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Eur J Health Econ (2010) 10 (Suppl 1):S91S98

DOI 10.1007/s10198-009-0195-9

ORIGINAL PAPER

Colorectal cancer in Russia


Maria Avksentyeva

Published online: 10 December 2009


Springer-Verlag 2009

Abstract Using peer-reviewed publications and official


government documents, this paper covers three important
issues concerning colorectal cancer (CRC) in Russia: (1)
CRC epidemiology, (2) screening for CRC, (3) medical
care for patients with CRC. Colon and rectal cancer are
registered separately in Russia. When colon and rectal
cancers are considered together, CRC is the second cause
of cancer death for women (after breast cancer) and the
third for men (after lung and stomach cancer), while both
incidence and mortality have increased over the past decade. About a quarter of all new colon and rectal cancer
cases are diagnosed at Stage IV and one-third of patients
with newly diagnosed disease die in the first year after
diagnosing, however, poor data collection and collation
presents problems with reliability of cancer statistics.
Screening for CRC is not included in the national programme of preventive medical examination. There are no
data about treatment effectiveness and access to innovative
drugs in common practice. New drugs for CRC are included in the documents that regulate access to care, notably,
drug lists and standards of medical care. However, many
cancer patients are not included in any reimbursement
programme and have to pay for the drugs, and there are
problems with drug supply even for patients who are
entitled to reimbursement. A national programme for
oncology care development was launched in 2009 but it
does not cover routine treatment.
Keywords Colorectal cancer  Epidemiology 
Access to treatment  Russia
M. Avksentyeva (&)
Russian State Medical University,
Moscow, Russian Federation
e-mail: avksent@yahoo.com

JEL Classification

I11  I12  I18

Introduction
Cancer was the second leading cause of death in Russia in
20062007, with colorectal cancer (CRC) accounting for 13%
of these deaths. The mean age of patients who died from
malignant neoplasms was 65.6 years, with 12.5% dying within
employed ages. Its significance in population health appears
underestimated, reflected by the lack of a national screening
programme and by the limited access to innovative drugs and
treatment. This report addresses three important issues concerning CRC in Russia: (1) the CRC burden, including discussion on data sources and quality of available data, (2)
screening for CRC and, (3) medical care for patients with CRC.

CRC burden in Russia


CRC epidemiology
Colon and rectal cancer are registered separately in Russia.
Incidence and mortality of both colon and rectal cancer
have increased over the last decade, although rectal cancer
age-standardized mortality has decreased [1]. Age-standardized incidence and mortality appear to be greater in
men than in women, though separate rates of colon cancer
are higher for women (Table 1).
Colon cancer comes fourth cancer morbidity in men
(after lung, stomach, skin and prostate cancers) and women
(after breast, skin and stomach cancers). Rectal cancer
comes fifth for men and eighth for women. When colon and
rectal cancers are combined, CRC is second in cancer
morbidity for both sexes.

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M. Avksentyeva

Table 1 Age-standardized colorectal cancer incidence (I) and mortality (M) in Russia, per 100,000 [1]
Year

Colon cancer

Rectal cancer

Men
I

Women
M

Men
M

Women
M

1997

12.25

9.2

10.28

7.02

11.54

8.65

7.64

5.25

1998

12.83

9.37

10.36

7.1

12.02

8.67

7.74

5.29

1999
2000

12.65
12.95

9.23
9.26

10.65
10.81

7.05
7.16

11.97
12.43

9.22
9.55

8.02
8.14

5.7
5.7

2001

13.05

9.29

11.13

7.21

12.37

9.46

8.08

5.62

2002

13.52

9.47

10.94

7.08

13.11

9.5

8.32

5.55

2003

13.93

9.67

11.51

7.38

13.00

9.75

8.27

5.46

2004

14.35

10.02

11.72

7.3

13.23

9.56

8.27

5.48

2005

14.45

9.88

11.98

7.33

13.76

9.64

8.47

5.43

2006

14.74

12.04

7.37

13.82

9.37

8.46

5.37

2007

14.96

9.91

12.20

7.37

13.89

9.58

8.55

?22.49

?10.29

?20.01

?5.27

?20.73

?9.17

?10.86

-2.86a

?2.05

?0.98

?1.84

?0.52

?1.90

?0.88

?1.04

-0.29a

Growth [%]
Average annual growth rate [%]
a

10.1

5.11

No statistically significant difference

In men, colon and rectal cancers are the fifth and sixth
causes of cancer deaths, accounting for 5.6% and 5.2% of
cancer deaths, respectively. In women, colon cancer is the
third cause of cancer mortality (9.1%), while rectal cancer
is fifth (6.5%). Taken together, they place CRC as the
second cause of cancer death for women (after breast) and
the third for men (after lung and stomach).
Median age of diagnosis for rectal and colon cancer was
66.9 and 68.3 years in 2007. Median age of death was 69.6
and 70.8 years, respectively.
Prevalence for both colon and rectal cancer has increased
between 1997 and 2007: from 51.8 to 75.4 for rectal cancer
and from 55.6 to 92.9 for colon cancer (per 100,000).
There is an extremely high first-year death rate of most
cancers in Russia, including CRC. This indicator has
slightly decreased in the last 10 years but is still high: in
2007, 30.0% and 34.4% of patients with newly diagnosed
rectal and colon cancer died in the first year after diagnosis
compared to 36.5% and 42.1% in 1997. However, in 2007,
48.2% and 47.5% of rectal and colon cancer patients were
followed up at medical institutions for 5 years and more
(this measure can be considered as a rough estimation for
CRC 5-year survival).
Cancer registries and data sources
The system of collecting cancer data (registration of incidence) was launched in 1939 in cities with oncology
institutions, and in 1953 in all cities and rural areas in the
USSR. First reports about cancer epidemiology in the
USSR were presented even earlier at oncology congresses

123

in 1931 and 1938. However, data collection in those years


was difficult due to political reasons and limited access to
information on population size, age and sex distribution
and mortality rates. After publication of the general population census of 1959, data collection and analysis became
easier, but even much later medical statistic specialists
noted the fact that proportions were often used instead of
rates to describe cancer epidemiology [2].
At present, data are collected at regional level and then
combined nationally by the Ministry of Health and Social
Development, the State Statistical Service and federal
research institutes. There are several specially designed
statistical registration forms that should be filled in by
doctors who diagnose cancer and provide outpatient,
inpatient and follow-up care for cancer patients. These
forms are completed each time the physician diagnoses
cancer, the patient with malignancy is discharged from the
hospital, or undergoes a planned medical examination. The
data collection system covers the entire population but
reliability of data is sometimes doubtful.
Annually, oncology medical institutions compile special
reports about cancer morbidity, mortality and treatment on
the basis of registration forms and send them to the
regional health care management department; the regional
reports are sent to the Ministry of Health and to the
regional statistical agency; regional statistical agencies
submit reports to the Federal Statistical Service; the report
of the Ministry of Health is also submitted to the Federal
Statistical Service.
Data are also submitted to the P.A. Gertzen Research
Oncology Institute responsible for the State Cancer

Colorectal Cancer in Russia

Register and to the N.N. Blokhin Russian Oncology Scientific Centre. The computer database at the Gertzen
Institute includes incidence (from 1980 onwards), prevalence, mortality (from 1989 onwards), percentage of
patients that died in the first year after diagnosis, percentage of patients that are still registered at oncology dispensary 5 years after diagnosis (known to be alive), stage
at diagnosis and some treatment details (for patients with a
likelihood of remission or eligible for curative treatment,
not for patients receiving palliative care). Cancer data are
presented separately for adults and children, and annual
reports have been published since 1993.
Annual reports of the Ministry of Health and Social
Care, Federal Statistical Service and P.A. Gertzen Research
Oncology Institute are published, but the number of copies
is limited and not all reports can be found in libraries. The
report of the Ministry of Health is on the internet, in
commercial databases of normative documents, but does
not contain all data; moreover, the structure of data presentation in the reports by the Ministry of Health differs
each year (for example not all types of cancer are analysed
each year, some reports present crude rates while others
age-standardized rates) so it is difficult to analyse trends or
compare time series. Furthermore, not all collected data are
analysed and included in the reports.
Data presented by federal research institutes usually do
not differ. However, several publications mention the
problems with collecting and analysing cancer data in Russia
due to misrepresentation. For instance, the Ministry of
Health and Social Care acknowledges that false registration
of the disease stage takes place, reflected by the unlikely
mortality rate of Stage I patients in the first 3 months in some
regions [3]. Other examples include abnormally low rates of
death due to complications despite high surgery rates,
postmortem diagnosis of cancer made without autopsy, high
5-year survival rates, in cancers known to have very low
survival rates, as well as discrepancies in table data [4].

CRC screening
There are no typical screening programmes in Russia;
instead, a preventive mass medical examination programme
occurs which is not aimed at the early detection of certain
diseases (particularly cancer), but includes examinations by
several specialists to assess individual health status.
Preventive mass medical examination was first launched
in 1986 in the USSR, but had many problems because no
targeted financing was provided, physicians had to do extra
work without any incentive and the population was not
interested in participating. Formal analysis of the programme has never been performed. Some publications
suggest that the programme failed because of disinterest by

S93

medical specialists, absence of concrete objectives, insufficient equipment, low level of professional skills among
primary care specialists and lack of continuity of care. In
1987, in spite of this mass population examination, 21.4%
of malignant neoplasms were detected in Stage IV and
28.2% in Stage III [5].
The programme stopped after the break-up of USSR, but
was restored in Russia in 2006. Nowadays, it is aimed at
preventive medical examination of certain population
groups: initially state and municipal institutions employees
and those exposed to professional hazards, subsequently
extended to all the employed population in 2008. The
programme includes: mammography (for women older
than 40 years once every 2 years), ECG, blood test, urinary
test, blood cholesterol and glucose, fluorography (once
every 2 years), PSA (for men older than 40 years), CA-125
(for women older than 40 years) and examination by a
number of specialists (therapist, endocrinologist, ophthalmologist, neurologist, surgeon, urologist or gynaecologist).
Ultrasound prostate examination is also included despite its
limitation in evidence-based diagnosis for prostate cancer.
The average cost of the programme was planned to be 500,
540, 974 and 1042 roubles per patient in 2006, 2007, 2008
and 2009, respectively, ( 14.63, 15.56, 27.11 and
25.141). The programme has not included any CRC
screening test. The Russian Society of Evidence-Based
Medicine Specialists criticized the contents of the programme and proposed including the pap smear and faecal
occult blood test (FOBT) [6]; the former was included in
2009, the latter was not, for unknown reasons.
Since 1948, there have been a number of legal decrees
from the Ministry of Health (in both the USSR and postSoviet Russia) enforcing different cancer detection examinations. Prevention was declared a priority in Soviet health
care and many activities proposed for early diagnosis,
especially cancer (i.e. mammography, pap smear, fluorography, surveillance of high-risk groups such as cervical
erosion, gastric ulcer, antacid gastritis, intestinal and gastric polyposis). However, implementation has always been
difficult for the aforementioned reasons, including lack of
incentive for providers and participants, absence of concrete objectives, insufficient equipment, low level of professional skills among primary care specialists and lack of
continuity of care.
The official statistics shows that few cancers in general and
colorectal cancer in particular are detected early (see Table 2).
There are limited data regarding time to diagnosis and
medical errors. Multiple sources systematically underline
the necessity for implementing a screening programme
with the use of the FOBT and colonoscopy. Many
1

Rate of exchange roubles to eurofor the date January 1 of the


corresponding year (source of data: http://conv.rbc.ru/convert.shtml).

123

S94
Table 2 CRC detection in
Russia [14]

M. Avksentyeva

Year

CRC patients revealed during


preventive medical examinations,
% of all new CRC cases

CRC patients with advanced newly


diagnosed cancer, % of CRC diagnosed
at Stage IV among all new CRC cases

Colon cancer

Rectal cancer

Colon cancer

Rectal cancer

1997

1.5

5.4

32.5

29.1

1998

1.5

5.8

31.8

28.6

1999
2000

1.6
1.6

6.2
6.1

32.4
31.3

28.4
27.8

2001

1.8

7.2

31.1

27.2

2002

2.2

8.3

30.5

26.7

2003

2.2

7.4

30.0

26.0

2004

3.1

8.6

29.5

26.5

2005

3.2

8.5

29.7

24.6

2006

2.5

8.2

29.7

26.3

2007

3.0

7.7

28.9

25.6

specialists still emphasize out-dated digital rectal examination in general practice. Still no formal screening programme exists at present with no explanation for the
rationale. We can suppose that underestimation of the
problem by decision makers and population, lack of
equipment and qualified specialists who perform colonoscopy, the low willingness of the population to undergo the
discomfort of an examination may play a role in the
absence of CRC screening in Russia.

Table 3 Expenditures of state medical guarantee program in Russia,


20012007 [15]
Year

Roubles, bill.

Euro, bill.

2007

897.3

25.9

2006

690.7

20.2

2005

559.5

14.8

2004

435.2

11.7

2003

355.6

10.7

2002

311.0

11.7

2001

238.4

9.1

Medical care provided for patients with CRC


Health-care system in Russiabrief description
In Russia, free medical care for all citizens is guaranteed by
the constitution. However, access is limited by financial
deficiency. The Soviet tax-funded health-care model has
changed for mandatory medical insurance (MMI) in the
1990s in order to obtain guaranteed sources of financing
and to improve efficiency of care. Presently, health care is
financed at different levels and sources: federal, regional
and municipal budgets, MMI funds and from patients
directly. MMI funds are collected from payroll taxes paid
by all employers in the country. Regional authorities
should also pay into MMI funds for children, disabled,
retired and unemployed, but are known not to do so in
many regions.
The federal budget is used for expensive high technologies provided by federal research and clinical institutions
and for target programmes approved by the Ministry of
Health. Regional budgets cover medical care for patients
with socially important diseases (TB, sexually transmitted
and mental diseases, cancer), emergency care and capital

123

costs of regional medical organisations. Municipal budgets


pay capital costs of municipal medical organisations.
MMI funds pay for salaries, medical devices, also medication and meals at hospitals. This means that most health
care institutions are financed from several sources
simultaneously.
Public sector expenditures for health care have increased
in the past 3 years (Table 3), but are still low if measured
as a share of GDP (2.73.6% since 2001). Russia also
spends much less on health per capita than most EU
countries and there are considerable regional variations in
per capita spending. A problem is that spending seems to
be equally balanced between public and private sector [7],
though not supported by official data.
Increase in financing took place mostly due to implementation of the National Health Project in 2006, whose
aim was to improve population health through the development of the material and technical basis of medical
institutions. The project included development of primary
care, development of high technology care and blood

Colorectal Cancer in Russia

service, mass preventive examinations (described above)


and activities aimed at decreasing deaths from preventable
causes (cardiovascular disease and road accidents).
Pharmacotherapy in Russia is covered by the health-care
system only in hospitals. Drugs included in the Essential
Drug List should be available for all hospitalised patients
throughout the country. Some regions and hospitals have
their own formularies, but legally must provide drugs from
the Essential Drug List to everyone who needs them.
Outpatient drugs are paid mostly by patients themselves.
There is no universal drug reimbursement, however, there
are several groups (privileged citizens or citizens with
benefits) who have the right to obtain drugs free or at a
discount. Privileged citizens include veterans of the Civil
and Second World War, survivors of the Leningrad siege
and of Nazi concentration camps, participants in the
Afghanistan war, disabled and Chernobyl disaster survivors, children less than 3 or 6 years in large families, nonworking disabled people, handicapped children and the
indigenous population of the North and Far East regions.
Some patients with certain diseases (TB, diabetes, asthma,
epilepsy, cancer and others) can obtain free drugs although
these are often not available, and there are certain citizens
who have 50% discount for buying drugs at the pharmacies
(working disabled persons, retired with a minimum pension, Chernobyl disaster sufferers, among others).
This system of drug supply was created in the Soviet Union
and remained after its breakup, though the groups of privileged citizens have changed several times. In post-Soviet
Russia, regional budgets became responsible for financing
pharmacotherapy for privileged citizens during outpatient
treatment, and the access to drugs varied greatly between
regions. In 2005, a new system of reimbursement for some
citizens covered by social benefits was launched (Subsidiary
Drug Supply Programme, Rus. DLO). In the DLO programme, drug expenditure for several groups was covered
from the federal budget to improve equal access to medical
care. A special list of drugs included in the DLO programme
was approved by the Ministry of Health and Social Development, and prices for these drugs were registered.
Other sources of drug financing include the seven
diseases programme with target federal financing of 17
expensive drugs for treating seven diseases (organ and
tissue transplants, nanism, Gauchers disease, multiple
sclerosis, myeloid leukemia and other myeloblastic diseases, cystic fibrosis and haemophilia) previously responsible for large portions of the DLO budget. In addition,
some categories of citizens are still included in regional
reimbursement programmes.
Thus there are several sources of financing pharmacotherapy during outpatient treatment: the DLO programme,
the seven diseases programme and regional programmes
for some categories of citizens. However, most patients

S95

have to pay for medicines out-of-pocket, and there are no


official data as to how many people are reimbursed.
Oncology care
Oncology care is not included in the MMI system, but is
financed directly from the regional and federal budgets. In
general, CRC care is financed in the same way as oncology
care. There are no data on national oncology expenditure.
Patients with malignancies are mostly treated and followed in specialised oncology institutions or in oncology
departments at polyclinics and hospitals. Large cities provide highly specialised care with the use of expensive
technologies in research, clinical oncology and radiology.
The system of oncology services has a long history in
Russia. The first Moscow tumour institute was organised in
1903 and re-established in 1920. At the same time, several
specialised clinics were opened in different cities, but the
intensive development of oncology care started after the
Second World War.
In 2007 there were 109 oncology dispensaries and more
than 30,000 oncology beds in Russia (2.1 beds/10,000
population plus 0.6 radiation therapy beds/10,000). In spite
of general attempts to decrease overall numbers of hospital
beds, the number of oncology beds remains stable. About
7% of beds are situated at the dispensaries, others at
oncology departments of multi-field hospitals; 5,754
oncologists and 1,874 radiologists worked at oncology
dispensaries in 2007, on average 428.6 cancer patients per
oncologist.
Oncology institutions are financed according to a cost
estimation defined without any transparent or clear mechanism. The most frequent norm for financing is cost per
hospital day and cost per average doctor visit. According to
the State Medical Guarantee Programme, the mean cost per
day in oncology for adults was 27.95 at regional hospitals, 22.54 at city hospitals and 16.57 at municipal
hospitals in 2006 [8]. There is a consistent opinion that
financial norms and charges are significantly below cost.
Special federal programmes on prevention and control
of socially important diseases, including cancer, are
financed from federal and regional budgets. The programme for 20022006 was approved by the Russian
Government in 2001. Oncology costs were estimated at
22,021.16 mill. roubles ( 511.6 million) for 20022006.
In 2007, the new program for 2007-2011 was approved
with oncology estimated at 12,353.9 mill. roubles ( 289
million) for the whole period. These programmes are not
allocated to specific cancers. The main areas for resource
allocation are: research; building and reconstruction of
specialized oncology institutions; development of a cancer
register; introduction of telecommunication technologies;
buying equipment and making a list of carcinogenic

123

S96

123

patients needing the procedure, number of procedures per


course of treatment, list of recommended drugs and their
doses per day and per course of treatment. The standards do
not include detailed guidelines for physicians but present
the desired care volumes; additionally, there are no clear
mechanisms for implemention or enforcement. No data on
monitoring these standards have been collected. At present,
the Ministry of Health is reviewing all care standards,
despite no clear claims against the approved versions.
Pharmaceutical CRC treatment
Oncology drugs are covered from regional budgets or from
the federal budget at federal centres. Outpatient sector
oncology drugs are covered by special programmes from
federal and regional budgets. Furthermore, there are special
lists of drugs that can be prescribed free of charge.
Pharmaceutical market of oncology drugs (several ATC
groups used in oncology) grew in 20032006 [12]:
2003 135.65 million;
2004 138.23 million;
2005 293.47 million;
2006 597.37 million.
The market growth has taken place mostly due to the
implementation of the aforementioned DLO programme.
There was no increase in the number of packs sold, and the
growth was a result of sales of more expensive new drugs.
Imatinib, Bortezomib, Anastrozole, Epoetin alfa, Trastuzumab and Rituximab were among 15 market leaders in
the DLO program in 2006 and 2007. According to market
sources, Imatinib, Bortezomib and Rituximab were
responsible for 54% of the oncology drugs market in
monetary terms and for only 3% of it in natural units
(number of packs).
Sales of certain CRC-specific drugs have also increased
in 2006 (Fig. 1). There are no data for 20072008, but

35000
30000
25000
20000
15000
10000
5000

2002

2003

2004

2005

2006

ab
ci
zu
va

Be

ap
e
C

2001

bi
ne
ci
ta

la
tin
O

xa

lip

FA

xi
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al
ti

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5-

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substances. These programmes do not cover routine treatment (medication, radiation therapy or surgery).
Resources for routine oncology care are allocated
annually at a federal and regional levels. Oncology institutions are financed mostly regionally, but there are several
federal institutions financed federally, including advanced
oncology centres supplying expensive and complex treatment. There is no free access to routine oncology care
spending. It is known that many oncology institutions are
situated in old buildings that need repair. There is lack of
equipment, and access to modern treatment is limited.
There are a few data on some cancer treatments in
official statistical databases and the number of patients
receiving different treatments is monitored. For rectal
cancer in 2007, 59.7% of patients who completed special
treatment had surgery only, 37.7% had surgery plus other
treatment, 1.9% had radiotherapy only, 0.1% had chemotherapy only, while the remainder received combined
chemo- and radiotherapy. There are no data about colon
cancer treatments, while laparoscopic CRC surgery is
rarely available.
The need for screening, high-risk group surveillance
(including polypectomy) and modern combined treatment
for CRC is systematically underlined by leading Russian
specialists, but there is little evidence of common practice.
We may suppose that limited access to updated information
about best practice, together with financial deficiency,
significantly impairs quality of care.
All leading oncologists consider a national oncology
programme to be necessary, despite its omission in the
2006 and 2007 National Health Projects. In 2009 the
Ministry of Health announced the launch of a national
oncology programme planned for 20092015, with the
proposed federal financing of 28 bill. roubles ( 675.7
mill.) for 20092012 [9]. On the whole, the programme is
aimed at early cancer detection with the goal of decreasing
cancer mortality and disability. Specific objectives include
population education, mass screening, improved posttreatment surveillance, development of epidemiological
surveillance and implementation of standards of care [10].
Eleven regions of Russia will be included in the programme in 2009, with subsequent national expansion.
These 11 regions were chosen on the basis of several criteria concerning mostly the material and technical basis of
oncology institutions, qualification of personnel and
availability of space to install new equipment. At the
moment, subsidies for purchasing equipment have been
approved for only these 11 regions [11], while routine care
has not been covered.
In 2005006 federal standards of medical care for CRC
patients were approved by the Ministry of Health and
Social Development. These standards include lists of
medical diagnostic and treatment procedures, percentage of

M. Avksentyeva

2007 (9 months)

Fig. 1 Sales of drugs used for CRC treatment, thousands USD (IMS
Health, RMBC database)

Colorectal Cancer in Russia

there were significant problems with the DLO programme


in 2007. According to the data of the Federal Service of
Surveillance in Health Care and Social Development, DLO
oncology spending in 2007 was half that of 2006 (6.4 vs.
12.3 bill. roubles; 0.18 vs 0.36).
At the same time, new oncology drugs are included in
documents regulating access to care. Federal standards of
medical care for CRC patients at specialised hospitals
include 5-FU, Irinotecan, Capecitabine, Bevacizumab,
Raltitrexid and Oxaliplatin. All these drugs are also
included in the Essential Drug List, while Capecitabine,
Bevacizumab and Raltitrexid are included on the DLO
drug list. However, there are no mechanisms for enforcing
standards, and access to these drugs is not guaranteed.
There are no formal procedures to attain access to
oncology drugs, and the access appears to depend on the
information available to the physician and patient, their
insistence and financing available at oncology institutions.
There are no official data about out-of-pocket payments in
health care in general or for oncology treatment. Limited
data concerning out-of-pocket payments for health services
in Russia exist in literature, however, the amount of payments is reportedly growing for both formal and informal
payments. An increasing share of private financing was
demonstrated in the reports of the Ministry of Health and
Social Development (2004). Several surveys showed that
families pay out-of-pocket, both formally and informally,
for outpatient and inpatient diagnostic and treatment services, including pharmaceuticals at hospitals [13].
Patients pay for certain services officially: choice of a
physician or institution, diagnostic examination without
referral from the primary physician or without waiting,
single hospital room, sometimes for modern methods of
treatment (for example laparoscopic surgery), sedation
during colonoscopy. The structure of informal payments is
unknown; patients may pay for any care provided. No
evidence of out-of-pocket payments for CRC care is
available, but they exist without any doubt.
The non-governmental organization Equal right for
life published a report in 2007 about drug supply for
cancer patients in Russia, surveying 3,000 respondents
from 44 regions of Russia, and interviewed 158 cancer
patients and 38 oncologists [16]. It showed that the population is not informed about new effective drugs against
cancer. Half of the respondents who had relatives or friends
suffering from malignancies thought that cancer patients do
not receive the necessary treatment, one-third of these
respondents reported that patients or their relatives had to
pay for drugs themselves. A quarter of the patients interviewed were not included in any reimbursement programme and had to pay for their drugs. Patients included in
reimbursement programmes mentioned that there were a
lot of bureaucratic hurdles in the system of drug supply; the

S97

treatment had to be interrupted frequently because of the


absence of drugs from pharmacies. Most of the interviewed
oncologists confirmed that patients have to pay for the
drugs or often interrupt treatment and emphasised that their
pharmacotherapy of cancer should be covered from a
special programme for all patients because of the high cost
of effective drugs.
Post-treatment surveillance
All patients with any type of cancer are followed up at
oncology dispensaries for at least 5 years. There are no
federal standards or approved national guidelines for posttreatment surveillance for patients with CRC. This problem
is much less discussed in articles in comparison with
diagnostic or treatment.

Conclusion
CRC is a serious and underestimated problem of population
health in Russia. CRC incidence and mortality seem less
than they are in reality because of the separate registration
of colon and rectal cancer. If counted together, CRC would
be the second cause of cancer death for women (after breast)
and the third for men (after lung and stomach).
About a quarter of all new CRC cases are diagnosed at
Stage IV and one-third of patients with newly diagnosed
CRC die in the first year after diagnosis. Screening for
CRC is still not included in the national programme of
preventive medical examination.
There are no data on CRC treatment effectiveness and
access to innovative treatment in common practice. New
drugs for CRC treatment are included in the documents that
regulate access to care, i.e. drug lists and standards of care,
but interviews with cancer patients showed that many of
them are not included in any reimbursement programme
and have to pay for the drugs, and there are problems with
drug supply even for patients who are entitled for reimbursement. A national programme for oncology care
development was launched in 2009, but it does not cover
routine treatment.
Conflict of interest statement The author does not report any
conflict of interest associated with this paper.

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Further reading
The report about the State Program of Free Medical Care Guarantees
implementation in 2006 (Translated from Russian: Doklad o
khode realizatsii Programmy gosudarstvennykh garantij
okazanija grazhdanam Rossijskoj Federatsii besplatnoj meditsinskoj pomoshi v 2006 godu). http://mzsrrf.ru/inf_cur/815.html

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