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Intervju dr. Kusta za časopis Asian Hospital & Healthcare Management


Davor Kust, a clinical oncology consultant, discusses challenges in cancer care, advancements in treatment modalities, interdisciplinary collaboration, personalized medicine, access to therapies, emerging technologies' impact, ethical considerations, patient empowerment, and future trends. The interview highlights collaboration, innovation, and hope in driving positive change in cancer care.


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1. What are the key challenges in current cancer care practices that you believe need immediate attention and innovation?


There are several key challenges in current cancer care practices that require immediate attention and innovation, including early detection, personalized treatment, access to care and palliative care. Detecting cancer at an early stage significantly improves treatment outcomes. Innovations in screening technologies, such as liquid biopsies and advanced imaging techniques, are needed to detect cancer at its earliest and most treatable stages. Tailoring treatment based on the individual's genetic makeup, tumor markers, and other factors can improve outcomes and reduce side effects. Innovations in precision medicine, including targeted therapies and immunotherapies, are crucial for advancing personalized cancer care. Disparities in access to cancer care exist across different populations, including racial and ethnic minorities, rural communities, and low-income individuals. Addressing barriers to access, such as cost, transportation, and health literacy, is essential to ensure that all patients receive timely and equitable cancer care. Palliative care plays a crucial role in managing symptoms, improving quality of life, and providing psychosocial support for patients with advanced cancer. However, access to palliative care services remains limited, particularly in resource-limited settings. Innovations in palliative care delivery and integration into standard cancer care are essential to ensure that all patients receive holistic and compassionate care throughout their cancer journey.


2. Could you share insights into the latest advancements or breakthroughs in cancer treatment modalities that hold significant promise for improving patient outcomes?


There have been several significant advancements and breakthroughs in cancer treatment modalities that hold promise for improving patient outcomes. Immunotherapy has revolutionized cancer treatment by harnessing the body's immune system to recognize and attack cancer cells. Checkpoint inhibitors, such as pembrolizumab and nivolumab, have shown remarkable efficacy in a variety of cancers, including melanoma, lung cancer, and kidney cancer. Targeted therapies are designed to specifically target cancer cells based on their molecular characteristics. Drugs that inhibit specific molecular pathways have shown efficacy in cancers with specific genetic alterations, such as EGFR mutations in lung cancer and BRCA mutations in breast and ovarian cancer. Advances in genomic sequencing technologies have enabled the identification of specific genetic alterations driving cancer growth. Precision medicine approaches utilize this genomic information to tailor treatment strategies to individual patients. Combining different treatment modalities, such as chemotherapy, immunotherapy, and targeted therapy, has shown synergistic effects and improved outcomes in many cancers. For example, combining chemotherapy with immunotherapy has demonstrated enhanced antitumor activity in certain types of lung cancer. Advances in radiotherapy techniques, such as intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and proton therapy, enable more precise targeting of tumors while sparing nearby healthy tissue. This leads to improved tumor control and reduced side effects for patients undergoing radiation treatment. These as well as some other advancements in cancer treatment modalities hold significant promise for improving patient outcomes and transforming the landscape of cancer care. 

3. In your opinion, what role does interdisciplinary collaboration play in overcoming barriers and enhancing the effectiveness of cancer care?

Interdisciplinary collaboration plays a crucial role in overcoming barriers and enhancing the effectiveness of cancer care in several ways. Cancer is a complex disease that requires a multidisciplinary approach for optimal management. Interdisciplinary teams typically include oncologists, surgeons, radiation oncologists, pathologists, radiologists, nurses, social workers, and other healthcare professionals. By bringing together experts from various specialties, interdisciplinary teams can provide comprehensive and coordinated care that addresses the diverse needs of cancer patients. Each member of an interdisciplinary team brings unique expertise and perspectives to the table. By sharing knowledge and collaborating closely, team members can collectively develop innovative treatment strategies, optimize treatment plans, and navigate complex clinical scenarios. This shared expertise can lead to better outcomes for patients by ensuring that they receive the most appropriate and personalized care.


4. How do you see personalized medicine and precision oncology shaping the future of cancer treatment pathways?


Personalized medicine and precision oncology are poised to significantly shape the future of cancer treatment pathways. As mentioned earlier, they involve identifying specific genetic alterations or molecular markers driving a patient's cancer and selecting treatments that target these specific alterations. Biomarkers, such as genetic mutations, gene expression profiles, and protein markers, provide valuable information about a patient's tumor biology and response to treatment. Precision oncology utilizes biomarker testing to guide treatment decisions, such as selecting targeted therapies, predicting treatment response, and identifying potential resistance mechanisms. Biomarker-driven treatment approaches enable oncologists to tailor treatment plans to individual patients, leading to more personalized and effective cancer care. Overall, personalized medicine and precision oncology hold great promise for shaping the future of cancer treatment pathways by enabling more targeted, biomarker-driven, and individualized approaches to cancer care. As our understanding of cancer biology continues to advance and technologies for molecular profiling and biomarker testing become more sophisticated, personalized medicine will play an increasingly prominent role in guiding treatment decisions and improving outcomes for cancer patients.


5. What are some of the major obstacles hindering access to cutting-edge cancer therapies, and what strategies can be implemented to address these challenges?


Several obstacles hinder access to cutting-edge cancer therapies, including:

1. Cost: Many innovative cancer therapies, such as targeted therapies and immunotherapies, are expensive, placing a significant financial burden on patients, healthcare systems, and insurers. High treatment costs can limit access to these therapies, particularly for patients without adequate insurance coverage or financial resources.

2. Reimbursement and insurance coverage: Reimbursement policies and insurance coverage criteria may not always align with the rapid pace of innovation in cancer care. Some insurers may impose restrictions or require extensive documentation before covering certain cutting-edge therapies, leading to delays or denials of coverage for eligible patients.

3. Limited availability and infrastructure: Access to cutting-edge cancer therapies may be limited in certain geographic regions or healthcare settings, particularly in low- and middle-income countries or rural areas. Infrastructure constraints, such as inadequate healthcare facilities, trained personnel, and technology infrastructure, can further exacerbate disparities in access to innovative cancer treatments.

4. Regulatory barriers: Regulatory approval processes for new cancer therapies can be lengthy and complex, delaying access to potentially life-saving treatments for patients with advanced or refractory disease. Additionally, clinical trial eligibility criteria may exclude certain patient populations, limiting access to investigational therapies outside of clinical trials.

Some of the strategies that could be implemented to tackle these issues are price negotiation and value-based pricing, expanded insurance coverage and reimbursement policies, investment in healthcare infrastructure, streamlined regulatory pathways, and global collaboration and resource-sharing. By implementing these strategies and fostering collaboration among stakeholders, we can overcome obstacles to access and ensure that all patients have equitable access to cutting-edge cancer therapies, regardless of their geographic location or socioeconomic status.


6. Could you discuss the impact of emerging technologies such as artificial intelligence and big data analytics on cancer diagnosis, treatment planning, and patient management?


I believe that AI and big data analytics are already revolutionizing cancer diagnosis, treatment planning, and patient management. AI algorithms can analyze medical images, such as mammograms, CT scans, and pathology slides, with unprecedented speed and accuracy. Machine learning algorithms trained on large datasets can identify subtle patterns and anomalies indicative of cancer, enabling earlier detection and diagnosis of tumors. AI-powered diagnostic tools have the potential to improve screening programs, reduce false positives and unnecessary biopsies, and increase the chances of detecting cancer at its earliest and most treatable stages. Big data analytics can integrate diverse datasets, including genomic profiles, clinical outcomes, and treatment responses, to identify predictive biomarkers and treatment targets. AI-driven decision support systems can assist oncologists in developing personalized treatment plans by synthesizing clinical data, evidence-based guidelines, and patient preferences. These systems can analyze vast amounts of data to generate treatment recommendations tailored to each patient's unique clinical profile, comorbidities, and treatment goals. Big data analytics can analyze longitudinal patient data to develop predictive models for cancer prognosis, survival outcomes, and disease progression. By harnessing the power of data-driven insights and predictive analytics, oncologists can deliver more precise, personalized, and effective care to cancer patients, ultimately improving clinical outcomes and quality of life.


7. From a regulatory perspective, what changes or initiatives do you believe are necessary to facilitate faster adoption of innovative cancer therapies without compromising safety and efficacy?


From a regulatory perspective, several changes and initiatives are necessary to facilitate faster adoption of innovative cancer therapies without compromising safety and efficacy, such as streamlined regulatory pathways, adaptive clinical trial designs, real-world evidence generation, flexible endpoints and surrogate markers, expedited access programs, and collaborative regulatory frameworks. Regulatory changes and initiatives that prioritize patient safety, while also facilitating faster adoption of innovative cancer therapies, are essential for addressing unmet medical needs, accelerating drug development, and improving outcomes for cancer patients. By embracing flexibility, innovation, and collaboration, regulatory agencies can support the rapid translation of scientific discoveries into new cancer treatments that benefit patients worldwide.


8. What are your thoughts on the integration of complementary and alternative medicine approaches alongside conventional cancer treatments, and how can this integration be optimized for patient benefit?


The integration of complementary and alternative medicine approaches alongside conventional cancer treatments is a complex and nuanced issue that requires careful consideration to ensure patient safety and optimize overall treatment outcomes.The integration of CAM approaches should be guided by the principles of patient-centered care, which prioritize the individual preferences, values, and needs of each patient. Oncologists should engage in open and honest discussions with patients about their interest in CAM therapies, provide evidence-based information about the potential risks and benefits, and support informed decision-making that aligns with the patient's goals and values. It is essential to evaluate the safety and efficacy of CAM therapies using rigorous scientific methods and evidence-based standards. While some CAM approaches may offer symptomatic relief or improve quality of life for cancer patients, others may lack scientific evidence or have potential risks and interactions with conventional cancer treatments.


9. How can healthcare systems globally work together to ensure equitable access to high-quality cancer care for all patients, regardless of socioeconomic status or geographic location?


Healthcare systems can collaborate to allocate resources, such as funding, infrastructure, and healthcare workforce, more equitably across different regions and populations. International partnerships, aid programs, and resource-sharing initiatives can help address disparities in access to cancer care, particularly in low- and middle-income countries where resources may be limited. They can also exchange best practices, guidelines, and clinical expertise through international collaborations, professional networks, and training programs. Capacity-building initiatives, such as educational workshops, telemedicine consultations, and twinning partnerships between healthcare institutions, can enhance the skills and capabilities of healthcare professionals in underserved regions and facilitate the delivery of high-quality cancer care. Other option is to collaborate with other sectors, including governments, academia, non-profit organizations, and industry stakeholders, to address the social determinants of health and promote comprehensive cancer control strategies. By working together in these areas, healthcare systems globally can make significant strides towards ensuring equitable access to high-quality cancer care for all patients, regardless of their background or circumstances. 


10. What are the ethical considerations surrounding genetic testing, genomic data privacy, and the use of patient data in cancer research and treatment decision-making?


Yes there are some ethical considerations. Patients undergoing genetic testing should be fully informed about the purpose, risks, benefits, and potential implications of testing, including the possibility of identifying genetic variants associated with increased cancer risk or hereditary cancer syndromes. Informed consent should be obtained prior to testing, and patients should have the opportunity to ask questions, discuss their concerns, and make informed decisions about whether to proceed with testing. Also, genomic data contains highly sensitive information about an individual's genetic makeup, health status, and familial relationships. Healthcare providers, researchers, and other stakeholders must prioritize patient privacy and confidentiality when collecting, storing, and sharing genomic data. Robust data security measures, such as encryption, anonymization, and access controls, should be implemented to safeguard genomic data against unauthorized access, breaches, and misuse. Patients have a right to control and consent to the use of their genomic data for research and clinical purposes. By integrating ethical principles into policies, practices, and decision-making processes, healthcare providers, researchers, and policymakers can uphold the highest standards of ethical conduct and ensure that genomic data is used responsibly and ethically in cancer care and research.


11. From your experience, what are the most effective strategies for empowering patients and caregivers with comprehensive information and support throughout their cancer journey?


From my experience, several strategies have proven to be effective in empowering patients and caregivers:

1. Patient education: Providing comprehensive and understandable information about cancer diagnosis, treatment options, side effects, and supportive care resources is crucial for empowering patients to actively participate in their care. Educational materials, such as written materials, videos, online resources, and educational workshops, can help patients and caregivers understand their diagnosis, treatment plan, and what to expect during each stage of their cancer journey.

2. Shared decision-making: Encouraging shared decision-making between patients, caregivers, and healthcare providers promotes collaboration, trust, and mutual respect in the decision-making process.

3. Psychosocial support: Addressing the psychosocial needs of patients and caregivers is essential for promoting emotional well-being and resilience throughout the cancer journey. 

4. Access to supportive care services: Ensuring access to comprehensive supportive care services, such as palliative care, pain management, nutrition counseling, rehabilitation, and spiritual support, is essential for addressing the physical, emotional, and practical needs of patients and caregivers throughout the cancer journey.


12. Looking ahead, what do you envision as the most significant trends or innovations that will reshape the landscape of cancer care in the next decade?


Looking ahead, several significant trends and innovations are poised to reshape the landscape of cancer care in the next decade. From all these, I would like to highlight precision oncology (advances in genomic sequencing technologies, biomarker identification, and targeted therapies), immunotherapy (including checkpoint inhibitors, CAR T-cell therapy, and cancer vaccines), liquid biopsy (offers a non-invasive method for detecting cancer, monitoring treatment response, detecting minimal residual disease, and identifying treatment resistance mutations, enabling more personalized and dynamic approaches to cancer care), artificial intelligence and big data analytics, telemedicine and remote monitoring (they can expand access to cancer care, particularly for patients in rural or underserved areas), and integrative and holistic approaches (combining conventional treatments with complementary therapies, psychosocial support, and lifestyle interventions).


13. In conclusion, based on our discussion today, what overarching message or key takeaway would you like to share with our audience regarding the ongoing efforts to break barriers and drive positive change in cancer care?


The overarching message I'd like to share is one of hope, resilience, and collaboration. Despite the many challenges in cancer care, there is a remarkable spirit of innovation, determination, and solidarity driving positive change in the field. From precision medicine and immunotherapy to telemedicine and integrative care, advances in cancer care are transforming the landscape of oncology and improving outcomes for patients worldwide.

However, our collective efforts to break barriers and drive positive change in cancer care require collaboration among healthcare providers, researchers, policymakers, patient advocates, and industry stakeholders. By working together, sharing knowledge, and leveraging technology and innovation, we can overcome obstacles, address disparities, and ensure equitable access to high-quality cancer care for all patients, regardless of their background or circumstances.


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