Provision of cancer care in Eastern Europe

Abstract

During a visit to Poland and Croatia in February, I heard from oncologists about the effect that the political developments in this region have had on cancer incidence, detection, and treatment. Poland and Croatia ended the 1980s in a similar position. Both countries had relatively liberal communist governments and were open to Western influences. Their experiences since then have been dramatically different. Poland now stands on the brink of EU membership, possibly as early as 2004, whereas Croatia, after suffering a damaging war of independence in the early 1990s, is barely on the starting blocks. Cancer treatment was given high priority in east-central Europe throughout the twentieth century, even during periods of financial crisis and rapid change. Services set up during the relatively prosperous 1970s were maintained during the financial crisis of the eighties and subsequent upheavals. Marie Curie herself opened the Radium Institute in Warsaw in 1932 (figure 1), with a gift of a gram of radium from the USA. The original institute was burned down during the Second World War but rebuilt a few years later, and still functions as the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology (figure 2). This institute now serves all of Greater Warsaw, an area covering a population of about five million people. About a fifth of new cancer cases in Poland are referred there, and it offers a full range of modern treatment modalities including combination therapies. “Over 60% of radiotherapy and 70% of chemotherapy is now delivered on an outpatient basis, or in a day hospital, which is less expensive and which the patients prefer,” says its director, Marek Nowacki. In addition, because the Polish currency, the zloty, is now fully convertible to other currencies, it is possible to import expensive equipment and drugs from the West. Oncologists in the institute are currently involved in close to 200 different clinical trials, involving drugs, radiotherapy, mixed modalities, and novel biological treatment methods. Many are conducted in According to the World Health Organization, in 1990, a 15-year-old boy from the former Soviet bloc was less likely to reach his sixtieth birthday than his counterparts in many less developed countries, including China and India. But disease patterns in Eastern Europe were already similar to those in the established market economies. This immense burden of disease was almost entirely due to an “epidemic” of cancer and other noncommunicable diseases. Since then, some of these transitional countries have made substantial progress in cancer control. However, it is still predicted that at least one in every five citizens of Eastern Europe will die from cancer. Reportage