Romania-Serbia joint initiative against cancer in cross-border region: improved diagnosis and treatment of malignant tumors

Common challenge of the programme area jointly tackled by the project: - Decline of population - the population in the border area on the Serbian territories declined by more than 10% in the last decade but the Romanian area is also losing population; - Serious aging of the population as a consequence of emigration and natural decline, especially in the rural areas; - Natural demographic trend is negative in most areas, with limited positive trends in Timiș county. Health is one of the strongest aspirations of today and is closely and inextricably linked to the concept of economic and social development. It is an inalienable right of all people and must be understood as "a complete welfare of physically, mentally and socially" and not just the absence of disease or infirmity. One of the common territorial challenges shared by the border region of ROM-SRB Programme area is the prevalence of cancer among the population as one of the leading causes of death, especially when we consider the aging of the population, which is an additional factor of high occurrence of malignant diseases. The most important issue is that mortality rates continue to increase in countries with limited resources and health infrastructure, including Romania and Serbia. According to WHO Global Health Observatory data repository for 2013, both countries have evidence-based national guidelines, protocols or standards for the management of major NCDs through a primary care approach, although an operational policy, strategy or action plan for cancer is only available in Romania. Screening at the primary healthcare level is available in Serbia for breast, cervical and colon cancer, but only for breast cancer in Romania. Nor Romania or Serbia have national population-based cancer registries in place. The financial cost of cancer is substantial, comprising direct (treatment, care and rehabilitation) and indirect (related to missed work) costs. The estimated cost of lost productivity due to premature cancer mortality in Europe in 2008 was €75 billion. Therefore, regional prioritization of efforts and cross-border cooperation are increasingly important in order to improve the limited surveillance systems and the treatment of cancer in low and middle income countries, such as Romania and Serbia. This project aims to tackle the challenge of better cancer diagnosis and treatment through improved medical research supported by cross-border networking, improved IT technologies, modernized hospital facilities and evidence-based policy development in healthcare. The overall objective of the project is to foster collaboration in the field of oncology between medical institutions on the two sides of the border in order to provide access to modern and efficient specific health care services for all oncologic patients resident in the Region, with the aim to improve their lifespan/survival/life expectancy and quality of life. The project is based on personalized medicine concept, which is widely accepted and used in developed countries but is still at an early stage in Romania and Serbia. It represents the state of the art in cancer diagnosis and treatment for countries like USA, UK and Germany, which are running even national programmes in the field. Even though the number of patients affected by malignant diseases had been continuously increasing in the last decades, healthcare development in the region couldn’t catch up with increasing treatment and diagnosis needs. Modernization of equipment, improved knowledge base and networking is needed in order to improve the treatment results for cancer patients. The project addresses all these needs and additionally to modernizing medical equipment and facilities, it includes the modernization of computer and communications hardware and software, as well as cross-border communication in order to share resources and knowledge base and complement the partners deficiencies. By establishing a cross-border partnership in the field of health care, by enabling access to medical expertise, on the design, development and deployment of a complete diagnostic software tool, which will help the oncologists choose a better therapeutic strategy for solid tumors (breast, pancreas, colon, and lungs) patients, the project significantly increases the chances for better cancer treatment in the region. Additionally, the project includes the policy development aspect with the aim to provide wider strategic results and improve the response to cancer treatment of healthcare systems in both countries. The successful implementation of project activities will result in improved medical expertise, modernized equipment capacities and improved human resources that enable more proficient and cost-efficient cancer treatment protocols, as well as evidence-based healthcare policies, which will consequently lead to greater economic and social development in the region. The main outputs of the project correspond to the three specific objectives: 1. To develop, improve and modernize diagnosis methods for cancer by: - Extending the network between hospitals in Romania-Serbia Border region through implementation of telediagnostic software and upgrade of existing IT equipment; - Development/implementation of new specialized software platform available for both Romanian and Serbian physicians that will allow fast exchange of information between oncologists and improved diagnosis and treatment for oncologic patients. 2. Transformation and Development of surgical treatment methods and transfer of knowledge between specialists. 3. Evidence-based policy development in the field of cancer treatment based on European best practices enabling and supporting national programmes in both countries devoted to personalized treatment in cancer to improve diagnostic accuracy and life expectancy of oncologic patients. Each output is linked to a specific objective accordingly: Specific objective 1: 1.1. Established networking of all hospitals and institutions included in the project partnership plus all hospitals in the Serbian programme area (min. 15 hospitals total); 1.2. Implemented Expert System Software for diagnosis and treatment of oncologic patients in all hospitals in border region (with the possibility of extending it outside of the programme area - Software will be available for all hospitals in both countries); 1.3. Installed secured system for storage and transmission of medical information in Romanian partner institutions and all health institutions in the Serbian programme area (min. 15 hospitals total); 1.4. Completed study: Development of advanced diagnostic procedures for personalized treatment of cancer in Romania and Serbia; 1.5. Implemented project visibility/knowledge transfer events (46 events total). Specific objective 2: 2.1. Finalized new hospital building in Pozarevac with six new operation rooms and other relevant departments for most common cancer types; 2.2. Modernized and upgraded equipment relevant for treatment of cancer patients in all partner institutions. 2.3. Established Regional Centre for the Prevention, Early detection and Control of Malignant Diseases in Pozarevac. Specific objective 3: 3.1. Developed Substantiation Report under the supervision of the Ministries of Health from Romania and Serbia and under auspices of the National Oncological Societies to improve the system of treatment of cancer patients and enable the implementation of medical and administrative procedures with the possibilities of Serbian patients receiving diagnosis from Romania, and Romanian patients receiving treatment in General Hospital Pozarevac. The project beneficiaries are as follows: Target group type 1 - Patients benefiting from the services of health institutions included in the network on both sides of the border. An approximate average annual patient throughput in 3 partner hospitals is around 397.000 visits (ECCHT 180.000, GHP 147.000, Resita 70.000), Target group type 2 - Population living in the border area that will experience the improvement of quality of life as a result of the efforts of the project. Target group type 3 - Health care personnel and health units in the border area: Healthcare units in the Programme area: GH Pozarevac +12 hospitals in Serbian Programme area; Emergency Clinical County Hospital „Pius Branzeu” Timisoara, ONCOGEN + County Emergency Hospital Resita, + a certain number of other hospitals in the Romanian programme area will have the newly developed expert software installed. Target group type 4 – Medical society of Romania and Serbia and beyond: The medical results stemming from research and cooperation activities completed in the framework of the project regarding diagnostics and treatment of malignant diseases will provide evidence and bases for the greater medical society in Romania and Serbia, but even beyond the borders of these countries regarding future discussions and research topics about the subject. Target group type 5 – Policy makers: Scientific observation and up-to-date databases provided by the project are key components of decision making and policy development regarding healthcare. Cancer is a common problem, with high incidence and mortality and above the European average in both countries (see http://eco.iarc.fr/EUCAN/). None of the two countries has found a solution to decrease cancer mortality so far on their own. Information added on 2020-05-12, regarding the mitigation of the effects of COVID-19 (the corona virus pandemic that started in 2019) (English language only): This project aims to tackle the challenge of better cancer diagnosis and treatment through improved medical research supported by cross-border networking, improved IT technologies, modernized hospital facilities and evidence-based policy development in healthcare.The World Health Organization recognized OncoGen( from the Emergency Clinical County Hospital „Pius Branzeu” Timisoara), as the only research centre in Romania that has a COVID-19 vaccine in pre-clinical tests.

Developed joint personalized working protocols for cancer patients. Based on project partnership between physicians and researchers on the two sides of the border acting in the field of oncology the project will implement activities that will enable knowledge transfer and better communication between researchers and physicians as well as activities relating to modernization of healthcare and R&D facilities in order to ensure more precise and faster diagnosis, accurate/appropriate monitoring of the therapeutic response of patients and as a result the provision of more efficient and cost-effective treatment for cancer patients. By improving the effects and cost-efficiency of provided care for cancer patients, the entire healthcare system will benefit, not to mention the patients themselves. The project also includes the policy-development aspect based on the achieved scientific and practical outcomes, consequantly enabling a wider-range strategical effect.