To this day, malignant tumors are still the most feared enemies of mankind. According to the latest global cancer burden report released by the World Health Organization’s International Agency for Research on Cancer (IARC), there will be 19.29 million new cancer cases worldwide in 2020, including 4.57 million new cancer cases in China. Although with the progress of medical technology and innovative research and development achievements, the current tumor treatment has changed from “talking about the discoloration of cancer” to “coexisting with cancer”, but how to maximize the benefit of patients is still a question worth pondering.
As we all know, tumor is a systemic disease, especially for patients with advanced stage, its treatment will definitely involve various disciplines. However, most patients have faced “choice anxiety” in the process of diagnosis and treatment: surgeons suggested surgical resection, radiologists suggested radiotherapy, and doctors suggested immunotherapy… Doctors in various departments can provide their professional scope The “best choice” in the hospital, but who should the patient trust and how to choose?
Who decides the “best treatment”
Liu Baorui still remembers a lung cancer patient twenty years ago. After the patient was diagnosed with bone metastases from lung cancer, his family went through a variety of treatment options in different hospitals, but his condition was never under control.
Only when comprehensive treatment is implemented in specific actions can patients truly benefit. “For a patient who doesn’t know medicine, the guidance the doctor gives him when he sees a doctor is very important. But because each doctor is fixed in each department, in the process of providing guidance to patients, there will still be a lack of scientificity and a certain degree of certainty. risk.” Liu Baorui said.
Now, as the vice president of the Drum Tower Hospital Affiliated to Nanjing University School of Medicine (Drum Tower Hospital for short), director of the tumor center, and director of the Nanjing University Clinical Oncology Institute, Liu Baorui has led a team to build a patient-centered, disease-based tumor center After more than ten years of practice on the model road, six oncology centers (subspecialties) have been established in Drum Tower Hospital, covering common head and neck, lung, esophagus and abdominal pelvic tumors and drug therapy, radiotherapy, biological therapy, hyperthermia, minimally invasive therapy and Traditional Chinese and Western medicine treatment and many other diagnosis and treatment techniques.
The birth of a new model is bound to go through multiple tests. In the early days of the establishment of the oncology center model, the multidisciplinary diagnosis and treatment model (MDT) has been gradually promoted in China, but in the reality of the huge number of patients, most hospitals can only achieve critical consultation, but cannot achieve true multidisciplinary comprehensive treatment .
The biggest “helplessness” is that most hospitals still use the department as a unit to assess performance. Doctors from non-undergraduate departments come to the undergraduate department to help with consultation, which will lead to unclear rights and responsibilities and performance. Therefore, multidisciplinary diagnosis and treatment can only be based on advocacy. , voluntarily.
However, with the original intention of being patient-centered and maximizing the benefit of patients, Drum Tower Hospital has practiced a different organizational system from most public hospitals, allowing doctors of different specialties to gather in the same department, abandoning the shackles of departmental interests and titles and qualifications. Performance bundling.
Liu Baorui analyzed that the oncology center model is structural, which systematically ensures that patients receive appropriate medical treatment and achieve maximum benefits. “Provide patients with an efficient and convenient medical process that does not require patients to be overly distracted, over-analyzed, and over-selected.”
Meet the development needs of tumor diagnosis and treatment
Nowadays, with the introduction of new treatment methods such as immunotherapy and personalized precision treatment, the tumor center model is in line with the development needs of tumor diagnosis and treatment.
For example, Liu Baorui said that traditional radiotherapy includes radical radiotherapy and palliative radiotherapy, but in recent years, under the new era of immunotherapy, “immune radiotherapy” was born, which uses radiotherapy as a means to change the immune microbiology of tumors. environment to achieve the purpose of comprehensive tumor therapy.
When the principle of treatment changes, a “comprehensive team” proficient in drug therapy, chemotherapy, immunotherapy and radiation therapy can be sensitively “randomized” to win more chances of survival and better quality of life for patients.
Liu Bin (pseudonym) is the beneficiary of “immune radiotherapy”. After he was diagnosed with gastric cancer three years ago, the doctor found multiple enlarged lymph nodes and fused and enlarged lymph nodes in the hilar area on his CT scan. If the traditional concept is used, the patient cannot be cured regardless of surgery, chemotherapy or radiotherapy.
However, Liu Baorui’s team designed a comprehensive treatment plan for Liu Bin with concurrent chemoradiotherapy combined with PD-1 antibody. After the lesion was significantly retracted, he underwent surgery, and no cancer cells were found in the pathological examination.
At present, the pathological complete response rate of this non-surgical treatment of gastric cancer is as high as 38%. This breakthrough research result will be exchanged in academic reports at the American Society of Clinical Oncology (ASCO) in 2021, which has aroused widespread attention in the academic community.
Patients benefit, doctors grow
With the rapid development of modern medicine, disciplines are becoming more and more subdivided, there are more and more specialties and sub-specialties, and doctors’ abilities are increasingly limited to sub-specialties. In this case, oncologists are separated by a department like a block. wall.
However, under the oncology center model, various departments can learn from each other, which can bring more advantages to clinicians in terms of cross-professional knowledge expansion and diagnosis and treatment efficiency. “Patients benefit and doctors grow.”
Benefiting from the success of non-surgical treatment of gastric cancer, the Pancreatic Tumor Team of Gulou Hospital has also applied this comprehensive treatment plan to the treatment of patients with pancreatic tumors, with remarkable curative effect.
Undoubtedly, the oncology center model promotes the continuous integration of diagnosis and treatment methods among different departments and bridges the imbalanced development of various departments. At the same time, it also poses a higher challenge to the improvement of doctors. They not only need to be proficient in their own specialty, but also need He has a vision beyond his major, has an in-depth understanding of comprehensive cancer treatment, and always maintains a patient-centered philosophy.
”You have to be mentally prepared to study and study for a lifetime. Without such mental preparation, you can’t be a good doctor. To be a scholar with a broad knowledge field, you need to keep exploring.” As an excellent doctoral tutor at Nanjing University, Liu Baorui not only He shoulders the heavy responsibility of the construction of oncology disciplines, and also understands the importance of talents.
Under his leadership, the discipline has won more than 60 provincial and ministerial-level and above projects in recent years, including the national key research and development plan key projects, the national “major new drug creation” science and technology major projects, and the National Natural Science Foundation of China’s major international cooperation projects and key projects; He has received more than 40 scientific and technological awards, including the first prize of Jiangsu Science and Technology Award, the second prize of Science and Technology Progress Award of the Ministry of Education, and the second prize of China Medical Science and Technology Award; published more than 100 SCI papers and obtained 15 national invention patents.
”Under this mode and structure of diagnosis and treatment, doctors can give full play to their ingenuity and achieve themselves while providing patients with a better medical process.” Liu Baorui said.
The “Healthy China 2030” Planning Outline proposes to achieve the strategic goal of increasing the overall 5-year cancer survival rate by 15% by 2030. On this road, Liu Baorui believes: “The changes in the model often bring about better results.”
He still remembers the day he first stepped into the Drum Tower Hospital more than 20 years ago, and was surprised to find that there was a flower shop in this small and expensive city center hospital. At that moment, this hospital, which was the first in the country to propose humanistic construction, left a deep impression on him. “There is a patient-centered and humanistic care here.”
Under the nourishment of this soil, the regrets of the lung cancer patient twenty years ago can now be made up for countless patients, and the tumor center model is being widely practiced and promoted. , to bring them the greatest benefit.