Projects / Programmes
Comprehensive analysis of management of urological cancer patients with an assessment of possible delays in referrals, realization of diagnostics procedures and first treatment
| Code |
Science |
Field |
Subfield |
| 3.04.00 |
Medical sciences |
Oncology |
|
| Code |
Science |
Field |
| B680 |
Biomedical sciences |
Public health, epidemiology |
| Code |
Science |
Field |
| 3.02 |
Medical and Health Sciences |
Clinical medicine |
Urological cancers, referrals, diagnostic practice, treatment, waiting times, survival, national cancer control plan
Researchers (20)
Organisations (3)
Abstract
BACKGROUND
The data on cancer collected by population-based cancer registries serve as the basis for assessing cancer burden in the country. They are important for planning and evaluation of the National Cancer Control Plan (NCCP), in the field of primary and secondary prevention, diagnostics, treatment and rehabilitation, for planning facilities and funding needed for cancer control (personnel, equipment and hospital capacities) as well as for clinical and epidemiological research. In Slovenia, national Cancer Registry of Republic of Slovenia is operating since 1950 at the Institute of Oncology Ljubljana (OIL). Urological cancers are ones of common cancers in men; their burden in women is lower. There are 370 people diagnosed with kidney cancer, 320 with bladder cancer, and 1,500 with prostate cancer annually in Slovenia. A remarkable increase in the incidence of prostate cancer over the past twenty years is due to the wide use of the prostate specific antigen (PSA) test in healthy men and the detection of a large number of cases that would otherwise remain hidden throughout life. Uncritical use of the PSA test has led to an unacceptable situation: extremely long waiting times for all urological surgeries not only for prostate cancers but including in patients with kidney and bladder cancer.
International comparisons of the survival of patients with urological cancers are also worrying. Survival of Slovenian patients with kidney, bladder or prostate cancer has been worse than the European average for many years. Survival depends primary on the stage and age at diagnosis; the proper treatment is crucial as well. In disseminated prostate cancer, medical specialists pointed out a few years ago that if we are to increase the survival of prostate cancer patients, more attention should be attributed to well managed hormone treatment of this disease. In the case of bladder cancer, not adequate proportion of patients treated with radical cystectomy were observed. However most necessary, there is no recent analysis of the management of patients with urological cancer in the Slovenian health care system.
In order to systematically control cancer burden and to reduce it in the long run, a new National Cancer Control Program (NCCP) was set up in Slovenia for the period 2017 to 2021, defining the strategic goals for reducing incidence, improving survival and improving the quality of life of cancer patients. The specific objective of the NCCP 2017-2021 in the field of diagnostics and treatment is to improve the overall organization of oncological health activities at the primary, secondary and tertiary level of health care, to increase number of medical personnel as well as diagnostic and treatment equipment.
PURPOSE AND OBJECTIVES
In accordance with the basic purpose of the project, which is to provide an evidence-based overview of the early management of patients with common urological cancers in Slovenia and, on the basis of solid data, to assess where in the process of referral, diagnostics procedures and implementation of the first treatment there are professionally intolerable delays or deviations from standardized procedures, the specific objectives of the project are:
to prepare a data-warehouse containing all key information on the early management of Slovenian patients diagnosed with kidney, bladder or prostate cancer in 2014;
to find out at which point in early management of patients with urological cancers there are delays or deviations from standardized procedures;
to prepare proposals for improving the situation.
CONTENTS
Slovenian patients with kidney, bladder or prostate cancer diagnosed in 2014 will be included into a retrospective study cohort. Their personal data and basic data on diagnostics and first treatment will be taken from the Cancer Registry of the Republic of Slovenia. Additional data on early symptoms, decisions on referrals, performed diagnostics and initiation of treatment will be collected by contact
Significance for science
The project is of upmost importance for controling quality and further development of Slovenian system of oncological health care. Results and conclusions of the proposed project will contribute to the advancements in science and improve numerous professional areas (oncology, urology, family medicine, public health). Among the most important contributions are:
quantification of delays in referrals, diagnostics and treatment of patient diagnosed with urological cancers in Slovenia;
presentation of deviations from recommended clinical pathways;
identification of healthcare system’s factors affecting the survival of Slovene patients with urological cancers;
identification of groups of Slovene patients with urological cancer in which it is possible to improve the disease outcome through appropriate systemic actions;
development of specific proposals to improve the management of the early management of patients with urological cancer.
We expect our final results will importantly influence the realization of goals of the National Cancer Control Programme (NCCP) of Slovenia for 2017-2021, principal national document by which the Slovenian health profession and policy intend to reduce the number of new cancer patients and improve the quality of life and the survival of the diseased. NCCP actively supports the proposed project.
Significance for the country
The project will have a significant impact on the economy, as it will, using its objectives, achieve:
improve the effectiveness of the systemic management of urological cancers;
reduce costs of diagnostics and treatment;
decrease absenteeism in active working population.
From both the economic and social point of view, the greatest importance of the proposed project is improving the systemic management of urological cancers. Annually, there are more than 2,000 people diagnosed with kidney, bladder or prostate cancer in Slovenia, in three-quarters of cases they are elderly men diagnosed with prostate cancer. Despite the fact that the survival of patients with prostate cancer is good, the outcome of the disease in all three types of urological cancer in the Slovenian population is still significantly worse compared with Europe and other developed countries.
From an economic point of view, it is most important that more effective disease management mean economic savings for society. It can be achieved by reducing the number of unnecessary interventions, and at the same time, by reducing waiting times for adequate clinical referrals and interventions. Timely diagnosis and appropriate treatment leads to more patients being diagnosed in early disease stage, more successful treatment, and shorter rehabilitation. The mutual effects of the above are expressed on a personal level with a better quality of life (and increased productivity of the patient) and on the population level with improved survival. The long-term impact of the proposed project for the economy is linked to the general health of the population and to the general quality of life, which all lead to a reduction in the costs of cancer treatment and decreased absenteeism in working population.
Most important scientific results
Most important socioeconomically and culturally relevant results
Final report
