Prof. MUDr. Marek Svoboda, Ph.D. is a Czech oncologist, born in Slavičín. Since 1 July 2019, he has been the Director of the Masaryk Memorial Cancer Institute in Brno. He has been working at Na Žlutém kopci since 2004. He works at the Clinic of Comprehensive Cancer Care and the Division of Genetics and Cancer Epidemiology. He was the Deputy for Research and Development from 2010. He also teaches at the Faculty of Medicine of Masaryk University. He is a member of several Czech and foreign professional associations. For his scientifi c and clinical work, he has won a number of prestigious awards, including two Minister of Health Awards for medical research and development. In his practice, he specializes in breast and colon cancer and, more generally, in cancer prevention and genetics.
How has the pandemic of Covid-19 changed the course of your institute? To what extent has the provided care been restricted? Have you seen a decline in the number of patients?
This pandemic fundamentally aff ects the operation of the entire institute. We have constantly been adapting to staff shortages, anti-epidemic measures and our own epidemic conditions. Fortunately, also thanks to well-coordinated care for patients with Covid-19 in the South-Moravian Region, we have not had to be involved in the treatment of the most serious cases, therefore, we are able to maintain the care provided to cancer patients. We experienced the biggest restrictions from mid-March to May 2020, when we reduced ‘deferrable’ care in anticipation of the Italian scenarios, e.g. preventive examinations or operations of benign tumours. Luckily, in the summer, unaware of the strength of the coming autumn pandemic, we created adapted conditions to deal with the backlog.
The preliminary fi gures for the year 2020 show that we have registered 4,270 newly diagnosed cancer patients, which is 214 (4.9 percent) lower compared to the year 2019. If we look at individual activities, there was a decrease in the number of operations on patients with malignant tumours by 4 percent (3,314 in total) and in chemotherapy applications by 9 percent (38,199) and a decline in the number of irradiated patients (2,643) by 6 percent. A more signifi cant decrease was seen only in mammography screening (-12 percent.)
In terms of performance, such a decrease, even for a temporary reason, may not seem fundamental. As an oncologist, I can no longer interpret it this way. You know, postponing a preventive examination for a few month does not mean anything serious. These examinations are aimed at citizens who do not have any symptoms of cancer and a vast majority of the tumours detected are caught in the early stages and grow slowly. However, if they are restricted significantly this year, it will be a problem. Unfortunately, there have been other causes behind the lower numbers, at least since October, when the force of the pandemic has practically disabled standard operations. Overloaded hospitals and fear among people brings delays in diagnosis of those who have warning signs of cancer and where every week matters. The number of patients who postpone examinations, despite having problems, because they are afraid of being infected in medical facilities, is increasing. And when there is no other option they come, expecting everything to go fast. But it is not always possible. For example, pulmonary and also other hospital departments are profiled to care for Covid-19 patients and it is not possible to place the patients in hospitals and finalize examinations. Even outpatient care is limited as there is a shortage of staff. The load on radiology centres and Emergency Units is also enormous. Additionally, there is an increasing number of patients who could not be diagnosed in time due to the seriousness of their own Covid -19 condition or they had to have their treatment interrupted or even discontinued.
What I mean is that even the relatively small reduction in the performance of the Masaryk Memorial Cancer Institute in Brno, which is a trans-regionally active and professionally specialized institution, does not mean that there is not a greater problem. Especially when I know how much we help other institutions in the region whose cancer patients’ treatment we take over, which they would otherwise deal with on their own, but cannot due to the care aimed at Covid-19 patients.
Has the pandemic brought anything positive, for example a more efficient system of care? Have you started to make more use of information technology?
Definitely, functioning under strict anti – epidemic conditions and in a very unstable situation as regards your own or regional health care capacities places high demands on the system of work. Numerous negotiations, including meetings of doctors and training sessions have been moved online. We even managed, in quite a short time, to transfer the largest Czech Oncology Congress – Brno Oncology Days into an on-line form (www.onkologickedny.cz). It has been held by the Institute for 44 years and it is standardly attended by more than 2,000 participants. We have more examples. We are the only institute in the Czech Republic using an automated entry system with artificial intelligence which does not allow anyone in without properly fitting masks and respirators. In cooperation with the academic and private sectors, we are working on the development of the “mHealth Application” for mobile phones, to be used for example for psychosocial care and when solving our patients’ health problems which are not urgent. But it is not only about increasing our “information literacy” and increased implementation of information technology. Our researchers, for example, developed a special sampling medium and our own sample processing procedure and thanks to this, we were officially the first hospital in the Czech Republic to provide PCR tests of SARS – CoV-2 without working with a live virus in the laboratory from 25 March 2020. In addition, we made our own rods for nasopharyngeal swabs and protective shields on 3SD printer.
You have been in charge of the institute for two years. Do you have a new team or did you continue with the team of your predecessor – Prof. MUDr. Jan Žaloudík, CSc.?
Before I became the director I had been in the management of the institute for 9 years as a Deputy for Science, Research and Training. I knew the team very well. And after reorganizing some activities I added one position – the Deputy for Strategy, Communication and Training and there was a new Deputy for Science and Research. I purposefully searched among younger colleagues to enrich the board meetings with new views on dealing with matters. They also have better knowledge of IT and they push the use of IT in medicine and communication. Prof. Žaloudík and prof. Vyzula are members of my advisory team.
What was and what is your plan for the development of the Institute and how successful are you at its implementation?
In February, we opened a completely renovated Bakeš Pavilion – the oldest of our buildings. This represented an investment of 43 million Czech Crowns, 180 million of which was provided from the state budget. We have a development plan until the year of 2030. We need to complete the construction of Švejda Pavilion, where mainly outpatient care is concentrated. Outpatient care has increased by 100 percent in the last 20 years, to the current number of 247,000 treatments a year. Completion of this building will not only add more space for the provision of support care and for clinical research, but also a new entrance to the entire MMCI premises, which will contribute to a better system of incoming patients. This proved to be very important during the pandemic. MMCI also needs to extend the nuclear medicine department to include both inpatient and outpatient departments and to create better conditions for terranostics and radiopharmaceutical research, which we have extensive experience with. However, our priority is the construction of a modern station for the outpatient application of anti-cancer treatment and also a new workplace for diagnosing and treating lung cancer patients. Even this is also what our experience with the current Covid-19 pandemic forces us to do. Last but not least, we would like to acquire the area of the former transfusion station, where we aim to build a new Centre for Cancer Prevention. There should be provided standard preventive examinations covered by health insurance and also the Oncological Prevention for Everyone Programme, which is being found to be more and more attractive (approximately 2,000 examinations a year). Cancer prevention advisory services will also be provided, including advice on healthy living.
Our ‘absorption capacity’ could turn up to CZK 2 billion into a meaningful investment in construction and instruments. It will not be possible without substantial state support, whether in the form of European Funds or the state budget. On the other hand, we can also work with funds from donors. Unfortunately, we have not been able to obtain such a gift that could pay for
one or two floors of a new building, or the whole building. At the same time, similarly to those e.g. in the USA, our buildings are named after personalities who contributed to the development of the institute.
What makes the Masaryk Memorial Cancer Institute unique?
Our uniqueness lies in several things. For more than 85 years, our doctors, nurses and other health professionals have been aimed at nothing else but cancer. It is one school and this extensive experience is passed on from generation to generation. The focus on a single topic within the framework of different specialisations also leads to a high work integrity with multidisciplinary cooperation. One roof covers oncological prevention, surgery, systemic treatment (e.g. chemotherapy, immunotherapy, and targeted treatment), radiotherapy, support and palliative care, i.e. everything which patients need. Patients feel at home with us.
Due to the size of the institute and the volume of provided care we are visible in the European context. We are part of the Organisation of European Cancer Institutes (OECI) bringing together a hundred important Cancer Institutes, such as CRUK Cambridge Centre, Institute Curie in Paris, NKI in Amsterdam, Jules Bordet Institute in Brussels and others. We are in excellent company and, after a year and a half of preparation, we have also achieved a highly prestigious international accreditation of this organisation. The care which we provide is in line with the principles and standards shared by the above-mentioned top institutes.
In one interview, you mentioned that the highest risk to the immune system is aging. Is it, with mild exaggeration, one of the aims of medicine to overcome aging, or rather to focus on quality of life?
You cannot bang your head against a brick wall, meaning, that unfortunately, we cannot stop the process of the human body ageing. Higher cancer incidence is one of the symptoms of the ageing process, as a result of an increasing error rate in the formation of new cells (replacing the worn ones), together with the decreased immune system control over tumour spreading. However, this does not mean that the processes leading to aging should not be researched. By the way, MMCI is involved in the Project of Molecular, Cellular and Clinical Approach to Healthy Aging known as ENOCH. I believe in partial achievements not in the elixir of youth. The question of life quality keeps its value and importance, especially when there are 600,000 people with cancer living among us.
What does quality of life represent for a patient suff ering from cancer?
Quality of life is important not only from the point of view of cancer patients, but also their relatives, who share their worries and difficulties. Unfortunately, there will always be a group of incurable patients and nobody wants to experience our loved ones’ suffering. Quality of life is equally important to cured cancer patients, which is a vast majority. Oncological treatments had side eff ects to many of them, which might have handicapped them in their personal and professional lives, including the loss of partners or jobs. In our institute, we are committed to the development and implementation of a cancer survivor care program within the frame of OECI accreditation. This care includes follow- up oncological monitoring, the aim of which is to spot potential return of the disease in time, and at the same time to monitor the occurrence of chronic and long-term adverse reactions to the previous treatment and to conduct interventions which benefi t the health of patients (psychosocial support, support care).
Precision and Molecular Profiling Oncology represents a new dimension of oncological care. Have the attitudes to treating cancer patients been altered thanks to advanced knowledge?
Definitely. With Precision Oncology, we search for genetic correlation of the tumour characteristics, possibly its host, using various genetic examinations, especially NGS sequencing, and based on the results, we choose a treatment which will hit the targets important for the tumour, as efficiently as possible. Thanks to this, the treatment can be more efficient and less toxic to the organism. Today, we use these principles more or less for the treatment of lung, colon and breast cancer and also for tumours of unknown origin, sarcomas, and tumours in children or in the case of haematological malignancies and others. Unfortunately, such indicated treatment is not always covered by insurance. Patients who have gone through all standard treatment options are seen as a problem, but when they are still in a good condition, further attempts at targeted treatment would certainly be possible. A specific group are patients with rare tumours
where there is not sufficient knowledge related to treatment supported by clinical studies. Especially in these cases it would be desirable if Precision Oncology were recognized by insurance companies and the treatment thus indicated were covered by insurance, at least in National Cancer Centres, where the NGS tests are performed and interpreted by a molecular tumour board.
You personally deal with the inheritance of tumours. What are the trends in this field?
Indeed, there exist a number of genes, whose damaged – mutated – form inherited in families, leads to high risks of developing cancer. We can intervene significantly even here. In addition to being able to identify such individuals and offer them the preventive programmes, we are able to interrupt the inheritance of cancer in their families by means of preimplantation diagnostics. Parents then give birth to a biological off spring, who no longer inherits the bad mutation.
How much are diseases influenced by the psyche? Do positive thinking people have a better chance of defeating the disease?
The psyche is significantly reflected in the patients’ fight with cancer. If they are in a depressive phase and they do not manage to overcome it, they become apathetic and lose both the will and power to fight. This is then visible on their low tolerance to the side effects but also in their willingness to cooperate and follow the recommendations of health professionals. These people then wither, suffer more pain, and experience higher levels of stress. Stress and poor nutrition further weaken the immune system influencing the success of oncological treatment. So, yes, we can say that people with positive mindset have a better quality of life and better chances of recovery. By the way, this is the reason why we are preparing psychological screening for new patients prior to the start of oncological treatment. We would like to spot those who need systematic care to achieve better treatment results.
The fight against cancer is one of the European Union’s priorities. How is the European strategy reflected in the national strategies? What benefits does it bring? For instance, targeted development of new drugs?
Efficient fighting against cancer represents a global challenge which cannot be addressed without international cooperation. Its overlap is not only to the fields of education and research but also in the exchange of know-how, setting and sharing of the best practices and quality standards together, securing equal access to modern technology and medicines, and generally to innovation. Since 2004, the Czech Republic has had a National Oncology Program, which is now being updated, and which will reflect also the recently published Europe’s Beating Cancer Plan. Its most important points are the strengthening of the Comprehensive Oncology Care Centres, preventive programs and equal access to innovative medicines, major focus on quality of care provided to cancer patients and survivors. We expect that with the implementation of the European Plan in the Czech NOP, we will be better prepared to join the common activities which the European Union is going to fund, including research and development.
Thank you for the interview.
