The buildings of the National Cancer Institute in Lomonosov Street in Kyiv… There is a mosaic with the symbolic figure of a doctor destroying the hydra of this pernicious disease with a spectrum of incinerating rays. It aims to convey the spirit and essence of the fight taking place at the university. The number of patients has always been high there. Last year over 150,000 people were examined at the institute consultative clinic and the numbers for the laboratory tests, scanning, radiographs, biopsies and other diagnostic tests were in excess of a million. A total of 13.086 million people underwent the inpatient treatment in clinics and the number of operative interventions numbered over 8,000 including the operations in the polyclinic. Moreover, the problem is unlikely to subside anytime soon, as cancer threatens one in every 50 Ukrainians.
“In general, the year 2010 can be characterized as a starting point or even a prequel for Ukrainian oncology,” says the director of the Institute, the main oncologist of the Ukrainian Ministry of Public Health, the Honored doctor of Ukraine, Professor Ihor SHCHEPOTIN. “The government allocated the largest amount of money in recent years, bolstering the modernization of cancer care facilities. For example, the Kyiv local cancer hospital opened a center of positron-emitting tomography, which reveals the cancer pathology with precision and in a timely manner. As for our institute, we got a first linear accelerator, which significantly increases the possibilities and safety of the ionizing radiation. The specialized surgical building, frozen in time for 20 years, is going to be set in operation. The government allocated the money we needed after the prime minister visited the institute. We expect that the institute will shortly have 18 modern operational blocks. Certainly, other clinics are being equipped, too.
“The Kirovohrad regional cancer clinic has opened a radiomanipulating building for 172 patients with the assistance of the Ukrainian president. They finished building and launched the new buildings in the Kherson and Rivne cancer hospitals; the specialized hospitals in Ivano-Frankivsk, Khmelnytsky and Chernihiv have been reconstructed. It’s clear that these are only preconditions for the necessary cancer care optimization, but they reflect some aspects of the new scientific doctrine of the Ukrainian oncology, comprising a standardization of treatment protocols for cancer tumor localization.”
As the chief oncologist and director of the institute since 2008, it is in a sense your brainchild. By the way, the Fourth Congress of CIS Oncologists and Radiologists, held last autumn, acknowledged the Ukrainian doctrine as the best suited for the post-Soviet space. Maybe it’s a certain turn for better?
“It’s rather a precondition. You know, this innovation significantly increases the responsibility of doctors and the cancer clinic toward patients. The protocols concern the main cancerous diseases: clay pipe cancer, buccal cavity cancer, cancer of esophagus, stomach cancer, mediastinum tumors, rectal cancer, genital cancer, breast cancer, and soft tissues and bones cancer. By the way, the standards and protocols being not only some resolutions and guidelines for the necessary medical treatment, but a certain policy for the patient to allow checking whether all the recommended and necessary treatment is used. Certainly, we often have difficult clinical situations, but similar therapeutic programs are standard all over the world. I’d like to add that in the case if a chosen treatment is inefficient the cancer hospital has to send the patient to the institute. Not only because it’s the new prerogative of the branch. The scientific reputation of the institute clinics is growing. Last year over 100 provincial oncologists voluntarily underwent a training course there that accounts for 10 percent of specialists. Mostly, they took great interest in our surgical innovations.”
I’d like to ask you a personal question. In the 1990s you spent nearly nine years working in the US. Did this American period influence the new surgical style of the institute?
“I should probably start by saying that surgery is an integral part of my life. I really operate a lot and try to do it every day if needed as a member of complex surgical brigades in order to save organs, even when removing the most dangerous tumors. Does the American experience have its influence? Probably, it concerns only the more pragmatic organization. Certainly, my essential acquisition of those years is the experience I got in the cancer hospitals of two Washington universities; by the way, I was chosen as Honored Professor in the surgical center at the George Washington University. I went to the US owing to the grant I won for my scientific project. You know, in the US one’s scientific potential has to be confirmed by publications in large specialized reviews with strict requirements. My works referring to my own experience of 700 unique stomach cancer operations were published, in English, of course, in 1995, twice in 1996, in 1997 and in 1998. I would characterize those attempts concerning the gastrointestinal tract tumors combined therapy, the molecular and biologic characteristics of malignant tumors and their changes during the treatment, the involution mechanisms of various therapeutic methods as a way of determining ‘who is who.’
“I’d like to say more about the institute surgical strategy. We have resumed the systematic conferences when the doctors of every department report in detail about the operations planned for the upcoming week. All the planned operations and their diagnostic picture are submitted to the collective comprehensive discussion since we have to know in advance how large the operation will be, whether this or that specialist has the sufficient qualifications to carry it out and whether related specialists will have to help. This is probably the new paradigm. That is why the multibrigade operational method has become common. We involve specialists of abdominal, thoracic and gynecological oncology, etc. Taking into account that surgical activity accounts for quite a high portion of our time — 68 percent in the urological oncology clinic, 56 percent in the gynecological oncology, 54 percent in the orthopedic oncology, 52 percent of breast cancer, 49 percent of abdominal oncology — it’s clear that we talk not only about radical resection, but about the augmentation of organ savings.”
Some of your operations are unique. Last year you removed a retroperitoneal tumor from one of your patients. In such cases they usually remove the nearby kidney as well, but you transplanted it to another vascular bed and saved the twin organ.
“Yes, we managed to do it owing to the skills in handling versatile surgical techniques, including the vascular suturing, and the patient is healthy now. On the other hand, the specialists in urologic and gynecologic oncology sometimes invite me or other specialists for complicated joint operations. Each case is difficult from both diagnostic (use of specific methods of computer programs) and surgical perspectives.”
So, the chances to overcome the disease and recover depend on an early and full diagnosis, and modern, complex therapy. The cancer incidence rates were reduced through insistent preventive measures.
“There’s nothing especially new... theses measures are probated and common: they start with breast mammography and radiography for women from risk groups and prostate checking for elderly men, and finish with non-smoking propaganda and urgent governmental measures aimed at limiting the chemical carcinogens emissions in the environment. The new national project “Fifty Steps to Fight Cancer in Ukraine” comprises eight priority directions of changes in the domestic oncology and the terms of their realization. According to the well-grounded prognosis, the realization of these necessary reforms concerning cancer care at the state level will allow to decrease deaths from cancer by 15 to 20 percent. It’s paradoxical, but the most difficult endeavor is to influence the people’s psychology concerning the necessity and reality of cancer prevention. Certainly, cancer is a sudden, nearly fatal ordeal, but there are chances to overcome it and recover and these chances are growing. Of course, people have to trust the specialists and not the quacks’ miracle cures and to share the scientific ideas and appeals at all levels.”
The saying about how one can’t enter the same river twice isn’t always true. Ihor Shchepotin, the son of the wonderful therapeutist Boris Shchepotin, who dedicated himself to surgery over thirty years ago, has been working at the Research Institute of Oncology and Radiology since 1983 and defended the doctor’s thesis “The Ways to Augment the Efficiency of Stomach Cancer Treatment” soon after. Then he had his “overseas dream.” In 1999 he rejected a successful director’s career at the surgical oncology laboratory in Washington and, guided by his patriotism, he returned to Kyiv as a senior scientist at the abdominal surgery department in his alma mater and since 2008 he’s been its reformer. We’re sick and tired of high phrases, they become just cliches, but in such devotion lies hope for Ukraine.
