Author: Pan Wenbo
"Cancer patients have and only one optimal chance of treatment. If the patient's condition develops to the middle and late stages due to misdiagnosis and mistreatment, no matter how much human, material and financial resources are spent, it is often difficult to remedy."
On March 7, Yu Jinming, a deputy to the National People's Congress, an academician of the Chinese Academy of Engineering, and the president of Shandong Provincial Cancer Hospital, said that it is necessary to standardize tumor diagnosis and treatment and accurately treat tumor patients.
At the two sessions of the National People's Congress, Yu Jinming submitted a proposal to accelerate the construction of a precision cancer prevention and treatment system. In the proposal, he called for the screening of key cancer species to be included in medical insurance, improve the level of early diagnosis and early treatment, and implement a multidisciplinary consultation (MDT) model to improve the ability of standardized diagnosis and treatment.
"Finally, we must make all-round efforts to establish a scientific and perfect tumor precision prevention and control system." Yu Jinming said.
The following is the content of the occasional conversation between Healing and Academician Yu Jinming.
Follow guidelines to regulate care
Occasional cure: At the two sessions of the National People's Congress, you called for improving the ability of standardized diagnosis and treatment of tumors in the proposal submitted. How to understand the importance of standardized diagnosis and treatment?
Yu Jinming: Because tumor patients have and only one optimal chance of treatment. If the patient's condition develops to the middle and late stages because of misdiagnosis and mistreatment, no matter how much manpower, material resources and financial resources are spent, it is often difficult to remedy, and eventually loses the opportunity for treatment or cure, so it is necessary to standardize diagnosis and treatment and accurately administer treatment.
Occasional cure: What should oncologists do under the requirements of standardized diagnosis and treatment?
Yu Jinming: The most basic thing is to follow the authoritative treatment guidelines and treat patients. Our country has CSCO (Chinese Clinical Oncology Association) guidelines, the United States has NCCN (National Comprehensive Cancer Network) guidelines, and Europe has ESMO (European Society of Oncology) guidelines, all of which are authoritative. Of course, following the guidelines does not mean rejecting personalized treatment, but rather means that the doctor's diagnosis and treatment behavior must be supported by evidence-based medical evidence.
Yu Jinming, academician of the Chinese Academy of Engineering and president of Shandong Provincial Cancer Hospital
Image source: Courtesy of Yu Jinming
Occasional cure: In your opinion, what is the main reason for the irregular diagnosis and treatment of individual tumors that currently exist?
Yu Jinming: It is mainly caused by the lack of responsibility of a very few doctors and the limited level of medical care. In terms of the degree of diagnosis and treatment standardization, large hospitals, more authoritative tertiary hospitals, the degree of standardization is usually relatively high. Like county-level hospitals and grass-roots hospitals, there will be more irregular diagnosis and treatment.
Occasional cures: Nowadays, patients often like to go to big cities and big hospitals. How do you think we should strengthen standardized diagnosis and treatment at the grassroots level?
Yu Jinming: First of all, we must do a good job in the "strong foundation" project. The grassroots must find ways to attract and retain talents, so that graduates are willing to work in grassroots hospitals. The second is "science and technology going to the countryside", that is, experts have to sink to the grassroots level, and I think experts in large hospitals have this obligation to do these things.
For example, we often go to county hospitals and city hospitals for standardized diagnosis and treatment of tumors. We usually talk about it all day. The third is to make good use of other methods, such as medical associations and medical communities, and then use the network for remote consultation to guide grass-roots doctors to standardize diagnosis and treatment.
Occasional Cure: In your opinion, how to strengthen the doctor's ability to standardize the diagnosis and treatment of tumors?
Yu Jinming: I think there are two aspects. On the one hand, it is technical training, and on the other hand, it is medical ethics and medical style training. In addition, during training or assessment, the results can be linked to the performance and promotion of doctors to form a reward and punishment mechanism.
MDT mode for oncology diagnosis and treatment
Occasional cure: How does Shandong Cancer Hospital regulate tumor diagnosis and treatment behavior?
Yu Jinming: We are a specialized oncology hospital, and standardized diagnosis and treatment is the lifeline of hospital development. So we innovated the diagnosis and treatment model, providing all inpatients with a fixed time, fixed location, fixed expert free meeting MDT. This MDT is one of the means by which we standardize the treatment of tumors.
Occasional Cure: You mentioned that your hospital's MDT model is "fixed specialist", how exactly did the expert group set it up?
Yu Jinming: We are grouped according to the disease type, such as lung cancer group, breast cancer group, gastrointestinal tumor group, gynecological tumor group, hepatobiliary and pancreatic tumor group, rare tumor group and so on. Consultations are held at fixed times of the week. Each group has a team leader, consultation experts, secretaries, etc. The consulting specialists are multidisciplinary, including surgery, internal medicine, radiotherapy, imaging, pathology, and so on.
For such a major disease as lung cancer, because there are more patients each time, we have set up two groups, and Vice President Wang Zhehai and I serve as the leaders and deputy leaders of the two groups at the same time. Each group takes turns for a week, but the team leader, deputy team leader, and a few more senior experts must come every week. As for the other expert group members, since they were indeed busy, they could take turns according to the grouping.
Shandong Provincial Cancer Hospital Held Multidisciplinary Consultation on Tumor (MDT)
Occasional Cure: What is the specific form of MDT?
Yu Jinming: Two days before the multidisciplinary consultation, the secretary will notify the doctor in charge and ask the doctor in charge to report the medical records. At the time of the consultation, we evaluate his diagnosis and then his diagnosis plan. If there is no opinion, if there is an opinion, it will be discussed and analyzed to standardize the doctor's diagnosis and treatment behavior.
Occasional Cure: How Is This Different from Traditional MDT?
Yu Jinming: Traditional MDT is selective, not for all patients, and it is charged. Our MDT covers all oncology patients admitted to the hospital at no charge and is held once a week per disease. We tailor an individualized diagnosis and treatment plan for the patient. After 2 years of operation, some results have been achieved, benefiting nearly 70,000 patients.
Occasional Cures: Do you think this comprehensive, free, regular MDT model of oncology diagnosis and treatment can be replicated?
Yu Jinming: Yes. In fact, when we first made this MDT model, some people doubted that everyone was so busy, how long could this model last? As a result, we have insisted on it for more than two years, and we are still insisting on it. We will definitely stick to it in the future.
In the final analysis, it is a matter of whether to pay attention to it or not. I am an academician, a dean, and I am also very busy, but I come every time. When we prescribe MDT, we often spend six or seven hours at a time, such as last week, when our lung cancer group consulted more than 150 tumor patients at a time.
Occasional Cures: What impact will standardized care have on hospitals?
Yu Jinming: After we innovated this MDT model, many patients knew that we were doing a standardized job and came to our hospital for treatment. So our outpatient volume in January and February this year increased by about 40% year-on-year. In the final analysis, the quality of medical care is more important, and standardized diagnosis and treatment is the soul of hospital survival and development.
Screening for key cancers should be included in medicare
Occasional cures: In this proposal, you also recommend that key cancer screening be included in Medicare, why?
Yu Jinming: In developed countries such as the United States and Japan, the 5-year survival rate of tumor patients is 66% and 64%, respectively, compared with only 40% in mainland China. I think one of the main reasons other than the different tumor profiles is that they do aggressive prevention and early screening, which is one of the most effective ways to reduce cancer mortality.
Early diagnosis and early treatment not only cost little, but also has good efficacy, which can save patients from the physical and psychological trauma of multiple tumor treatment, and do more with less. Therefore, we should shift our focus forward, vigorously promote cancer screening and early diagnosis and early treatment strategies, and screen means, screening populations, and screening results "three precisions" to truly achieve effective screening.
Occasional healing: So what do you think the specific steps should look like?
Yu Jinming: I think it should be implemented step by step, first taking common and multi-morbid diseases as the focus of medical insurance to improve the universality of tumor screening. At the same time, it is recommended to open a special anti-cancer health examination center in the secondary and above hospitals that open oncology departments, generally carry out opportunistic screening, and establish a nationwide work model of early diagnosis and early treatment of cancer in which population screening, opportunistic screening and anti-cancer physical examination complement each other and promote synergistically.
Source: The official public account of the hospital
Occasional cure: At the two sessions of the National People's Congress, you suggest accelerating the promotion of the precision tumor prevention and control system, what is the reason?
Yu Jinming: Because the prevention and treatment of major diseases and infectious diseases is a major livelihood issue, cancer, as one of the major diseases that threaten the health of mainland residents, needs early prevention, effective screening, standardized diagnosis and treatment, precise prevention and control, and early detection, early diagnosis and treatment are the keys to improving tumor prevention and treatment.
Occasional cure: In your opinion, how to establish a precise tumor prevention and control system?
Yu Jinming: Tumor prevention and control is a systematic project, which requires multi-faceted and multi-departmental efforts.
First, it is necessary to strengthen the early prevention and accurate screening of tumors, accelerate the establishment of a complete tumor big data network sharing platform, improve the quality and efficiency of data statistics, and accurately grasp the information such as tumor incidence and death in the region, so as to provide a scientific basis for the accurate prevention and control of tumors. At the same time, we will continue to promote the focus of accurate screening forward, strengthen the training of cancer screening talents, and improve the level of early diagnosis and early treatment of cancer.
The second is to encourage multi-field and multi-disciplinary cross-integration and vigorously carry out scientific and technological innovation. Especially in today's country vigorously advocating and implementing the "Internet +" development strategy, precision medicine combined with big data and artificial intelligence is bound to be the direction of future tumor prevention and control, through real-world data collection and cloud computing analysis to guide clinical practice, so that doctors' clinical decisions are more practical.
Producer: Li Chen