“The situation of the people suffering from acute leukemia in Romania is dramatic. The medicines are not enough, hospital conditions are disastrous. The main issues are the lack of money and improper resource management. Therefore, leukemia patients in Romania have fewer chances to survive and to recover than the ones in Western Europe, for instance.
However there are Romanian doctors trying to change this tragic situation. One of them is MD Andreea Moicean, in the Fundeni University Institute, Center of Hematology and Bone Marrow Transplantation, the most important institute of this type in Romania.
[c:1:s]What is the current situation of the leukemia patients in Romania?
Andreea Moicean: Leukemia patients are divided in two categories: the ones suffering from chronic leukemia and the ones with acute leukemia. For the patients in the first category efficient and very expensive drugs, recently discovered, are also available in Romania. (e.g. Glivec for chronic granulocyte leukemia).
I must mention though that the access to these medicines is somehow restricted, for Romanian patients. Mainly this access depends on a commission of the National House for Health Insurance that monthly approves the start and also the continuation of the treatment. This commission gives the green light within the limits of the approved and inflexible funds. Those commissions exist in the Western countries, too.
Apart from that, in Romania, modern and efficient treatments for chronic leukemia are not at discretion but they are accessible.
The most important issue in Romania is the situation of acute leukemia patients.
In the field of acute leukemia, as it was emphasized at the latest Congress of European Group for Blood and Marrow Transplantation (EBMT), which took place between 24 and 28 March, 2007, at Lyon, France, no new medicines have been released in the last decades.
What has been brought as novelty in treating acute leukemia, recently, was the treatment strategy and particularly: the administration of new combinations of the well-known cytostatics and, most important, the use of large and very large doses of these drugs.
Sadly, in Romania, acute leukemia patients rarely benefit from proper treatment and looking after.
And the reason is the complete lack of accurate and complete statistics - at any level (either locally at the level of sanitary units, or centrally at the level of the above mentioned institutions) -, regarding the number of people suffering from hematological malign diseases, including acute leukemia.
To put it simple: we do not know the number of people suffering of acute leukemia in Romania, either general or by leukemia categories. This is an example of improper management and lack of communication.
In the Center for Hematology and Medullary Transplant of Fundeni Clinical Institute, which is the largest unit treating hematology patients in the country and the oldest (with a total of 157 beds, it is a mammoth unit compared to any of the ones existing in the Western countries!!!), we have registered, between 1979- 2005, only the adult patients with acute lymphoblast leukemia - 802
- and the one diagnosed with acute myeloblast leukemia - 1827. Talking strictly about years 2004 and 2005, we have come up with an average of 40 patients per year with acute lymphoblast leukemia and 50 patients per year with acute myeloblast leukemia.
What about the treatments? Are they the same as abroad? Do the Romanian leukemia patients have the same chances of recovering?
A. M.: Unfortunately, and I regret to say that, to the question whether acute leukemia is treated in the same way here like abroad, my answer is yes and no. To the second question I can definitely answer NO, the Romanian people suffering from acute leukemia DO NOT have the same chances of healing.
The reasons can be grouped in two main categories:
The first one refers to the medicines: cytostatics, antibiotics, antiviral, antifungal, growth factors, and cortisones, all essential and indispensable for the treatment of acute leukemia. The quantities are insufficient and frequently they are not provided in due time.
A doctor, treating averagely 12 hematological patients of all kinds, is given “a portion” of cytostatics, antibiotics, which will - at most -provide the proper treatment for only one acute leukemia patient.
But what if there are 2? What about the other patients? They may need the same medicine, except in smaller quantities! There are terrible situations when, for instance, a patient comes in on, let’s say, April 2nd and he cannot have a proper and complete treatment, not until after the 15th of the month, when the medicine provisions for this month arrive.
This may lead to loosing the remission, altering of the treatment protocol with a definite impact on the recovering chances. The money spent are the same only the efficiency is lower. Improper management.
The second category refers to the hospital conditions: hygiene, isolation, diet, quality of air and water. In Romania, all these are much below the ones imposed by efficient treatment of acute leukemia patients. There exist no written European standards in the sanitary field, but there are some requirements imposed by the level of care.
You cannot look after an acute leukemia patient in the same conditions as a chronic leukemia patient, because you might kill him. You cannot hospitalize in the same place an acute leukemia patient with a patient having lymphoma.
The first one may develop life risking complications, while the second may very well receive the correct treatment in ambulatory conditions, too (option often chosen in Western Europe).
We must understand one thing: the acute leukemia patient is not an ordinary hematological patient. He is one of the most complicated and demanding patients of known by medical science. The basis of acute leukemia treatment has radically changed during the last decade.
It consists now of administration, after inducing the remission, of high and very high doses of cytostatics within a short period of time.
Administering small and repeated doses, to acute leukemia patients, over a period of 2.5 - 3 years, treatment popular in the 70s - 80s, is now obsolete.
These large doses that represent the basis of the modern treatment for acute leukemia are meant to diminish, ideally to eradicate, the residual disease which represents the source of relapse and the cause for late death in acute leukemia.
During and after these very aggressive treatments, the acute leukemia patient is extremely vulnerable to infections of all kind: bacterial, viral, fungic - infections that represent the precocious cause of death in acute leukemia.
These infections have both internal origins, meaning that they originate within the natural cavities of the human body (bowel, alimentary canal, pharynx, and upper breathing apparatus), and contamination from the environment: air, water, food.
Therefore an acute leukemia patient must be hospitalized from the very beginning in an extremely clean environment, even “sterile”, similar to the one required by transplantation: filtered air, filtered water, sterile food, in a room with its own bathroom/ toilet for one, maximum two patients, not more.
There are also some other issues related to visitors and to overworked medical staff. We have the same situation in the whole country. Anywhere in Romania, there are no conditions for a proper looking after leukemia patients.
The hospitals are poorly equipped, the hygiene conditions are way below the international standards and all these are making patients’ life much more difficult. Is this mainly because of money shortage? What about the management?
A.M.: This situation is due to the lack of money. However, part of these issues could be solved by a better management.
There are lots of examples of possible improvements such as: instead of having 4 or 8 patients with all types of hematological diseases (acute leukemia mixed with chronic leukemia, lymphomas, anemia, and hemorrhagic syndromes) hospitalized in the same room, a good management would have rooms with only 1-2 beds with its own bathroom/ toilet exclusively for caring the acute leukemia patients,
while the others can be hospitalized in rooms with more beds with common bathroom/ toilet or in clinic because they don’t have such severe diseases.
This separation would be beneficial from all points of view: the treatment would develop without complications or with fewer complications, for the patient, less expenditures, better results in terms of surviving and quality of life, and even better healing chances.
Back in the ‘90s, when I visited for the first time a hematology unit in Western Europe, in France, they were saying that treating acute leukemia was much more expensive compared to curing lymphomas and chronic leukemia.
Today, by rationalizing the consume because of hospitalization conditions for the acute leukemia patient on one hand, and because of introducing expensive medicines in the practice of lymphomas and chronic leukemia treatments on the other hand, we cannot talk with the same certitude about expensive and cheap diseases.
This is just an issue of management and of understanding the treatment programs on medium and long term.
To draw a conclusion, in Romania we desperately need to build adequate hospital units dedicated strictly to the care of acute leukemia patients, with trained personnel for dealing with these very fragile patients and with permanent supplies of the necessary medicines.”
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