Beyond the Cancer Diagnosis: Dialogue with Emanuela Dodeva, by Adrian Pogacian

Through candid conversations and inspiring insights, in this edition of “Beyond the Cancer Diagnosis”, Adrian Pogacian and Emanuela Dodeva, delve into the efforts of individuals and organizations dedicated to reshaping cancer care. From addressing systemic inequalities to leveraging digital health innovations, these narratives underscore the power of resilience, collaboration, and advocacy.

Emanuela Dodeva

Adrian Pogacian, MS Psychology, clinical psychologist with executive education in Psycho-oncology, holding a degree in Global Health Diplomacy from Geneva Graduate Institute. Currently, researcher and associate lecturer with focus on Impact of Cancer Diagnosis on Couples and Families, Communication in Cancer Care and Posttraumatic Growth. His expertise is on Coping with Cancer and managing Fear of Recurrence.

Additionally, Founder of INCKA Psycho-oncology Center, Host of Beyond the Cancer Diagnosis Interview Series as well as Writer and Host Content in Psycho-oncology at OncoDaily.com, co-author of the first Romanian Multimodal Care Guideline in Pediatric Onco-hematology, active contributor to the International Psycho-oncology Society, presently IPOS Fear of Cancer Recurrence SIG member and IPOS Early Career Professionals in Psycho-Oncology Committee founder member.

Improving cancer patient care among current health security challenges

Adrian Pogacian: Dear Emanuela, to begin with, I would like you to briefly describe for our audience the idea behind the “EZRA” Organization, its mission and vision in today’s reality.

Emanuela Dodeva: EZRA was born out of a deeply personal journey. A journey of loss, frustration, and a newfound purpose. It began with the passing of my beloved grandmother, just days after I gave birth to my child. The heartbreak of witnessing her long battle with cancer, compounded by the efforts that my mother started with her organisation in order to improve the healthcare system in our country, left me determined to continue the legacy and to make a change.

Our mission is simple but powerful: to stand by those fighting cancer and to fight for a healthcare system that prioritizes dignity, accessibility, and quality. In Macedonia, the challenges faced by cancer patients are immense, from long wait lists for all diagnostic procedures needed for early diagnosis of cancer, limited access to innovative therapies and treatments, to systemic issues.

EZRA exists to bridge these gaps, aligning our healthcare system with European Union standards and ensuring no one feels left behind. At the heart of our work is a dual commitment. First, we are providing direct psychosocial support to patients and their families through our SOS helpline, organising public campaigns for community outreach and raising awareness, and direct support for patients in the hospitals, during their treatments, surgery and therapies.

Furthermore, our second pillar of our commitment is to advocate and make actions for improving quality of healthcare services within the healthcare system, ensuring early detection and implementation of screening programs, health education initiatives, and improved healthcare infrastructure. EZRA represents my hope that no one should endure the helplessness I felt watching my loved one’s struggle.

It is a legacy and a promise to the people of Macedonia that their voices will be heard, their struggles and pain acknowledged, and their lives valued. In EZRA, we believe in creating a future where healthcare is not a privilege but a fundamental right, and where every life is treated with the dignity it deserves.

Adrian Pogacian: You are deeply committed to improving healthcare access and advocating for a more accessible high-quality healthcare system. To what extent do you think these topics depend on health security issues?

Emanuela Dodeva: Health security is the backbone of an accessible, high-quality healthcare system, yet it remains a significant challenge in North Macedonia. This is particularly evident in the fight against breast cancer, where systemic shortcomings have dire consequences. On average, one woman dies from breast cancer every day in Macedonia, a preventable tragedy highlighting critical gaps in our healthcare system. These include limited access to mammograms, shortages of advanced therapies, and inconsistent availability of medications, which hinder early detection and timely treatment. Late-stage diagnoses and reduced survival rates are the devastating outcomes.

Educating the public about the importance of early detection is another critical challenge, compounded by an overstretched healthcare infrastructure. Patients face long waits or unavailable appointments, creating barriers that directly impact outcomes.

At EZRA, we are committed to systemic advocacy to address these issues. It was an honor to represent EZRA in the Parliament of North Macedonia alongside NGOs, the WHO, UNFPA, and medical experts to present actionable recommendations for bridging these gaps.

Our proposals included:

• Expanding diagnostic services to ensure timely and accessible screenings for all patients.
• Updating the national list to include advanced and innovative treatments.
• Establishing a national cancer registry to enable data-driven decisions in oncology.

A significant milestone was achieved when the Government endorsed key resolutions proposed by EZRA, including mandatory health screenings as part of occupational exams. However, we remain cautious, as promises must translate into action to bring real change.

Health security is about more than addressing crises, it ensures equitable access to preventive care, diagnostics, and treatment for all individuals. A strong health security framework is vital to avoid disruptions in medication supply, diagnostic tools, and treatments that can have life altering consequences for patients, especially those with cancer. It also involves building resilient, equitable systems prepared to address emergencies while supporting vulnerable populations.

Improving healthcare access is not merely about availability but about reliability, sustainability, and equity. By addressing workforce shortages, logistical barriers, and financial inequities, we can create a more inclusive healthcare system. Health security lies at the heart of these efforts, ensuring that every cancer patient in Macedonia can access timely, high-quality care without fear of systemic failures.

At EZRA, we believe that health security and healthcare access are deeply intertwined. By focusing on these interconnected issues, we can drive meaningful, lasting change and build a healthcare system that meets the needs of every patient, no matter their circumstances.

Adrian Pogacian: Inequality in cancer care is one of the topics that is becoming increasingly debated these days. Could you name the main barriers to fulfilling this desire?

Emanuela Dodeva: Inequality in cancer care is indeed one of the most pressing issues in North Macedonia, rooted in systemic barriers that must be urgently addressed. As a patient advocate, I believe tackling these barriers requires a multi-faceted and strategic approach.

The first major challenge is geographical disparities. Patients in rural and underserved areas face immense difficulties accessing diagnostic services and treatment due to the highly centralized nature of the healthcare system. Nearly all advanced cancer treatments, such as chemotherapy, are concentrated in Skopje, forcing patients to undertake long and often expensive journeys.

For many families, the logistical and financial strain is simply unsustainable, leading to delayed or foregone care. This is particularly acute for women seeking mammograms or consultations, as the lack of decentralized diagnostic services compounds these access challenges.

Financial barriers are another critical obstacle. Out-of-pocket costs for medications, treatments, and diagnostics place an overwhelming burden on many families. For low-income households, this can mean forgoing life-saving therapies altogether. The reliance on private care due to public healthcare limitations only deepens these inequities.

The shortage of healthcare professionals, including oncologists, radiologists, and technicians, further exacerbates the problem. Overburdened public hospitals, especially in Skopje, struggle to meet the rising demand, leading to long waiting times and pushing patients toward expensive private options. This shortage highlights the urgent need for workforce development and better resource allocation.

Additionally, the lack of organized screening programs undermines early detection efforts. With limited accessibility to screenings like mammograms, many cancers are diagnosed at advanced stages when treatment is less effective. Long wait times for diagnostics discourage preventive care, further worsening outcomes.

Finally, low public awareness about cancer prevention, early detection, and the importance of regular screenings contributes to late-stage diagnoses. Many individuals are not informed about the signs and symptoms of cancer, which delays timely intervention and exacerbates disparities.

To address these systemic barriers, North Macedonia urgently needs a National Cancer Control Strategy.

This plan would:

• Decentralize cancer care to improve access in underserved areas.
• Allocate resources to enhance public healthcare infrastructure, modernize equipment, and expand capacity for diagnostic services.
• Address workforce shortages by investing in training and hiring oncology specialists.
• Introduce financial policies to reduce out-of-pocket costs and make treatments more accessible for all, especially expanding “positive list’ – reimbursement of new innovative therapies and treatments.
• Promote organized, nationwide screening programs for early detection.
• Raise public awareness through targeted education campaigns, empowering individuals to prioritize preventive care and recognize early warning signs.

By addressing these challenges through comprehensive reform and greater investment, North Macedonia can move closer to achieving equitable cancer care, ensuring that no patient is left behind due to systemic barriers.

Adrian Pogacian: Consequently, do you believe in opportunities within the challenges when talking about improving cancer patient care?

Emanuela Dodeva: Absolutely, I do. Challenges, while difficult, often bring the biggest opportunities for change. They push us to look at things differently, to find new solutions, and to work together in ways we might not have before. In cancer care, these struggles show us exactly where we need to focus our efforts, reminding us that real progress happens when governments, healthcare professionals, organizations like EZRA, and the public unite toward a common goal.

For example, geographical disparities inspire us to decentralize healthcare delivery, leveraging regional oncology centers and telemedicine to ensure services reach underserved areas. Financial barriers, though significant, present an opportunity to advocate for equitable funding mechanisms and policies that ease the economic burden on patients. The lack of access to advanced diagnostics and treatments underscores the need to invest in modern technologies like artificial intelligence and digital health tools. These innovations not only enhance efficiency and accessibility but also empower healthcare systems to deliver personalized, patient-centered care.

Around the world, we are witnessing a shift as healthcare systems adopt advanced technologies like artificial intelligence and digital health tools. These innovations are reshaping how care is delivered, bringing it closer to patients, making it more efficient, and tailoring it to individual needs. This isn’t just about adopting new tools, it’s about reimagining how we approach healthcare to create a future that is proactive, inclusive, and centered on the patient.

I believe that challenges are not roadblocks; they are stepping stones. They push us to innovate, collaborate, and drive meaningful progress. With determination, collective action, and a patient-centered approach, we can transform these challenges into opportunities for a brighter, healthier future for all cancer patients.

Adrian Pogacian: Another field of your expertise is Digital Health and AI. Are these instruments useful in cancer care? If yes, would you be able to give some practical examples?

Emanuela Dodeva: As I mentioned before, I believe every challenge pushes us to think outside the box, and in doing so, we often discover transformative solutions. Cancer care is no exception.

The complexity and gaps in the system force us to innovate, and digital health and AI are among the most promising tools reshaping how we detect, diagnose, and treat this disease.

This belief led me to create Detectra.io, an AI platform designed to revolutionize breast cancer detection and diagnostics. While currently in the pre-MVP stage, we are working tirelessly to develop AI-driven solutions that address critical gaps in early detection and diagnostic precision.

Our vision is to equip healthcare providers with tools that enable earlier and more accurate cancer detection, ultimately improving patient outcomes. Our AI algorithms are designed to analyze both 2D and 3D medical images, such as mammograms, CT scans, and MRIs, to identify subtle abnormalities that might be missed by traditional methods. This capability has the potential to improve early detection, which is critical in increasing survival rates and reducing the need for invasive treatments.

We are also working on integrating breast density assessment into our platform. By automating BI-RADS classifications, Detectra aims to provide radiologists with consistent and precise evaluations of breast tissue density. Women with high-density breast tissue face a significantly higher risk of developing breast cancer, and our platform aims to support clinicians in tailoring screening protocols to ensure timely and targeted care for these patients.

Detectra was born out of the conviction that advanced technology can do more than just improve systems, it can save lives. Globally, we’ve seen how AI can make a measurable difference. In the U.S., AI-assisted screening systems have reduced false positives by 37.3%, decreased unnecessary biopsies by 27.8%, and detected 86.8% of screen-detected cancers, highlighting its ability to enhance outcomes while reducing strain on healthcare systems.

Similarly, in Denmark, AI integration into breast screening programs led to a 33.4% reduction in radiologists’ workloads and a 20% increase in the detection rate of smaller tumors, proof that this technology is changing lives.

I believe that technology, when used responsibly and with purpose, has the power to transform challenges into opportunities. AI is not something to fear. It doesn’t replace radiologists, rather, it supports them by serving as a tireless, highly trained pair of “eyes,” designed to work with precision and consistency. AI acts as an ally, enhancing the capabilities of healthcare professionals, reducing the burden of human error, and helping them make more accurate, timely decisions. When used with compassion and purpose, AI becomes a powerful partner in delivering better outcomes and saving lives.

Adrian Pogacian: We are living tremendous times in oncology from the point of view of technologies. Do you agree with the following statement that psycho-oncology seems to have developed in the opposite direction and has not followed the direction of medical oncology? (This is called The Oncological Paradox)

Emanuela Dodeva: I do agree with this statement. In the previous question, I spoke about the incredible advancements in AI, and it’s equally important to acknowledge the development of new drugs and groundbreaking research that have transformed cancer care in remarkable ways. However, while these advancements are crucial, we cannot overlook the psychosocial aspects of cancer care. Surviving cancer is, of course, the ultimate goal, but the quality of life during and after treatment is just as vital. Cancer affects not only the patient but also their entire family, bringing immense emotional, social, and psychological challenges.

As I mentioned earlier, at EZRA we provide psychosocial support to patients and their families, recognizing that healing is not just about treating the body but also the mind and spirit. We offer free wigs, prostheses, and comfort packages to newly operated patients, ensuring they feel supported both emotionally and physically. Through our SOS hotline we aim to make sure that no patient or family member feels alone in their journey.

I believe that the impact of a cancer diagnosis on mental health, coping strategies, and quality of life is profound, and these aspects need to be integrated more deeply into cancer care. It’s not enough to simply survive. It’s about living fully, with dignity, strength, and hope. Cancer doesn’t just affect the body, it touches the mind, the heart, and the lives of everyone around the patient. That’s why I’m sure prioritizing psycho-oncology and incorporating mental health support as a standard part of cancer treatment, can create a more balanced and comprehensive care model that addresses all aspects of the patient’s journey.

Adrian Pogacian: As for the last question, after all these years of experience “on the ground”, how do you see the future of cancer patient care from a psychosocial perspective?

Having walked alongside countless patients and families, and having experienced the personal loss of a loved one to cancer, I have come to believe that the future of cancer care lies not only in medical breakthroughs but also in a profound understanding of the human spirit.

Psychosocial care must take center stage, recognized as essential to healing as any advanced treatment. Research continues to underscore the profound impact of mental health and social support on treatment outcomes, including improved adherence to treatment, better immune response, and overall quality of life. Integrating evidence-based practices such as cognitive-behavioral therapy, stress-reduction programs, and tailored support groups, will be crucial.

But beyond clinical tools, care must reflect compassion, empathy, and recognition of each individual’s unique journey. I see a future where every oncology clinic has a dedicated psychosocial team: therapists, social workers, peer supporters, and spiritual counselors.

These teams will work hand-in-hand with medical providers, offering resources that empower patients and families to face the complexities of cancer with resilience and dignity. Technology, too, will play a transformative role, with telehealth expanding access to support services and digital tools helping patients stay connected to communities that uplift them.

On a personal level, I’ve learned that cancer reshapes the lives it touches in profound ways. The grief of loss taught me that while we cannot always control outcomes, we can ensure that no one faces this battle feeling isolated or unheard. We can create spaces where tears, fears, hopes, and triumphs are shared, honored, and embraced.

Cancer will always test the human spirit, but it also reveals an unparalleled capacity for strength, connection, and hope. The future of cancer care must ensure that no one feels alone in this fight, not in their fear, their grief, or their triumphs.

Together, we have the power to transform the future of cancer care into something far greater than medicine alone, a beacon of resilience, compassion, and unwavering support. Let us be relentless in building that future, one where every patient feels seen, supported, and empowered to live their fullest life, no matter the challenges they face.

In the end, to truly heal someone, we must care for their body, mind, heart, and soul as one. The future of cancer care will not be defined solely by survival rates, but by the courage we inspire, the hope we ignite, and the humanity we bring to every step of the journey.

It is this vision of care that inspires my work every day.

Previous editions of “Beyond The Cancer Diagnosis”.