26.07.18 Diario EL OBSERVADOR
Mario Varangot, Head of the Oncology Department, analysed the incidence of the disease in the country and reviewed the progress made in recent years. Already in the 80’s, Uruguay was pioneer in the oncology field. It was at that time when the firsts postgraduates and specializations in the study of cancer were created. Today, almost 40 years later, more than 120 doctors have specialized in such area of medicine. One of them -and a reference in the subject – is Dr. Mario Varangot. Varangot, British Hospital’s Oncology Unit Director and ex-president of the National Cancer Institute, affirms that the specialization has developed in a progressive way in the country and that thanks to policies such as the held by the British Hospital – that renewed and redraw its oncological area in 2016 – a better comprehension of the disease and the way in which patients should be treated and accompanied has been achieved. He also ensures that the oncologist is a key point for the recovery of the patient, but that it only works when other elements – nursery, psychologists, radiotherapy, surgery and family – are also involved in the job. Such path of teamwork and great variety of opinions on the different cases is, according to him, the one that British Hospital has gone through, and through which they wish to develop every day for the wellbeing of their users. How has the oncology field developed in Uruguay in the last years? It has progressed very quickly, not only due to the formation of the oncologists but because it interconnects with various specializations. Because of that it has improved from the healthcare point of view, as a result of the teamwork or for what we call athenaeums or tumours committees. All the specializations are integrated there and a particular patient case or a specific illness is discussed.There has also been progress and improvement on the diagnosis and treatments. Nowadays we make use of the latest technology for the different oncological treatments and immunotherapy. How important was to improve on the previous diagnosis and the prevention of the illness? Greatly. There are two types of prevention. One is the primary, in which you try to lower the frequency of a cancer linked with risk behaviours. That’s what happens, for example, with tobacco. If the tobacco consumption is reduced or avoided, there’s a fall in the incidence of lung cancer. Then there’s the secondary prevention, which best example is the mammography. This medical test is a very important tool that has proved what an early diagnosis may allow. Due to periodical mammographies there are more opportunities for healing. Therefore, avoiding the cause and making an early diagnosis are two key points. Which are the most common cancers in Uruguay? For men, are lung, prostate and colon cancers. For women are breast and colon. There’s a point that concerns us greatly that’s that in the last 10 or 15 years there’s been a sustained growth of the incidence and frequency of lung cancer in women. It’s probably due to the fact that women started smoking later in time and the impact has been visible in the last 20 years. This doesn’t occur only in Uruguay; in the United States, lung cancer is a greater death cause than breast cancer. It’s not an irrelevant fact and it wouldn’t be surprising that this would happen in Uruguay as well. For men, are lung, prostate and colon cancers. For women are breast and colon. How does Uruguay stand in the field comparing to the rest of the continent? Uruguay has a cancer incidence profile similar to the European or the United States’, that is, of the developed countries. Regarding the rest of the continent, sometimes because of the characteristics of the population or because of the life expectancy, it might eventualize that we don´t have accurate records of the illness’ incidence. That’s not the case in Uruguay. Our country stands out for its good registers on the mortality and incidence of cancer. This helps our statistics to be, in general, well known. In Uruguay the population has access to the information and that’s fundamental. If the country has a high profile of cause of death, it’s due to the characteristics of the population and to such good statistic register. Two years ago the oncological department was renewed; why was it done and how did it affect the actual work with the patient? A project according to which all the oncologists of the Hospital could work along in the same area with Day Care (that’s where chemotherapy and other treatments are held) was contrived. Today we have three big sections: the medical, the nursery, and the administrative staff section. Nobody is isolated and we all work together because the focus is on the patient and we all adapt our roles to what the patient needs. We conceived it in such a way so all the parts would be connected. There was no sense in making this place in a way in which we would be disconnected. We have a meeting room to hold athenaeums twice a week in which we discuss the cases with all the oncologists of the unit, but also with the rest of the specialists. This helps tremendously the patient because we get more than one opinion and these are discussed.This is crucial because sometimes during the process of making a decision, different recommendations arise which maybe didn’t come to mind to the doctor taking the case. The discussion, in that sense, is fundamental. It’s a key professional act. But in addition to the team of oncologists and nurses, a psychologist and a nutritionist also work along with us and it’s expected that new specific units would be created in the future. For the moment, it’s already working here a palliative care unit that among other things can take care of a patient at their homes. Today we have three big sections: the medical, the nursery, and the administrative staff section. Nobody is isolated and we all work together because the focus is on the patient and we all adapt our roles to what the patient needs. How much attention must the oncologist pay to the patient’s psychological area and to his/her relationship with the patient during the medical consultation and treatment? The relationship established between patient and doctor is different in each case. The management of these moments during the consultation is from one to another. A key point is to know how to manage the information and the time in which the patient wants to hear it. Not everyone wants to know everything from the beginning; but the doctor doesn’t know that at first and must establish a bond in order to handle such information, because it’s very hard, many questions arise in that moment, some of which have answer but some don’t. It’s very important to generate trust, that the patient has faith in the medical team, that the doctors are clear about what we think and about the decisions taken at the athenaeum. Patients need time and doctors too. Anyway, that relationship is not exclusive of the oncologist. The patient first goes to the reception, and before that was referred by the general practitioner. There should be stages for support. Someone who has been understood from the moment that he/she makes the appointment comes to the consultation in a different manner. How’s the work with the patient’s family? We need the family. The doctor has to give information to the immediate family, but it often happens that the doctor also need information from them. It shouldn’t be forgotten that we are getting to know a person from whom we only know that in that particular moment is ill, but there are lots of other things that we don’t know. It should also be highlighted that the patients, before they arrive to the consultation have already consulted their general doctor. We get in touch with them because they have known the patients for a larger period of time than we do. It might occur that the following consultations could be different, but even so such information from their general practitioners is indispensable, not only for the technical part, but also because they can tell us about the patient’s inherent characteristics.