At the same time, from 45 to 70% of patients with the first and second stages of malignant neoplasms do not undergo dispensary observation in full. “It is in the first stages of the disease, after surgery, that dispensary observation is extremely important. But for many patients who have undergone surgery, it is psychologically difficult to visit an oncologist again, many of them, after removing the tumor, consider themselves cured and do not pay due attention to regular examinations. And this can lead to untimely late detection of recurrence or metastasis, and, consequently, to the late start of chemotherapy and targeted therapy, which reduces the effectiveness of treatment and may have irreversible health consequences,”.
About how this type of medical care is organized today, what the patient can count on, what the most frequent violations he should pay attention to, say the experts of the MHI.
How is surveillance organized?
The order of the Ministry of Health No. 548n “On approval of the procedure for dispensary observation of adults with oncological diseases” regulates the dispensary observation of oncological patients. According to the document, the patient must be registered with an oncologist at the place of residence within three working days from the diagnosis.
The dispensary observation itself is organized in an outpatient oncological care center or in a primary oncology office of a medical organization, an oncology dispensary, or in other medical organizations that provide oncological care. The patient should be under the supervision of a specialized specialist, i.e. an oncologist, and not a general practitioner.
The order also establishes the frequency of examinations. During the first year from the oncological diagnosis, the patient is invited for examination once every three months, during the second year – once every six months, and then once a year. This order is maintained if the course of the disease does not require a change in the tactics of managing the patient.
“Dispensary observation is free of charge under the CHI program. It is established for life for all patients with a confirmed oncological diagnosis. The exception is patients with basal cell skin cancer who have undergone radical treatment. These patients are removed from dispensary observation after five years if the disease does not recur. However, if a relapse occurs, then life-long dispensary observation is established for patients with this pathology, ”notes Elena Tretyakova.
An important point is that dispensary observation is organized with informed voluntary consent. The patient or his legal representative may issue a written refusal from dispensary observation, but the doctor is obliged to explain to him all the risks and possible consequences of such a decision.
What to expect from admission
“The follow-up plan is developed by the oncologist for each patient individually. Information about this should be recorded in the patient’s medical records. And the doctor is obliged to inform the patient about the procedure, scope and frequency of dispensary observation,” emphasizes Elena Tretyakova.
Directly, the dispensary appointment with an oncologist consists of mandatory items:
1. Assessment of the patient’s condition, collection of complaints and anamnesis, appointment and evaluation of laboratory and instrumental studies.
2. Establishment or clarification of the diagnosis of the disease.
3. Evaluation – how effective was the previous treatment. To do this, it is necessary to organize an examination of the patient and, if necessary, to correct the treatment. If the disease progresses, the doctor should refer the patient to a medical facility that provides specialized oncology care.
4. Brief preventive counseling. The doctor should explain to patients who have a high risk of developing a life-threatening condition or complications, how to act if the disease worsens, explain the need to promptly call an ambulance.
5. Appointment for medical reasons of additional preventive, diagnostic, therapeutic and rehabilitation measures, including referral of the patient to a medical organization providing specialized, including high-tech, medical care.
If the patient cannot visit the medical organization on his own due to the severity of the disease, then the oncologist who carries out dispensary observation must organize home observation.
When changing residence
If you change your place of residence or leave for a period of six months outside the region where you underwent dispensary observation, you must notify the oncologist about this at least two weeks before the date of departure. Then, within seven working days from the date of receipt of the information, the doctor will stop dispensary observation and prepare an extract from the patient’s medical records. This extract must be handed over to the patient within three working days from the date of termination of dispensary observation so that he can provide it to a medical organization at a new place of residence.
Under the control of insurers
Representatives of HMOs supervise medical organizations, conduct an examination of the quality of medical care for cancer patients. And as the statistics show, various defects and violations of the rights of patients with cancer are often detected. Among them:
1. Lack of informed voluntary consent to dispensary observation indicating the planned result and possible consequences of violations on the part of the patient.
2. Shifting dispensary observation from the oncologist to the therapist.
3. Absence in the patient’s medical record of the protocol of the decision to establish dispensary observation.
4. Absence in the documentation of assessing the patient’s condition, prescribing and evaluating laboratory and instrumental studies, etc.
Member of the Council of Public Organizations for the Protection of Patients’ Rights under Roszdravnadzor, Advisor to the Capital-MS medical insurance organization, Doctor of Medical Sciences, Professor Alexei Starchenko:
— We conducted research in several regions and found out that 79% of patients with MN are monitored not by an oncologist, but by a general practitioner. This is a disaster, as patients do not receive adequate examination. Informed consent for dispensary observation, as a rule, is not included in the documentation. At the same time, it cannot be treated formally. For successful dispensary observation, it is necessary to inform the patient about risk factors, existing diseases, the risks of complications, and preventive measures. Plus, it is not always possible for a patient to physically get to see a doctor.