Sergei Sobyanin: The new Loginov MCSC complex will operate under a unified oncological care standard

State Duma’s Chairman Vyacheslav Volodin and Moscow Mayor Sergei Sobyanin visited the new medical and diagnostic facility located at Loginov Moscow Clinical Scientific Center (MCSC) on Entuziastov Highway. At the meeting they discussed the introduction of the new oncological care standard in Moscow.

The discussion was also attended by State Duma’s Deputy Chairmen Vladislav Davankov (New People Party) and Petr Tolstoy (United Russia), faction leaders Vladimir Vasilyev (United Russia), Gennady Zyuganov (CPRF), Sergey Mironov (Just Russia — Patriots — For Truth), Leonid Slutsky (LDPR), as well as committee chairmen Badma Bashankaev (on health protection), Vladimir Gutenev (on industry and trade), Yaroslav Nilov (on labor, social policy, and veterans’ affairs), Maxim Topilin (on economic policy), and Alexander Khinshtein (on information policy, information technologies and communications).

Starting in 2019, Moscow is introducing the new oncological care standard step by step. Even prior to the reform, the Russian capital had high-quality hospitals, and urban, federal and private therapeutic centers provided this type of assistance. However, the city has decided to centralize this system.

“A person who had serious cancer problems was doing everything by themselves, alone in that journey. The first facility provided diagnostics, the second facility issued processed images, the third facility did the surgery, the fourth facility provided therapeutic care and so on. Moreover, sometimes this happened in different parts of the city and in different systems,” said Sergei Sobyanin. “We have completely changed the routing and created five centers that deal with cancer. Five centers: from diagnostics, chemotherapy, surgery to follow-up”.

Now, if a general practitioner of a city polyclinic suspects cancer in a patient, he or she is obliged to refer him or her to a cancer center. There, the patient is accurately diagnosed, receives prescriptions and given treatment tactics. “Once treated, the person is followed up at the outpatient diagnostic center, and this follow-up period essentially lasts for life,” said Sergei Sobyanin.

He emphasized that thanks to the Healthcare National Project, the quality of cancer care is improving across the country. In Moscow, the trend is stronger due to the process optimization and modernization of the material base.

“We don’t turn anyone down. If we have a referral from regional medical services, we accept everyone — in all clinics. That’s a first. Second, we conclude agreements with regions that imply a reduction in the Moscow tariff. One of the principal problems for regional medical care is that in Moscow salaries and tariffs are somewhat higher than in other regions. To somewhat negate this difference, we conclude agreements with regions, reducing the tariff, making it more acceptable,” said Moscow Mayor.

Vyacheslav Volodin noted the openness of Moscow medical institutions for those who come from other regions. Today we are talking about every fifth patient of Moscow clinics. According to State Duma’s Chairman, the systematic approach, which Moscow has now chosen, means that the patient is always supported throughout his or her journey.

“Diagnostics is closely integrated into treatment and diagnosing process itself, among other things. So these are the approaches that have shown their effectiveness along with the fact that conditions for physicians are being created. Hence, we have good social standards and opportunities for work,” said Vyacheslav Volodin. “The standards that Moscow is now setting for itself require not only attention on our part but also their development and spreading to other territories”.

New medical facility

The Loginov MCSC was established in 2013 at the Central Research Institute of Gastroenterology and City Clinical Hospital (CCH) No. 60. This large multidisciplinary medical institution is one of the five anchor cancer hospitals and the center of abdominal robotic surgery (high-tech operations on abdominal organs) in Moscow.

Previously, the center was located in outdated medical facilities built in the 1950 s−1970 s, lacking the area to provide medical care according to modern standards. This prompted Moscow Mayor to build a new medical and diagnostic facility. The erection of the eight-story building with an underground floor began in 2020, and it was completed in 2023. It is now in the process of commissioning.

“We intended to reconstruct the old buildings, but in the end, together with the staff, we decided that it would be better and more promising to demolish them and build a new clinic on this site. The famous 62 nd clinic has the same fate. A new clinical center is being built for it in Skolkovo,” said Sergei Sobyanin.

The new medical complex is designed for 633 beds, including 455 beds of a round-the-clock inpatient facility, 38 beds of an intensive care unit, 120 beds of a day hospital, and 20 beds of a short-stay hospital. The new building is connected to the existing medical facilities by covered passages.

Once it opens its doors, cancer patients will receive all types of medical care in one place. The facility will provide continuity at the inpatient and outpatient stages. Patients will be seamlessly routed there, and a multidisciplinary team of physicians will provide care.

“This center will provide patients with all types of medical care — from diagnostics to high-tech treatment and follow-up. We plan to receive the first patients in August,” wrote Sergei Sobyanin in his Telegram channel.

Source: Sergei Sobyanin’s telegram channel @mos_sobyanin

Doctors will be able to treat malignant tumors of the most complex localizations and perform surgeries for cancers of the head and neck, upper respiratory tract, lungs, esophagus, stomach, reproductive system, pancreas, liver, skin, and other organs. They will be able to provide comprehensive care for cancer comorbid patients: those who have several other serious chronic diseases in addition to cancer.

The center’s hybrid room has an angiograph that allows performing the most complex interventions, said Igor Khatkov, Director of the Loginov MCSC. Actually, three operating theatres are united in one room, and here three operations can be done simultaneously: this is a hybrid technology, added Valery Subbotin, Head of the Department of the Center of Anesthesiology and Reanimatology of the MCSC.

“The opportunities in Moscow allow us to be absolutely equal to the world’s leading clinics. People from the Netherlands, South Korea, and Germany used to come to us to study,” said Igor Khatkov.

The unique technological equipment of the facility will allow to expand the possibilities of performing high-tech operations and to perform radiation therapy (3D and 4D), which was not available in the institution. Patients will be able to undergo treatment under MRI guidance, which will increase the accuracy of the treatment without damaging the tissue and organs surrounding the tumor. In addition, the facility will perform organ transplantation, including in case of malignant neoplasms.

The clinic’s doctors will use the state-of-the-art Fast-Track rapid recovery system, which helps patients return to their everyday routine in the shortest possible time (two to three days for standard surgical procedures). For this purpose, gentle methods of anesthesia, minimally invasive methods of surgical treatment, pain control, and active postoperative recovery are used in the pre- and postoperative period. This significantly reduces the traumatic load on the body and shortens the time to full recovery.

Over 40 thousand units of medical equipment were purchased to equip the new Loginov MCSC medical and diagnostic complex, including three magnetic resonance and five computed tomography scanners, three X-ray complexes (for two and three workplaces), three angiography units, two C-arc X-ray units, ultrasound machines, endoscopic and laboratory equipment, equipment for radiation therapy, operating theaters and resuscitation.

The operating unit will include 18 operating theaters, which are equipped with anesthesia machines, anesthesia monitors, and transport lung ventilators. They are also have a unique microclimate monitoring system to control bacteriological air purity and a Telemedicine system for consultations and training broadcasts of surgeries.

The clinic offers the most comfortable conditions of stay and work for patients, their relatives, and medical staff. Small inpatient wards are equipped with multifunctional beds with electric drives, call buttons for nursing staff, the air conditioning and ventilation system, a shower, and sanitary facilities. You can talk to doctors and psychologists in special rooms and relax and wait in cozy waiting areas.

A barrier-free environment has been created for visitors with reduced mobility: special elevators and sanitary rooms (handrails and seats in the shower), wide doorways, handrails, Braille navigation (for the visually impaired), barrier-free flooring, separate entrances for wheelchairs.

The second floor of the complex housed the outpatient cancer center, organized according to the new standard. In one building, patients can receive all necessary examinations and consultations, including SPECT-CT and PET-CT, within a minimum number of visits. The short-stay operating units will perform minimally traumatic operations to treat general, oncological, urological, gynecological, otorhinolaryngological, and cardiovascular diseases.

According to the Moscow standard of oncological care, the new complex is equipped with an up-to-date pathomorphological laboratory, including an oncogenetic department for diagnosing patients with hereditary forms of cancer.

At the moment, the construction of the new Loginov MCSC medical and diagnostic facility has been completed. Commissioning works and landscaping of the adjacent territory are being finalized. There are convenient driveways for intra-hospital logistics, sidewalks for pedestrians and open parking. New trash cans and benches are scheduled to be installed.

The first patients will be admitted to the new Loginov MCSC medical and diagnostic facility in August 2023.

Moscow’s anchor oncology hospital

Besides the main treatment buildings on Entuziastov Highway (building 86), the Loginov MCSC includes the Outpatient Cancer Center on Perervinsky Boulevard ( house 5, building 1), the Outpatient Cancer Center on Verkhnaya Pervomayskaya Street (house 48, building 1), the Oncosurgical Hospital (house 51, 3 rd Parkovaya Street) and the branch on Akademika Pavlova Street (house 22). The stand-alone units will soon be relocated to the new facility.

The total capacity of the multidisciplinary clinic is about one thousand beds. The consulting and diagnostic department is designed for about two thousand visits per day. Doctors of the Loginov MCSC provide medical care in 19 medical fields, with cancer as a priority.

In 2022, 40.9 thousand people were diagnosed and treated at the center (40.6 thousand in 2021). Outpatient care was provided to 610.7 thousand people (629 thousand in 2021). 33.8 thousand courses of chemotherapy were performed in the day hospital (29.6 thousand in 2021). Specialists performed 14.1 thousand operations (14.1 thousand operations in 2021), including 417 operations using the Da Vinci robot-assisted surgical system.

Since the beginning of 2023, 21.9 thousand people have been treated, 378.9 thousand people have received outpatient care, 30.2 thousand courses of chemotherapy have been carried out in the day hospital, and more than 9.1 thousand operations have been performed.

The clinic employs about three thousand people, including 780 doctors (including eight honored doctors of Russia, two corresponding members of the Russian Academy of Sciences, 66 doctors and 158 candidates of medical sciences, 13 professors, nine associate professors), 150 researchers, 1001 employees of the middle and 111 employees of the junior medical staff.

The Loginov MCSC is a treatment base for the departments of four medical universities: A. I. Yevdokimov Moscow State University of Medicine and Dentistry, Sechenov First Moscow State Medical University, Peoples’ Friendship University of Russia, and Pirogov Russian National Research Medical University. The Center implements postgraduate education programs in 12 medical specialties. In 2022, about 5.1 thousand specialists were trained here, and about 2.3 thousand people since the beginning of 2023.

MCSC specialists initiate and supervise numerous professional educational online communities, participate in Russian and international conferences, and have scientific publications in domestic and foreign periodicals (in 2023, the Hirsch index for the institution is 74).

 

 

New oncological care standard

Moscow is the Russian leader in the application of cutting-edge technologies and cancer treatment methods. In 2019, Sergei Sobyanin approved a new oncological care standard for the population. Throughout 2020, the main provisions of this standard were introduced into the practice of Moscow healthcare institutions, which allowed it to significantly speed up the treatment process, simplify it for the patient and achieve better results. Within three years, early detection of malignant tumors rose from 62.3 percent to 65 percent, and the number of patients who are registered more than five years after the diagnosis rose from 55.6 percent to 58.7 percent.

As part of the new standard, five multidisciplinary cancer centers (a clinic plus a pathomorphological laboratory plus outpatient cancer centers) with a full range of clinical capabilities: diagnostics, surgical treatment, drug therapy, follow-up, and others were established on the basis of the largest city hospitals. Each center is assigned to one or two Moscow administrative districts.

Thus, specialized care is provided within the structure of one medical organization at all stages: examination, treatment, and follow-up of patients. It reduces the diagnosis time, increases its accuracy and allows patients to quickly start treatment.

A standard for outpatient cancer centers (OCC) with the ability to perform all diagnostic tests necessary to make or exclude a cancer diagnosis has been created and implemented.

Cancer care algorithms, or client pathways, have been developed. They provide a seamless system of patient routing from polyclinics to outpatient cancer centers and cover all stages: from suspected malignancy to lifelong follow-up.

Oncological infrastructure is being developed, buildings are being repaired and constructed to provide comfort and a high level of care. New outpatient cancer centers with a full range of diagnostic and treatment capabilities (OCC of the Botkin City Clinical Hospital, City Clinical Oncological Hospital (CCOH) No. 1, Moscow Multidisciplinary Clinical Center (MMCC) Kommunarka), the oncological surgical building of City Clinical Oncological Hospital No. 1 were opened after major repairs. The construction of a new medical and diagnostic building of the Loginov MCSC has been completed, which will welcome patients as early as August 2023. In addition, the construction of the radiation building of MMCC Kommunarka and the multifunctional complex of Moscow City Oncological Hospital No. 62 will be completed. In terms of diagnostic and treatment capabilities, the new centers will match the world’s leading clinics.

The bed capacity for cancer patients is about 1800 beds. The infrastructure development allowed to increase the volume of oncologic care almost twofold. Meanwhile, the mortality rate for cancer patients in the first year of diagnosis decreased by 23 percent (from 17 percent in 2019 to 13.1 percent in 2022).

Every multidisciplinary oncology center (A.S. Loginov MCSC, Moscow City Oncological Hospital No. 62, Botkin City Clinical Hospital, MMCC Kommunarka, CCOH No. 1) has an advanced pathomorphological laboratory. In 2019–2020, the Moscow City Government carried out large-scale re-equipment there, and more than 300 pieces of medical equipment were purchased.

“In 2019, when the reform began, our five oncology departments were picking up about a million drug admissions a year. Now it’s 1.5 million. That is this flow has practically increased by 1.5 times. And this, of course, required definite infrastructural changes. That is why we initiated a huge retrofit. At the moment, more than 350 units of complex high-precision equipment have already been purchased,” said Nikita Savelov, Head of the Pathology Department of Moscow City Oncology Hospital No. 62.

Such work requires a large number of pathologists, according to him. Moscow has managed to accumulate a professional resource, with 10–20 people engaged in oncology in each pathology department. Narrow area specializations have emerged within the community. When the structure was dispersed, such a thing was impossible. “When the ideological, infrastructural, logistical centralization happened, we decided to make the next stage and conduct a digital transformation of the material industry that had already been created,” noted Nikita Savelov.

Digital technology has given pathologists new opportunities. “It’s a step forward for us, too. Since when we look through the microscope, it remains even a little mystery of the doctor: what he saw there — is described, and that’s where the story ends. And here we can track everything the doctor has looked at, he can put notes and leave comments. Later, the head of the department or another doctor will be able to understand the reasoning to make a diagnosis,” added Nikolai Karnaukhov, Head of the Pathology Department.

As a result of the laboratory re-equipment, it became possible to organize work according to the latest standards:

— perform studies to individualize the selection of targeted and immune therapies for patients;

— reduce the time required for pathomorphologic studies;

— automate the processing of diagnostic material as much as possible;

— go digital: digitize images and archive them, hold consultations on complex and ambiguous cases with experts from cancer centers, and provide consultations to other regions.

The number of studies to select the most effective targeted and immune therapies has increased nearly 1.5-fold (from 1,102,015 in 2019 to 1,560,842 in 2022), with an 80 percent increase in the number of immunohistochemical studies and a nearly 3.5-fold increase in the number of molecular genetic studies due to improved equipment productivity.

For the first half of 2023, 809,600 pathomorphologic studies were performed, including 688,645 histologic, 13,344 molecular genetic, and 107,611 immunohistochemical studies.

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Early detection of digestive cancers

The colorectal cancer and gastric cancer early detection and prevention project was launched in August 2021. Modern endoscopy centers were created at Botkin City Clinical Hospital, Buyanov City Clinical Hospital and MMCC Kommunarka, equipped with high-quality expert-class equipment.

Endoscopic examinations are performed on patients from risk groups (follow-up groups with pre-tumor diseases, genetic and family risks, and age) in comfortable conditions under mild sedation.

Since its opening, more than 100,000 patients have been examined, with malignant neoplasms diagnosed in 1,814 of them. Approximately 78 percent of patients were diagnosed for the first time, with more than 60 percent of cases in the early stages (first and second).

Drug therapy

Moscow is the first Russian region to implement the new federal clinical guidelines for the most common cancer types treatment. The city has reached that milestone three years ahead of schedule. As of April 1, 2019, patients are prescribed the most effective targeted and immune drugs.

“Today, 90 percent of oncological diseases are already treated with modern drugs,” said Sergei Sobyanin.

Current medications make it possible to:

— achieve tumor control, increasing the chances of saving the patient even in cancers previously considered fatal;

— accurately target certain malignant tumors, thus avoiding many side effects;

— target certain mechanisms of malignant cells through the immune system, increasing resistance to cancer and protecting the individual from disease and infection;

— make the treatment process more comfortable for the patient because the drugs can be used in a day hospital.

The Moscow modern drug therapy program covers 90 percent of patients who are indicated for this type of treatment. From January through June 2023, more than 37,000 patients received drug therapy for 10 cancer types (breast, prostate, kidney, colon, lung, melanoma, bladder, ovaries, stomach, head, and neck).

Moscow City Cancer Registry

The independent service of the Moscow City Cancer Registry, fully integrated with the Unified Medical Information and Analytical System (EMIAS), was established in 2020. It enabled the pooling of data on cancer patients.

Data on the current stage of treatment, including the entire set of medical documents (chronologically collected protocols of oncology conferences, oncologists’ examinations, hospital discharge summaries, etc.), as well as information on the patient’s follow-up after the completion of treatment is displayed in the patient’s oncology passport. It is available in the EMIAS to oncologists and to Moscow patients with a confirmed cancer diagnosis in their electronic medical records on the mos.ru portal and in the EMIAS.INFO mobile application.

Digital services and telemedicine technologies

Moscow is implementing a project to digitally transform pathomorphological studies. Doctors create digital copies of biological materials and a unified database of histology images. It will serve as the basis for machine learning. Doctors themselves will be able to use digital copies to get second opinions online or hold case conferences.

Digital copies of biological materials will be available both online (during the diagnostics) and post factum (on the EMIAS database). Patients will be able to use them too, for example, when visiting other doctors. There would be no need to take biological materials to the clinic: the EMIAS will have their digital copies. The plans include organizing the stored digital copies into one leading databank to be used as a basis for neural network learning and assisting in pathomorphological studies.

A telemedicine consultation service was introduced into the OCC work. Oncologists and hematologists can use it to issue electronic prescriptions to patients for drugs that are used in protracted courses of therapy (about 80 thousand electronic prescriptions have been issued during the service’s operation). The service also informs about and explains the decisions of an oncology conference if the patient did not attend it in person (more than 18 thousand consultations have taken place).

Telemedical consultations are also carried out based on the results of histological studies if the diagnosis of a malignant neoplasm is excluded. Since the service was introduced, more than four thousand such consultations have been held.

Referrals for required tests or admissions can be created in the telemedicine consultation format. All consultations are formalized by the doctor’s protocol, which is available to the patient in the electronic medical record or in the EMIAS.INFO mobile application.

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Personal Assistant. Service to protect Muscovites’ health

Moscow launched the Personal Assistant pilot project for citizens with cancer in August 2020. Assistants help them to make appointments with the necessary specialists, to take tests and conduct investigations, remind them about their upcoming visit to the doctor, enter information into the city cancer registry, and solve problems that arise. “Every day is critical in oncology, every week is crucial. They are of great value and importance in order to provide help in time,” said Sergei Sobyanin.

Information about the possibility of personalized support is provided in polyclinics when referring to an oncologist. If consented, patients are given a card with the phone number of their future personal assistant.

The project now covers patients with suspected or confirmed cancer in all Moscow administrative districts. More than 140,000 people have already participated in the project.

Appointment posts

Another project is creating appointment posts at outpatient cancer care centers. Specialists help patients to make a one-time appointment for instrumental and laboratory tests, treatment and diagnostic procedures and medical consultations. The regular interactive kiosk does not allow you to see available dates for multiple scheduled exams. If a patient wishes to undergo them on the same day, more time has to be spent on selecting options.

Appointment posts proved to be in demand by patients: their services have already been used more than 80 thousand times. Over 50 percent of all admissions to the OCC are made at the posts.

High-tech medical care

Most types of specialized oncological care are included in the basic CMI program. In addition, patients in need receive free 3D and 4D radiation therapy in 13 city, federal, and private clinics.

In 2022, treated 99 patients (82 patients in 2021) were treated with the proton therapy method. In the first half of 2023, 5,498 completed courses of treatment were performed within the framework of high-tech medical care (3D and 4D radiation therapy) (10,750 in 2022).

Today it is possible to predict the patient’s prognosis, determine the direction of treatment and clarify the diagnosis with the help of genetic research, said Natalia Bodunova, Head of the Center for Personalized Medicine. According to her, this direction can be of use beyond oncology.

“Our center is a scientific facility in nature, and we do scientific research using state-of-the-art equipment. We hope to advance this area of medicine here as well. Currently, our flows count up to a thousand trials per day, which is quite a lot for such complex tests, but if necessary, we can increase them up to one and a half times and thus expand trials for non-oncology patients who also need a personalized approach and personalized medicine,” said Natalia Bodunova.

City oncology conference

Leading oncologists participate in the work of the city oncology conference. It is chaired by Igor Khatkov, Chief External Oncologist of Moscow, Director of the Loginov MCSC.

The city conference allows doctors to find non-standard methods of treatment for the most severe clinical cases faster, as well as to accumulate the experience of the best specialists to select therapy for patients with a complex clinical picture. Chief specialists of not only city but also federal centers take part in the conference; if necessary, doctors of related specialties are involved.

The city conference is responsible for deciding how to prescribe medications to patients when a non-standard clinical approach is needed or prescribing medications not covered by clinical guidelines or not on the supplemental drug list. More than 1.3 thousand clinical cases have been solved during the work of the city oncology conference.

Customer pathways and ranking of oncology inpatient facilities

The priority in the development of Moscow oncology service is the transition to a patient-centered system. The focus is shifting from the volume of services provided-doctor visits, hospitalizations, procedures, and tests-to outcomes essential to patients: timeliness of care, and quality of life after treatment.

Client pathways are detailed algorithms for routing patients with suspected malignant neoplasms across 24 localizations. Client pathways have already been developed, with clearly defined case management routes covering all stages and types of treatment and lifelong follow-up.

Client pathways result in improved quality of cancer care and ensure maximum transparency. By analyzing the timing of diagnoses, conferences, the beginning of treatment, and complications in patients, we can compile quarterly rankings of oncology hospitals. They incorporate feedback from patients who are regularly interviewed by personal assistants.

Observational study of oncology drug efficacy

In 2022, at the initiative of the Moscow Cancer Society, an observational study aimed at forming a clinical basis for the use of the latest oncologic drugs was launched.

The study continues to monitor and treat 10 drugs across four nosologies: lung, kidney, breast, and prostate cancer. More than 900 patients have been enrolled in the study since the beginning of 2022. Based on its results, the most effective and safe drugs are recommended for introduction into the clinical practice of Moscow oncologists.