT. MD, PhD
Gustave Roussy Comprehensive Cancer Center
Cancer Campus Grand Paris,
France
Research Output and
Valorisation
пЃ¶ > 1400 publications in 2013
пЃ¶ 2003-2012: 7000 publications: H-Index 150
пѓ Number 1 in Europe
пѓ France : (2003-2012) : Curie 118, Leon BГ©rard 77)
пѓ Europe: (2003-2012) NKI (144), VHIO 118, Royal Marsden (89)
пѓ USA: DF(273), MSK(222), MDA(198)
пЃ¶ 125 with impact factor >10
пѓ 45
>20
пѓ 80
IF10-20
(10 x NEJM; 25 Lancet/Onc)
(27 x JCO; 16 x Blood)
150 PATENTS = 3 Spin Off companies
EDUCATION
пЃ¶ Only Doctoral School of Oncology in France
пЃ¶ MD/PhD Programs
пЃ¶ Oncology Nursing, Nurse Practitioners, Research Nurses
пЃ¶ INTERNATIONAL TRAINING PROGRAMS
пѓ Cancer Specialists (> 100 Kazakhstan specialists
in 3 years)
пѓ Technology Transfer
пѓ Transversal Oncology Courses (4 week programs)
пѓ Full specialist formation programs (2 years)
Come Visit Gustave Roussy in 2
Other INTERNATIONAL Developments
•
Saudi Arabia : medical, scientific, technical and teaching cooperation
for medical students;
•
Kazakhstan : medical and scientific cooperation with comprehensive
cancer centres, and the development of a second opinion service
(telemedecine);
•
Chine : exchanges on clinical, continuing education and research with
Fudan University, training of Chinese Directors, partnerships for the
development of innovative therapies ;
•
Algeria: teaching and assistance in setting up and operating local
cancer centres (invitation of the Minister of Health for a second visit
in March).
20
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