Plaušu vēža pacientiem valsts ir sakārtojusi tikai pusi no nepieciešamā – diagnostika un pirmās līnijas terapija tiek apmaksāta, bet 2.līnijas inovatīvā ārstēšana netiek nodrošināta.
Valdībai, tostarp Veselības ministrijai, Finanšu ministrijai, kā arī Nacionālajam veselības dienestam (NVD) vajadzētu uzklausīt ārstus un prioritātēm onkoloģisko saslimšanu gadījumā ir jānāk no ārstu puses. Starp finanšu trūkuma attaisnojumiem no NVD puses ir dzirdama pozīcija, ka ir nepieciešams sakārtot sistēmu, ko arī uzsver prof. dr. med. Gunta Purklane un dr. Sigita Hasnere – ir vairāk jāieklausās ārstos un sistēmu varēs sakārtot. Tāpat svarīga atziņa nāk no Dr. Viktora Kozirovska puses, ka uz šo situāciju ir jāskatās plašāk, ko arī iezīmē viņa komentāri un statistika.
Prof. Dr. Med. Gunta Purkalne par plaušu vēzi saka: “Tā nav onkoloģiskā saslimšana ar kuru saslimst tikai gados vecāki cilvēki, ap 70 gadu vecumu, jo apmēram 10% no visiem plaušu vēža pacientiem ir arī gados jauni, darbspējīgā vecumā. Un pieaug arī sieviešu skaits, kas saslimst ar plaušu vēzi. Visus pacientus galvenokārt vieno smēķēšana, aptuveni 80% no visiem plaušu vēža pacientiem ir smēķētāji.”
Ir efektīvi medikamenti šiem pacientiem, bet Latvijā nav iekļauti kompensējamo zāļu sarakstā – profesore stāsta: “Šobrīd tie medikamenti, ko mēs prasām, jau pietiekoši ilgu laiku ir zināmi medikamenti un pieejami pacientiem citās Eiropas valstīs, kas finansiālo apsvērumu dēļ vai, vienkārši, sistēmas nesakārtotības dēļ joprojām Latvijas pacientiem nav pieejami.”
“Valstij ir jāpagriežas ar seju pret problēmu – mēs runājam par to vairākas dekādes un ir jāsaprot, ka šie līdzekļi ir vajadzīgi tiem pacientiem, kas šobrīd dzīvo Latvijā, kas veido Latvijas ekonomisko vidi. Tieši tāpat kā to risina citas līdzīgā situācijā nonākušas valstis – šis risinājums ir jāatrod.” uzskata profesore Purkalne.
NVD pārstāve Zinta Rugāja saka, ka onkoloģija, tai skaitā plaušu vēzis, ir viena no Veselības ministrijas prioritātēm, tomēr, individuālo kompensācijas piešķiršanu regulē MK noteikumi. “Ja pacients jau ir saņēmis no kompensējamo zāļu saraksta medikamentus, tad nākamajās līnijās valsts vairs neparedz kompensāciju individuālā kārtā, tāpēc, ka pie konkrētās diagnozes ir iekļauti medikamenti ārstēšanai.” skaidro NVD pārstāve. “Mēs gribētu iekļaut visām pacientu grupām gan pirmo, gan otro izvēles terapiju, bet mēs atduramies pret regulāru naudas trūkumu, lai varētu iekļaut šos inovatīvos medikamentus.”
NVD katru gadu veic aprēķinus un iesniedz Veselības ministrijai, kas tālāk iesniedz Finanšu ministrijai prioritāros pasākumus. Zinta Rugāja skaidro: “Konkrēti onkoloģijai nākamajos gados ir vajadzīgs daudz vairāk naudas, piemēram, tiem pašiem jaunajiem inovatīvajiem medikamentiem onkoloģijā mēs bijām iesnieguši uz nākamo gadu, ka ir nepieciešami 28 milj. eiro, bet visa prasītā summa netiks piešķirta.”
“Mūsu uzdevums, ko ar inovatīvajiem medikamentiem būtu jāpanāk – to, ka mēs ievērojam solidaritātes principu un pēc iespējas vairāk pacientiem nodrošinām šo terapiju, un es runāju ne tikai par plaušu vēža pacientiem, bet visiem. Mūsu uzdevums ir nodrošināt, ka visām lokalizācijām vismaz 1. līnijā būtu šī inovatīvā terapija.” stāsta Rugāja. Viņa piekrīt, ka vienreizējas naudas “iešprices” vai pāris gados neko nedos, vajadzētu regulāru pietiekamā apmērā līdzekļu piešķīrumu tieši onkoloģijā: “Un es ļoti ceru, ka ar jauno onkoloģijas plānu tas mainīsies, jo līdzekļu ieguldījumam ir jābūt regulāram, lai mēs varam atļauties medikamentu iekļaušanu kompensējamo zāļu sarakstā visiem pacientiem, visās lokalizācijas.”
Ārstu viedoklis ir nelokāms, Dr. Sigita Hasnere uzsver: “Katrs pacients mums ir ļoti individuāls un ar katru pacientu mēs strādājam (ārstējam) savādāk, ja mēs redzam iespēju palīdzēt, protams, mēs meklēsim iespējas, kur pacients var saņemt atbalstošos medikamentus. Lielākā problēma un izaicinājums – kā mēs komunicēsim ar šiem pacientiem un kā mēs tiksim ar to galā, ka mēs redzam, ka ieguvums būs labāks no šīs terapijas, kuru mēs nevaram izrakstīt kā valsts apmaksātu.” Ārste ir kategoriska un NVD viedokli komentē skarbi: “Mums vajag šos inovatīvos medikamentus ne tikai 1. līnijā, bet arī 2. līnijā. Mēs vēlamies, ka mūs kā ārstus uzklausa un lai NVD prioritizē, ko mēs prasām kā pirmo un kas būtu sekundārs. Protams, mēs gribam visu – bet mēs gribam arī kaut ko tādu, ar ko citi pasaulē jau strādā 20 gadus.”
Ārstu viedoklim piekrīt ar Plaušu vēža pacientu un tuvinieku biedrības vadītājs Harijs Gals: “Ir situācijas, kurās valsts zāles neapmaksā, ko brīžiem regulē pilnīgi muļķīgs normatīvais akts. Pacientam var būt viena terapija, kas ir ļoti dārga un dakteris iesaka citu terapiju, kas patiesībā ir lētāka – valstij būs jāpērk lētākas zāles. Absurdas situācijas, ar kurām ir jācīnās. Gribās, lai arī 2. līnijā tās zāles ir iekļautas un cilvēks var ārstēties ar to, kas viņam ir vislabākais. Muļķīgi noteikumi, ka nedrīkst būt 2. līnija ir steidzami jāmaina.”
Dr. Viktors Kozirovskis iesaka mācīties no citām Eiropas valstīm: “Es nedomāju, ka vienreizēja naudas piešķiršana atrisinās visas problēmas, drīzāk jāskatās, cik valsts tērē veselībai no IKP. Latvijā tas ir aptuveni 4-5%, ja mēs paskatīsimies, citas Eiropas valstis, piemēram, Austrijā tas ir virs 8%, savukārt, kaimiņvalstīs – Igaunijā 6-7%, Lietuvā 7-8%. Jādomā ir tajā virzienā – kāpēc kaimiņvalstīs var nodrošināt nepieciešamo terapiju, bet Latvijā nevar. Latvijā pacientiem iespējas saņemt inovatīvās zāles ir par vienu trešdaļu ir mazākas, nekā citviet Eiropā. Kompensējamo medikamentu sarakstā šo zāļu ir mazāk.”
Ja Latvijai būtu pietiekošs finansējums, tad NVD nevajadzētu meklēt attaisnojumus, kāpēc valsts nevar šos medikamentus kompensēt.
“Ārstu uzdevums ir pacientus ārstēt un ieteikt labāko, savukārt valdības uzdevums ir sakārtot sistēmu tā, lai pacienti saņemtu labāko un efektīvāko terapiju.” uzskata dr. Kozirovskis.
Pēdējos sešos gados Ziedot.lv ir vērsušies vairāk kā 300 onkoloģiskie pacienti – naudas izteiksmē tie ir vairāk kā 5 milj. eiro. Savukārt, 20 ir plaušu vēža pacienti, naudas izteiksmē tie ir 170 tūkstoši eiro, vienam pacientam tie ir aptuveni 60 tūkstoši eiro gadā.
Inese Danga no Ziedot.lv vērš valsts institūciju uzmanību uz to, ka prasīt ziedojumus cilvēkiem ir ļoti emocionāli grūti: “Domāju, ka ļoti daudzi cilvēki pie mums neatnāk, jo grūti ir lūgt palīdzību. Tāpat pacientam tiek radīta papildus emocionālā slodze, jo ziedošanas process nav viegls, pastāv neziņa par šo procesu, cik daudz tiks saziedot. Ziedojumu vākšana ir pietiekami sarežģīta un tas nav nekāds prieks, jo publiski ir jādalās ar savu nelaimi, publiski jāatzīst, ka Tev ir tāda nelaime un publiski arī jāuzklausa dažādi komentāri.”
Dr. Ģirts Šķenders izgaismo vēl vienu problēmu – pacientu datu trūkumu: “Tas ir ļoti labi, ka ir bijusi iespēja novirzīt šo finansējumu diagnostikai, taču, mums nav objektīvi dati, cik daudz ir šie plaušu vēža pacienti, ir tikai atsevišķu slimnīcu uzskaites, manuprāt, datu trūkums arī valdībai neļauj novērtēt inovatīvo medikamentu efektivitāti – cik tad pacientiem šie inovatīvie medikamenti ir palīdzējuši, mēs nevaram sagaidīt no valsts, kura nevāc datus, attaisnot savas rīcības.”
Konteksts
2021.gada 27.oktobrī Plaušu vēža pacientu un tuvinieku biedrības, Nacionālā veselības dienesta, Paula Stradiņa klīniskās universitātes slimnīcas un Rīgas Austrumu klīniskās universitātes slimnīcas speciālisti diskutēja par plaušu vēža pacientu ārstēšanas problemātiku Latvijā.
Diskusijas “Plaušu vēzis – kā dzīvot tālāk?” tiešraidi ikviens interesents var Plaušu vēža pacientu un tuvinieku biedrības Facebook kontā https://ej.uz/PlausuVezisDiskusija
Plaušu vēzis ir viens no izplatītākajiem ļaundabīgajiem audzējiem pasaulē, kā arī galvenais nāves cēlonis onkoloģisku saslimšanu vidū. Latvijā katru gadu plaušu vēzi diagnosticē vairāk nekā 1000 pacientiem, no kuriem viena trešdaļa ir darbspējas vecumā. Kā liecina Slimību profilakses un kontroles centra (SPKC) dati, 2020. gadā no plaušu vēža mira 942 personas, bet 265 pacienti no tiem bija darbspējīgā vecumā. Līdz ar to plaušu vēzis kļūst par galveno priekšlaicīgas mirstības cēloni šo slimību grupā, radot vislielāko ekonomisko slogu no visiem ļaundabīgajiem audzējiem.
Plaušu vēža pacientiem Latvijā ir nepieciešams lielāks valsts atbalsts onkoloģiskās saslimšanas ārstēšanā, kas nodrošinātu līdzvērtīgas tiesības visiem saņemt ārstēšanu atbilstoši starptautiskām vadlīnijām un palielināt savas izredzes pagarināt dzīvildzi.
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