The state of cancer care in Russia. Analytical indicators: one-year mortality (population study at the federal district level)

Abstract

         In February 2019, Russia's first Population-based Cancer Registry (PCR) was created at the federal district level with a database of more than 1 million 350 thousand observations. It is important to note that the levels of standardized morbidity and mortality indicators in the North-Western Federal District (NWFD) and on average in Russia do not have significant differences: morbidity – 261.3 and 249.5 ⁰/₀₀₀₀ (both sexes), men - 293.2 and 286.8 ⁰/₀₀₀₀, women - 252.7 and 234.5 ⁰/₀₀₀₀, respectively; mortality is both sexes (117.6 and 106.8 ⁰/₀₀₀₀, men - 164.7 and 152.4 ⁰/₀₀₀₀, women - 91.3 and 79.5 ⁰/₀₀₀₀, respectively, which allows us to consider the data obtained from the database of the population cancer registry of the Northwestern Federal District to be close to the national average.

After we created the first population cancer registry in Russia in St. Petersburg in 1993, operating according to international standards, the Ministry of Health of the Russian Federation issued Order No. 420 dated December 23, 1996 "On the creation of the State Cancer Registry", which included our recommendations on the nature of work, staffing and technical support. Cancer registries have been established in all administrative territories of the country, many doctors have been trained in St. Petersburg.

In this paper, we will focus our attention on the main important criteria of one-year lethality, its true magnitude and the patterns of its changes.

Methods. The research material was the database of the population cancer registry of the North-Western Federal District. Statistical methods recommended by the International Association of Cancer Registries were used to assess the patterns of death of patients.

Purpose.  To reveal the true state of the oncological service of Russia by the leading parameter - the level of one-year mortality.

The main criteria for evaluating the effectiveness of anti-cancer measures is the level of the proportion of patients who died during the first year after registration in a territorial oncological institution.

Results. According to official data, the one-year mortality rate of patients with malignant neoplasms in Russia and the Northwestern Federal District of the Russian Federation is currently (for both sexes) 20.6 and 20.9% (F. No. 7 of state reporting). The planned indicator is to reduce this level to 16-17% in the coming years.

The real values of this indicator, calculated on the basis of the population cancer registry database, are at least 30-40%, as in other countries. All this is what we have to figure out.

Such a low value of the indicator is explained by the fact that when preparing state reports by superimposing tables from the district level to the reverse, those who died in the last months of the calendar year are not taken into account. They have not yet been received by oncologists from the State Statistics Committee, and the report for the past year must be submitted from the district level on January 20. The main misconception of all management structures is that they do not know on what basis the state reporting is formed and that the database of the population cancer registry has nothing to do with it. This is what our attention has been directed to in recent years - to compile a state report based on the database of the population cancer registry.

Conclusions. Taking into account the presence of existing territorial cancer registries in all administrative territories of Russia, which have accumulated extensive statistical material, switch to calculating one-year mortality rates only on the basis of the population cancer registry database after the data for the reporting year is fully completed. Present these data not only together for both sexes, but separately for men and women. To bring the database of the population cancer registry in full compliance with International standards of its management, to calculate not only the mortality rate in the first year of observation, but also the one-year and five-year observed and relative survival. The assessment of the activity of the oncological service should be carried out according to the dynamic series of survival only on the basis of the database of the population cancer registry.