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Stucturing Cancer Care in Kazakhstan

Stucturing Cancer Care in Kazakhstan. Primary – Secondary – Tertiary Care. Alexander Eggermont ASTANA, 22 May, 2014. Cancer Worldwide Burden (2008  2030). 12.4 million new cases 7.6 million deaths 28 million living with cancer. 26.4 million new cases 17 million deaths

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Stucturing Cancer Care in Kazakhstan

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  1. Stucturing Cancer Care in Kazakhstan Primary – Secondary – Tertiary Care Alexander Eggermont ASTANA, 22 May, 2014

  2. Cancer Worldwide Burden (2008  2030) 12.4 million new cases 7.6 milliondeaths 28 millionliving with cancer 26.4 million new cases 17 milliondeaths 82 millionliving with cancer Courtesy of Peter Boyle. IARC 2

  3. Cancer the leading cause of death Global and premature mortality rates in France in 2005 Premature mortality rate Global mortality rate External causes (injuries, suicide…) CANCER Cardiovascular disease Respiratory disease Source : CépiDc Database – 2005

  4. 15 Millions people 21% 32% LUNG CANCER CANCER France Europe World Incidence 320 000 2 600 000 12 000 000 Mortality 144 000 1 600 000 7 600 000 Prevalence 800 000 8 000 000 28 000 000 Current smokers in France Males Females IARC 2008; INSERM 2007

  5. Sturcturing Cancer Care in Kazakhstan • 0 LEVEL: PUBLIC HEALTH ACTIONS • Public Health: understand demographics • Start Cancer Registries • Information Campaigns /Education / Awareness • 1ST LEVEL PRIMARY CARE/DIAGNOSTIC CENTERS • Basic/ Early Diagnosis Campaigns (Breast, Colorectal, Cervix) • Education, Awareness • Screening programs (Breast, Cervix, Colorectal, Lung, Prostate(?)) • 2ND LEVEL REGIONAL CANCER CARE CENTERS • Multidisciplinary care of patients • Develop INTEGRATED Surgery, Radiotherapy, Cancer Medicine • 3RD LEVEL COMPREHENSIVE CANCER CENTERS • TERTIARY TOP-NOTCH COMPLEX MULTIDISCIPLINARY CARE • RARE TUMORS • GENETIC COUNSELING • RESEARCH, RESEARCH / INTEGRATED WITH CLINICAL RESEARCH

  6. Sturcturing Cancer Care in Kazakhstan 0 LEVEL: Public Health Campaigns • Create Awareness: • Education / Information Campaigns • Create Demographic Knowledge • Cancer REGISTRIES • Install IT infrastructure at Levels 1-2-3 • Institute of Public Health • Cancer ,Cardiovascular, Infectious diseases, Obesity and Diabetes, etc

  7. PREVENTION and EARLY DIAGNOSIS0 + 1 LEVEL Tumors Cause Prevention Early Diagnosis Lung Tobaccocampaign CT screen Head and Neck Tobacco campaign Alcohol campaign Esophagus/StomachTobacco campaign (Barret) endoscopy Diet campaign Colorectal Diet campaign EndoscopyStool / Endoscopy Liver Hepatitis B/C Vaccines Alcohol campaign Cervix HPV infection Vaccine PAPsmearPAPsmear Breast Lifestyle campaign Mammography screen BRCA1/2 Self Examination Prostate Age ? PSA screen ?

  8. Sturcturing Cancer Care in Kazakhstan 2ND LEVEL CITY /REGIONAL CANCER CARE CENTERS • MULTIDISCIPLINARY CARE SYSTEM • Multidisciplinary Tumor Board structure • Pathology, Radiodiagnostics, • Surgery, Radiation Therapy, Medical Oncology • Develop INTEGRATED care pathways • All tumors except for: • Very complex • Head and Neck/Esophagus/Pancreas • Very rare tumors • Osteosarcomas, neuroendocrine tumors, paediatric

  9. Sturcturing Cancer Care in Kazakhstan 3RD LEVEL COMPREHENSIVE CANCER CENTERS • CARE – RESEARCH - TRAINING • Tertiary Care – Clinical/Translational/Basic Research – Training • 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

  10. Comprehensive Cancer CenterTowards a Cancer Campus Alexander EGGERMONT. MD, PhD Gustave Roussy Comprehensive Cancer Center Cancer Campus Grand Paris, France

  11. Premier Comprehensive Cancer Center in Europe • + 12000 new patients /yr • + 50.000 treatments/yr • >10.000 surgical interventions/yr • >250.000 chemotherapies/yr • > 200.000 outpatient visits Per January 2015 • 560 beds (including 90 outpatient beds/chairs) • Expansion with 110 beds in 2015 • 230 FTspecialists + 200 PartTimeSpecialists • Employees + 2800 • Budget: 300 millions Euros • Research: 70 millions Euros

  12. Key Missions • Tertiary / Highly Complex Medicine • Complex Surgery/reconstructive surgery/stereotactiv RTX/ induction radiochemotherapy, bone marrow transplantation etc.. • Rare Tumors ( > 20%) • Care integrated with Clinical Research (36000 pts/yr in Clinical Trials) • Early Drug Development • (680 pts included in 2013 : >20% of CR program) INTEGRATION of RESEARCH and CARE to create TOMORROWS MEDICINE

  13. 50 000 Treatments per year Spectrum of Cancer Treatments

  14. Clinical RESEARCH • 3600 patients / year in clinical trials in 2013 • 2010: 2160 pts – 2013: 3600 • 24% of new patients in clinical trials • 1/3 Pharma; 1/3 GR- led multicenter ;1/3 IGR- single institution • Drug Development Phase I/II # 1 in Europe in Europe in Phase I • 2013 Creation of Department of Drug Development • In 2010: 226 pts– 2013 : 680

  15. BASIC + TRANSLATIONAL RESEARCH CREATING A CONTINUUM FOR Basic-Translational-Clinical RESEARCH 35 Research Groups: 450 Researchers, 240 Technicians • Basic Research • Research Building 1 and 2 (each 5000 M2) • Translational Research • Research Building 3 (6000 M2 • Additional Laboratories in Hospital Building • Clinical Research • Specialists, Research Nurses • Trial Office with 150 persons

  16. Comprehensive Cancer CenterTowards a Cancer Campus Alexander EGGERMONT. MD, PhD Gustave Roussy Comprehensive Cancer Center Cancer Campus Grand Paris, France

  17. Comprehensive Cancer CenterTowards a Cancer Campus Alexander EGGERMONT. MD, PhD Gustave Roussy Comprehensive Cancer Center Cancer Campus Grand Paris, France

  18. Research Output andValorisation • > 1400 publications in 2013 • 2003-2012: 7000 publications: H-Index 150 • Number 1 in Europe • France : (2003-2012) : Curie 118, Leon Bérard 77) • Europe: (2003-2012) NKI (144), VHIO 118, Royal Marsden (89) • USA: DF(273), MSK(222), MDA(198) • 125 with impact factor >10 • 45 >20 (10 x NEJM; 25 Lancet/Onc) • 80 IF10-20 (27 x JCO; 16 x Blood) 150 PATENTS = 3 Spin Off companies

  19. EDUCATION • Only Doctoral School of Oncology in France • MD/PhD Programs • Oncology Nursing, Nurse Practitioners, Research Nurses • INTERNATIONAL TRAINING PROGRAMS • Cancer Specialists (> 100 Kazakhstan specialists in 3 years) • Technology Transfer • Transversal Oncology Courses (4 week programs) • Full specialist formation programs (2 years)

  20. Come Visit Gustave Roussy in 2020 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).

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