– Problems do exist. Even with sufficient funding, pediatric oncology remains one of the most complex areas of medicine. This year, we are completing a key project for the country – creating conditions for performing independent bone marrow transplants, which will be a significant achievement. Currently, such operations are mainly performed abroad – in Turkey or India.
– What steps are necessary for this?
– First of all, we need special chambers with laminar ventilation to ensure a high level of sterility. Their equipping is nearing completion, and soon we will be able to perform bone marrow transplant operations on-site.
– How is laboratory diagnostics, without which modern oncology is impossible, progressing?
– We need molecular diagnostics, immunohistochemistry, and a FISH laboratory, as well as qualified specialists. Pediatric tumors often look similar under the microscope, unlike adult tumors. Without modern methods, it is impossible to accurately determine the type of tumor and select the best treatment.
Immunohistochemistry is actively used for this purpose worldwide. However, creating a complete set of equipment for immunohistochemistry in our department is economically unfeasible, as we have about 80 patients per year. Therefore, we hope for the development of this area at the National Oncology Center, from where we will seek assistance. The situation is similar with radiation therapy.
– Are these areas included in government plans?
– Yes, they are outlined in the strategy. The development of both immunohistochemistry and radiation therapy is planned. A contract was recently signed for the supply of a radiation machine from India. This will create excellent conditions for treating our patients with all available methods.
– Are there timelines for implementation?
– Presumably, this year. Although I do not have all the details, I know that the process has already begun. We have also prepared a project for creating a FISH laboratory, which will allow us to identify tumor mutations. This will help determine in advance whether the tumor will be resistant to standard chemotherapy and immediately start more targeted treatment. The equipment already exists, and I hope that within a year we will have our own FISH laboratory. This will significantly increase the chances of saving many children.
The key strength of Western medicine lies in powerful laboratory equipment. They can determine in advance whether there are mutations in the tumor that may reduce treatment effectiveness. This helps doctors immediately understand that the patient should be switched to more complex treatment methods, such as targeted therapy or radiation therapy.
Here, diagnoses are most often made based on histology. We see the tumor, know its type, and treat it according to standard protocols. However, the protocols specify special groups of tumors that require a different approach. Without molecular diagnostics, we cannot see these features.
– What is needed for the implementation of immunohistochemistry? Is it just equipment, or are specialists also important?
– First and foremost, equipment is necessary. But when we write projects, we always include training. Our laboratory technicians need to undergo training and be able to work with new methods.
– Currently, parents have to send tests abroad, which leads to a loss of time and additional expenses. Do you accept research results conducted abroad?
– Yes, we take into account the results of such studies when determining the risk group and choosing a treatment protocol. We are actively trying to eliminate the lag in pediatric oncology. At the same time, we realize that this is a special field, different from adult oncology, as prevention is not applied here.
– So, screening programs do not work?
– Correct. Preventing pediatric oncology is impossible. Children do not smoke and do not work in hazardous industries. In most cases, it is the result of spontaneous genetic mutations, a kind of mathematical randomness that cannot be predicted. All global screening programs have shown zero effectiveness, as confirmed by WHO reports.
– What should be emphasized?
– Early detection and strengthening the primary level – pediatricians. We are developing a system where, if two or more symptoms of pediatric oncology are present in the electronic outpatient card, a "red flag" will automatically trigger, and the child will be referred to an oncologist. There are no pediatric oncologists in clinics, so pediatricians play a key role, and their level of knowledge needs to be raised.
– How is the staffing situation in pediatric oncology? Are there enough doctors?
– We would like to increase the staff. If the staffing level were expanded, we could attract additional doctors.
– Is the problem related to the number of positions or the level of salaries?
– Both factors matter. However, doctors are starting to come into pediatric oncology now. As for salaries, they are indeed still low, but compared to the past, they have significantly increased and continue to grow.
– But is that enough given the responsibility and workload?
– Yes, there is a great responsibility here, especially in working with parents, who can perceive everything very sharply and often blame doctors. But despite this, if we compare today's medicine with what it was before, the difference is colossal. We have even started performing endoprosthetics independently.
– Regarding endoprosthetics, in neighboring countries such as Kazakhstan, Uzbekistan, and Russia, children with bone sarcomas are provided with endoprostheses at the state's expense. In Kyrgyzstan, there is no such support, and the cost of one endoprosthesis can reach 20 thousand dollars, which is a significant financial burden for families. Is there work being done to address this issue?
– This issue is under discussion. We are currently looking for suppliers. If companies start registering oncological endoprostheses in Kyrgyzstan on a permanent basis, a mechanism may be implemented where the state allocates certain funds, and as needed, prostheses of the required size will be purchased from this fund.
– Is the government ready to allocate such funds?
– These funds can be included in the general budget for chemotherapy drugs. Considering the average number of children with such diagnoses per year, it is quite feasible to plan these expenses.
This year, we plan to negotiate with several companies to approach "Kyrgyzpharmacy" and start the registration of oncological endoprostheses, which will allow them to be included in applications for the high-tech fund.
– Who are the potential suppliers?
– First of all, Turkey and Germany, and there is also a possibility of cooperation with China.
– How has funding for pediatric oncology changed in recent years?
– Significantly. Previously, about 10 million soms were allocated for drug provision, but now this amount ranges from 100 to 200 million soms per year. There has been a centralization of purchases, and now we can treat diseases that we could not treat before.
– Nevertheless, social media often features messages from parents and children asking for help, organizing fundraisers for treatment abroad. What is this related to?
– Usually, these are patients who need second-line treatment. Previously, such children simply did not survive to this stage. Now we are bringing them into remission and treating them, but relapses, unfortunately, are possible. Treating relapses involves high technologies, which is why families are struggling to find funds and seek treatment abroad.
– What innovative technologies do you consider a priority for implementation?
– Robotic surgery, molecular diagnostics, targeted therapy, and much more. Pediatric oncology requires high technologies. If survival was around 20% before, it is now about 50%. According to forecasts, it may reach around 60%.
– You mentioned international projects. What is their significance?
– It is extremely important for us to become part of the global WHO platform and St. Jude's clinic. If we manage to win, the drugs for primary treatment will be provided, and the freed-up funds can be directed towards high-tech treatment methods.
– What budget do you think is necessary for pediatric oncology?
– A minimum of 300–400 million soms per year, ideally more. Treating one patient with neuroblastoma, which remains our challenging task, costs about 300 thousand dollars abroad. More than 10 children with this diagnosis come to Kyrgyzstan every year. Very expensive medications are required: the cost of one vial is about 50 thousand dollars. Two vials are needed for one course, and there are six such courses. In total, we are talking about colossal amounts.
– How do you manage without such funding?
– We work strictly according to protocols. With a high risk of neuroblastoma, bone marrow transplantation allows for a cure in about 40% of children. If we add one immunotherapy drug, this figure can rise to 60%, and with another, to 80%. If effectiveness reached 100%, the state would certainly purchase these drugs. But neuroblastoma remains one of the most challenging tumors to treat worldwide, and only a few clinics use such drugs with successful results, which generally depends on financial capabilities.
– How do you manage to adhere to treatment protocols, and how do they align with global standards?
– It is clear that we cannot fully comply with global standards. We adapt protocols to our capabilities. This is what all countries do, even those like Turkey or Russia, using adapted versions of protocols.
We fulfill most of the requirements, but there are diseases where this is extremely difficult due to the high cost of medications and necessary equipment. However, compared to the past, progress is evident.
