Patient blood management in oncology in the Russian Federation: resolution to improve oncology care.

Cover Page
  • Authors: Hofmann A.1,2, Aapro M.3, Fedorova T.A.4, Zhiburt Y.B.5, Snegovoy A.V.6,7, Kaganov O.I.8,9,10, Ognerubov N.A.11,12, Lyadov V.K.13,14,15, Moiseenko V.M.16, Trofimova O.P.14, Ashrafyan L.A.4, Khasanov R.S.17, Poddubnaya I.V.14
  • Affiliations:
    1. Institute of Anesthesiology, University Hospital Zurich
    2. Medical School and Division of Surgery, The University of Western Australia
    3. Genolier Cancer Center
    4. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology
    5. Pirogov National Medical and Surgical Center
    6. Blokhin National Medical Research Center of Oncology
    7. Yevdokimov Moscow State University of Medicine and Dentistry
    8. Penza Institute for Medical Excellence – branch of the Russian Medical Academy for Continuous Professional Education
    9. Samara Regional Clinical Oncology Center
    10. Samara State Medical University
    11. Derzhavin Tambov State University
    12. Tambov Regional Oncology Center
    13. Novokuznetsk Institute for Medical Excellence – branch of the Russian Medical Academy for Continuous Professional Education
    14. Russian Medical Academy for Continuous Professional Education
    15. City Clinical Oncological Hospital №1
    16. Saint Petersburg Clinical Scientific and Practical Center for Specialised Types of Medical Care (Oncological)
    17. Kazan State Medical Academy – branch of the Russian Medical Academy for Continuous Professional Education
  • Issue: Vol 22, No 3 (2020)
  • Pages: 59-78
  • Section: Lecture
  • URL: https://journals.rcsi.science/1815-1434/article/view/52490
  • DOI: https://doi.org/10.26442/18151434.2020.3.200340
  • ID: 52490

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Full Text

Abstract

The huge global burden of oncological diseases is growing and measures to counter this complex challenge are high on national health agendas. The Russian National Long-Term Oncology Strategy 2030 defines priorities, goals and directions in the fight against cancer. It also contains action plans for more effective prevention, earlier and more specific diagnosis and more effective treatment options. Against this backdrop, experts now suggest to complement standard oncology treatment strategies by adding Patient Blood Management (PBM). For many clinical disciplines where a low blood count and considerable blood loss are commonly encountered, this bundle of care is the new standard. Based on clinical and scientific evidence, it aims to optimise medical and surgical patient outcomes by clinically managing and preserving a patient’s blood. The principles of this comprehensive concept can and must be transferred to oncology, thus offering value in improving cancer care and the efficacy of medical institutions. Accumulating evidence demonstrates that anaemia and iron deficiency, but also thrombocytopenia, blood loss and coagulopathy are independent risk factors for adverse patient outcomes including morbidity, mortality, reduced quality of life and prolonged average length of hospital stay in both surgical and medical patients. For the timely and effective detection and correction of these risk factors, an international network of multi-disciplinary clinicians and researchers has developed PBM. The rapidly growing body of evidence for PBM not only shows improved patient outcomes, but also reduced resource utilisation including the use of allogeneic blood components. The reduction of allogeneic blood transfusion further improves patient safety and outcomes, since transfusion is another independent risk factor for adverse outcomes. Supported by WHO endorsements and following the recommendations of an increasing number of state or national health authorities, PBM is about to become a new standard of care. However, even though the aforementioned risk factors are highly prevalent in oncology settings due to chemo-/radiotherapy and the pathology of the disease, the integration of PBM in standard oncology treatment pathways is lagging behind. Thus, and in support of the Russian National Long-Term Oncology Strategy 2030 to improve quality of oncological care, with the support of the National Association of Specialists in PBM (NASPBM), the PBM Oncology Working Group of the Russian Federation was created, consisting of national and international experts in oncology and PBM. On July 9, 2020, the Working Group met to discuss the rationale for PBM in oncology and to assess the need to implement PBM in Russian oncology care. As a result, the Group recommended to include PBM as an integral part of standard oncology treatment pathways, delineated the action required from facilitating stakeholders in the Russian Federation, determined a roadmap for implementation and developed a national resolution as a call to action on the matter. Presented herein, this resolution acknowledges the global and local impetus to reduce cancer mortality, and the rationale for PBM interventions to improve patient outcomes and alleviate the social and economic burden of cancer on the healthcare system.

About the authors

A. Hofmann

Institute of Anesthesiology, University Hospital Zurich; Medical School and Division of Surgery, The University of Western Australia

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0003-0615-7474

D. Sci. (Med.) with a master’s degree in economics; Visiting Prof. at the Department of Anesthesiology and the Institute of Anesthesiology, University Hospital Zurich; Adjunct Assoc. Prof., University of Western Australia School of Surgery; Adjunct Prof. (Emeritus) Curtin University School of Health Sciences

Switzerland, Zurich; Perth

M. Aapro

Genolier Cancer Center

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0003-3570-8319

Prof., oncologist, Member of the Executive Board of European School of Oncology (ESO) and International Medical Society for Geriatric Oncology (SIOG); President of the European Cancer Organization; President of the Society for the Sharing of Progress in Cancer Treatment (SPCC); Co-founder of the International Patient Foundation Blood Management

Switzerland, Genolier

T. A. Fedorova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0001-6714-6344

Sci. (Med.), Prof., Institute of Anesthesiology, Resuscitation and Transfusiology and Department of Transfusiology and Extracorporeal Hemocorrection, Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, President of the National Association of Specialists patient blood management­

Russian Federation, Moscow

Ye. B. Zhiburt

Pirogov National Medical and Surgical Center

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0002-7943-6266

D. Sci. (Med.), Prof., Acad. RANS, Head of Transfusiology and Hemotransfusion Department, Pirogov National Medical and Surgical Center, President of the Russian Association of Transfusiologists

Russian Federation, Moscow

A. V. Snegovoy

Blokhin National Medical Research Center of Oncology; Yevdokimov Moscow State University of Medicine and Dentistry

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0002-0170-5681

D. Sci. (Med.), Prof., Head of Outpatient Chemotherapy Department (day care), Blokhin National Medical Research Center of Oncology, Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, Moscow

O. I. Kaganov

Penza Institute for Medical Excellence – branch of the Russian Medical Academy for Continuous Professional Education; Samara Regional Clinical Oncology Center; Samara State Medical University

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0002-4569-1031

D. Sci. (Med.), Head of Oncology and Urology Department, Penza Institute for Medical Excellence – branch of the Russian Medical Academy for Continuous Professional Education; Samara Regional Clinical Oncology Center, Prof., Samara State Medical University

Russian Federation, Penza; Samara

N. A. Ognerubov

Derzhavin Tambov State University; Tambov Regional Oncology Center

Email: ognerubov_n.a@mail.ru
ORCID iD: 0000-0003-4045-1247

D. Sci (Med.), Derzhavin Tambov State University, Tambov Regional Oncological Clinical Dispensary

Russian Federation, Tambov

V. K. Lyadov

Novokuznetsk Institute for Medical Excellence – branch of the Russian Medical Academy for Continuous Professional Education; Russian Medical Academy for Continuous Professional Education; City Clinical Oncological Hospital №1

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0002-7281-3591

D. Sci. (Med.), Assoc. Prof., Head of Oncology Department, Novokuznetsk Institute for Medical Excellence – branch of the Russian Medical Academy for Continuous Professional Education; Russian Medical Academy for Continuous Professional Education; City Clinical Oncological Hospital №1

Russian Federation, Novokuznetsk; Moscow

V. M. Moiseenko

Saint Petersburg Clinical Scientific and Practical Center for Specialised Types of Medical Care (Oncological)

Email: ivprectorat@inbox.ru

D. Sci. (Med.), Prof., Director of Saint Petersburg Clinical Scientific and Practical Center for Specialised Types of Medical Care (Oncological), Chief oncologist and chemotherapist of Saint Petersburg

Russian Federation, Saint Petersburg

O. P. Trofimova

Russian Medical Academy for Continuous Professional Education

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0002-7204-370X

D. Sci. (Med.), Prof., Oncology and Palliative Care Department, Russian Medical Academy for Continuous Professional Education

Russian Federation, Moscow

L. A. Ashrafyan

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: ivprectorat@inbox.ru

D. Sci. (Med.), Prof., Acad. RAN, Deputy Director of the Kulakov Medical Research Center of Obstetrics, Gynecology and Perinatology; Director of the Institute of Oncogynecology and Mammology

Russian Federation, Moscow

R. Sh. Khasanov

Kazan State Medical Academy – branch of the Russian Medical Academy for Continuous Professional Education

Email: ivprectorat@inbox.ru
ORCID iD: 0000-0003-4107-8608

D. Sci. (Med.), Prof., Corr. Memb. RAS, Director of the Kazan State Medical Academy – branch of the Russian Medical Academy for Continuous Professional Education, Head of Oncology, Radiology and Palliative Medicine Department, Kazan State Medical Academy – branch of the Russian Medical Academy for Continuous Professional Education

Russian Federation, Kazan

I. V. Poddubnaya

Russian Medical Academy for Continuous Professional Education

Author for correspondence.
Email: ivprectorat@inbox.ru
ORCID iD: 0000-0002-0995-1801

D. Sci. (Med.), Prof., Acad. RAS, Vice-Rector for Education, Clinical Care and International Cooperation; Head of Oncology and Palliative Care Department, Russian Medical Academy for Continuous Professional Education

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. A – haematological risk factors for adverse outcomes in oncology patients; B – an adapted three-pillar strategy of Patient Blood Management (PBM) in cancer and the reduction of blood utilisation as a corollary.

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3. Fig. 2. Age-standardised cancer death rates by type, Russian Federation, 1990 to 2017 [55].

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4. Fig. 3. The three dimensions of the Donabedian Quality Framework for healthcare systems.

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5. Fig. 4. Using the Donebedian Quality Framework to translate PBM from an international initiative to a national clinical standard.

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6. Fig. 5. The six-layer PBM implementation strategy.

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7. Supplementary Figure. Traditional three-pillar, nine-field matrix strategy of PBM in the surgical setting.

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