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Ocena finančnega bremena pri bolnikih z rakom v Sloveniji
Get PDFBackground: This study aims to define the financial burden experienced by Slovenian cancer patients, including both objective financial consequences and subjective financial worries resulting from their disease and treatment. Additionally, we investigate the impact of financial toxicity (FT) on quality of life (QoL). Prior to this study, no research had been conducted on this topic in Slovenia. Aim: The objective of this study was to evaluate the financial burden experienced by cancer patients in Slovenia, its impact on their QoL, and to test the effectiveness of existing tools for assessing FT and QoL. Methods: A survey methodology was employed to measure FT. We developed our own questionnaire to assess FT, and the internationally validated FACIT-COST and EORTC QLQ-C30 questionnaires were used. The study was prospective and cross-sectional and was held at the Institute of Oncology Ljubljana from June to October 2023. Results: We analysed 590 valid surveys. Based on the FACIT- -COST questionnaire, we found that the majority of surveyed patients (53.7%) had no FT, and 42.9% of surveyed patients mostly had mild to moderate FT. The low FT among Slovenian cancer patients was also confirmed by the EORTC QLQ-C30 questionnaire and our own questionnaire. The majority of patients (85.1%) estimated that they did not incur any major costs due to their disease and treatment. Based on the FACIT-COST and the EORTC QLQ-C30 indicator for financial burden, we found that the risk groups for increased FT were mainly patients with a lower net household income (p ≤ 0.001), younger patients (p < 0.001), breast cancer patients (p = 0.016), working patients (p < 0.001) and patients undergoing active oncological treatment (p = 0.039). In our own questionnaire, a lower level of education (p ≤ 0.001), a rural environment (p = 0.033) and the type of health insurance (p = 0.006) also proved to be important for FT. The effect of religion on FT is not associated with higher FT based on our own questionnaire, as shown by the FACIT-COST and EORTC QLQ-C30 questionnaires. We also confirmed the effect of lower income on poorer QoL. Other parameters influencing QoL are: a very low or very high level of education, head and neck cancer and treatment activity. Conclusions: In Slovenia, the majority of cancer patients do not suffer from FT, and 42.9% have mild to moderate FT. FT is statistically significantly associated with income level, age, type of cancer, employment status, oncological treatment activity, education level, rural environment and type of health insurance. Higher FT is associated with poorer QoL. It is also associated with income level, education level, cancer type and oncological treatment activity.Izhodišče: Finančna toksičnost (FT) predstavlja vse objektivne finančne posledice in subjektivne finančne skrbi, ki se pojavljajo pri bolnikih z rakom in njihovih svojcih zaradi bolezni in zdravljenja. Finančno breme, ki ga imajo slovenski bolniki z rakom, pred našo raziskavo še ni bilo opredeljeno, prav tako ni bil poznan vpliv FT na kakovost življenja (QoL). Namen: Cilj raziskave je bila ocena FT pri bolnikih z rakom v Sloveniji, njen vpliv na QoL bolnikov in preizkus dosedanjih inštrumentov za oceno FT in QoL. Metode: Za merjenje FT smo uporabili anketno metodologijo. Razvili smo lasten vprašalnik za oceno FT in uporabili mednarodno validirana vprašalnika FACIT-COST in EORTC QLQ-C30. Raziskava je bila prospektivna in presečna, potekala je na Onkološkem inštitutu Ljubljana od junija do oktobra 2023. Rezultati: Analizirali smo 590 veljavnih anket. Na podlagi vprašalnika FACIT-COST smo ugotovili, da večina anketiranih bolnikov (53,7 %) nima FT, pri 42,9 % anketiranih bolnikov pa je bila ta večinoma blaga do zmerna. Nizko FT med slovenskimi bolniki z rakom smo potrdili tudi z vprašalnikom EORTC QLQ-C30 in lastnim vprašalnikom. Večina bolnikov (85,1 %) je ocenila, da zaradi bolezni in zdravljenja niso imeli večjih stroškov. Na podlagi kazalnika finančnega bremena FACIT-COST in EORTC QLQ-C30 smo ugotovili, da so rizične skupine za večjo FT predvsem bolniki z nižjim neto dohodkom na gospodinjstvo (p ≤ 0,001), mlajši bolniki (p < 0,001), bolniki z rakom dojk (p = 0,016), zaposleni (p < 0,001), pa tudi bolniki na aktivnem onkološkem zdravljenju (p = 0,039). Pri lastnem vprašalniku so se za statistično pomembne pokazali še nižja stopnja izobrazbe (p ≤ 0,001), podeželsko okolje (p = 0,033) in vrsta zdravstvenega zavarovanja (p = 0,006). Vpliv veroizpovedi na FT na podlagi lastnega vprašalnika ni povezan z večjo FT, kot je to razvidno iz vprašalnikov FACIT- COST in EORTC QLQ-C30. Potrdili smo tudi vpliv nižjega dohodka na slabšo QoL, ostali parametri, ki vplivajo na QoL, pa so še: zelo nizka ali zelo visoka stopnja izobrazbe, rak glave in vratu in aktivnost onkološkega zdravljenja. Zaključki: V Sloveniji večina bolnikov z rakom ne občuti FT, v 42,9 % pa je ta blaga do zmerna. FT je statistično značilno povezana z višino dohodka, starostjo, vrsto raka, zaposlitvenim statusom, aktivnostjo onkološkega zdravljenja, pa tudi s stopnjo izobrazbe, podeželskim okoljem in vrsto zdravstvenega zavarovanja. Večja FT je povezana s slabšo QoL. Ta je povezana prav tako z višino dohodka, stopnjo izobrazbe, vrsto raka in aktivnostjo onkološkega zdravljenja
Onkološko zdravstveno svetovanje na daljavo
Get PDFBackground: At the beginning of 2023, we established a tele-health counselling service in a call centre to empower and support patients and their relatives. In a study, we analyzed the frequency and severity of symptoms related to illness and treatment using an assessment protocol and further referrals according to the intensity of the problem. Methods: A retrospective analysis of telephone calls to the tele-health counselling line in the call centre was performed from 1.10.2023 to 31.1.2024. An assessment tool in the REDcap database was validated and used to collect data from callers. We used Microsoft® Excel® for Office 365 to calculate the percentages and descriptive statistics. Results: The sample included 144 phone calls, of which 60% were phone calls from patients and 39% from patients' relatives. The reason for 60.4% of the phone calls was due to side effects of systemic treatment, which were most common up to one week after the last treatment. In the analysis of telephone calls, the most frequently expressed symptoms were pain (10%), nausea (10%), loss of appetite (7%), and diarrhoea (7%). There were 144 tele-health consultations, 87 referrals to a general practitioner or specialist oncologist, and 14 referrals to emergency medical care. Conclusion: Tele-health counselling should be used as an opportunity to provide access to information and timely healthcare through information and telecommunication systems, as it has a positive impact on promoting self-care, reducing hospitalizations, lowering healthcare costs, and ultimately the quality of life of cancer patients.Izhodišče: V začetku leta 2023 smo v okviru klicnega centra vzpostavili zdravstveno svetovanje z namenom opolnomočenja in podpore bolnikov ter njihovih bližnjih. V raziskavi smo analizirali pogostost in stopnjo pojavljanja simptomov, povezanih z boleznijo in zdravljenjem, z uporabo ocenjevalnega protokola in nadaljnjih napotitev glede na izraženost težav. Metode: Izvedena je bila retrospektivna analiza telefonskih klicev na linijo zdravstvenega svetovanja v klicnem centru od 1. 10. 2023 do 31. 1. 2024. Za zbiranje podatkov o klicateljih je bilo potrjeno in uporabljeno ocenjevalno orodje v podatkovni bazi Redcap. Za izračun odstotnih deležev smo uporabili program Microsoft® Excel® for Office 365 in opisno statistiko. Rezultati: Vzorec je vključeval 144 telefonskih klicev, kar je predstavljalo 60 % telefonskih klicev bolnikov in 39 % klicev bolnikovih bližnjih. Vzrok telefonskih klicev je bil v 60,4 % posledica neželenih učinkov sistemskega zdravljenja, ki so bili najpogostejši do tedna dni od prejetja zadnjega zdravljenja. V analizi telefonskih klicev so bili najpogosteje izraženi simptomi bolečina (10 %), slabost (10 %), izguba apetita (7 %), driska (7 %). Na podlagi tega je bilo izvedenih 144 zdravstvenih svetovanj, 87 napotitev na osebnega zdravnika ali lečečega onkologa in 14 napotitev na nujno medicinsko pomoč. Zaključek: Zdravstveno svetovanje na daljavo je treba uporabiti kot priložnost za zagotavljanje dostopnosti do informacij in pravočasne zdravstvene oskrbe prek informacijskih in telekomunikacijskih sistemov, saj vpliva na spodbujanje samooskrbe, zmanjšanje števila hospitalizacij, znižanje stroškov zdravstvene oskrbe in nenazadnje na kakovost življenja onkoloških bolnikov
Paliativna oskrba odraslih bolnikov z rakom v Sloveniji: temeljni pojmi in priporočila: urednici Maja Ebert Moltara, Marjana Bernot
Get PDFIncidenca raka v prvem letu epidemije covida-19
Get PDFIntroduction: During the past decade in Slovenia, the number of new cancer diagnoses (incidence) has risen by 1.6% annually. In 2020, the first year of the COVID-19 epidemic, a 3–8% decrease in new cancer diagnoses was projected by the OnCOvid platform. Our aim is to present the official cancer incidence for 2020 for Slovenia and to communicate the actual lack of new cancer diagnose. Methods: In the Slovenian Cancer Registry, all Slovene inhabitants diagnosed with cancer in 2020 were registered following the international rules. The results were compared to the official incidence for 2019, modelled incidence for 2020, OnCOvidˊs preliminary results and available data from other population-based cancer registries. Results: In 2020, 15,096 inhabitants were diagnosed with cancer in Slovenia (7,034 women, 8,002 men). Compared to the modelled incidence for 2020, there was a decrease of 1,854 persons (10.9%; 11.6% in women, 10.4 % in men). The decrease is highest in the localized stage and in patients aged 50–69 years (13.2%). The decrease for Slovenia is comparable to decreases in England, the United States and Canada, but somewhat higher than in Scotland and Sweden. The largest decrease in new cancer cases was found for non-melanoma skin cancer (23%, mostly after age 50), prostate (15.9%, localized stage), lung (8.9%, 60–64 years, regional stage) and breast cancer (8.3%, 45–64 years), non-Hodgkin lymphoma (9%) and leukaemia (11.6%), with no decrease in melanoma and colorectal cancer cases. Conclusions: The decrease in cancer incidence for 2020 is likely due to containment measures, healthcare reorganisation and health-seeking behaviour during the COVID-19 epidemic, which is also reported by other countries. Uninterrupted provision of cancer care during epidemics is needed.Uvod: Število novih diagnoz raka (incidenca) se v Sloveniji v zadnjem desetletju povečuje za povprečno 1,6 % na leto. V letu 2020, prvem letu omejitvenih ukrepov zaradi epidemije covida- 19, smo s platformo OnKOvid predvideli 3–8-odstotni padec novih diagnoz raka. Namen je predstaviti uradno incidenco raka za Slovenijo za leto 2020 in ugotoviti, kolikšen je bil dejansko manko novih diagnoz raka. Metode: V Registru raka Republike Slovenije smo v skladu z mednarodnimi pravili registrirali vse nove primere raka pri prebivalcih s stalnim prebivališčem v Sloveniji. Primerjali smo jih z registrirano incidenco za 2019, modelno incidenco za 2020, preliminarnimi rezultati OnKovida in dostopnimi rezultati incidence iz registrov raka iz drugih držav. Rezultati: V letu 2020 je za rakom zbolelo 15.096 oseb v Sloveniji (7.034 žensk, 8.002 moška). Glede na modelno oceno incidence za leto 2020 gre za manko 1.854 oseb (10,9 %; 11,6 % žensk, 10,4 % moških). Pri tem je za 10,5 % manj ugotovljenih rakov v omejenem stadiju, najbolj izrazito v starosti 50–69 let (za 13,2 %). Upad je primerljiv s poročili iz Anglije, ZDA in Kanade ter deloma večji kot na Škotskem in Švedskem. Najbolj izrazit upad novih diagnoz raka ugotavljamo pri nemelanomskem kožnem raku (23 %, najbolj po 50. letu), raku prostate (15,9 %, najbolj v omejenem stadiju), pljučnem raku (8,9 %, 60–64 let, v razširjenem stadiju), raku dojk (8,3 %, 45–64 let), ne-Hodgkinovem limfomu (9 %) in levkemijah (11,6 %). Pri kožnem melanomu, raku debelega črevesa in danke ni bilo primanjkljaja. Zaključek: Upad incidence raka v letu 2020 gre verjetno na račun omejitvenih ukrepov, reorganizacije zdravstva in z zdravjem povezanega vedenja med epidemijo covida-19, beležijo jo v več državah. Med epidemijami je potrebno nemoteno izvajanje onkologije
Priporočila za obravnavo bolnikov s pljučnim rakom
Get PDFIn 2019, the Recommendations for the management of patients with lung cancer were published bringing much-needed standardisation of diagnosis and treatment to improve survival of patients with lung cancer. Three years after the original Recommendations were published, the update of the Recommendations brings the most innovations in the chapter on systemic treatment of patients with lung cancer. This reflects the remarkable progress made in the field of understanding the oncogenesis and biology of lung cancer and thus the development of new drugs. The burden of lung cancer remains high, as lung cancer is still the most common cause of cancer related death in our country and worldwide. Lung cancer is responsible for one of five cancer-related deaths. Almost one third of patients with lung cancer do not receive any oncological treatment, either because of poor performance status, comorbidities or the extent of the disease. Half of the patients have metastatic disease at diagnosis, resulting in only small improvements in survival despite advances in the treatment of lung cancer patients. These data remind us that if we are to make major shifts in the management of lung cancer patients, we will need to take different approaches. The most promising seems to be the detection of early stages of lung cancer which offers the best treatment results. The Recommendations written here are guidelines for the management of patients with lung cancer. Only with comprehensive multidisciplinary treatment approach, the best outcome from the prognostically unfavourable disease can be offered.Leta 2019 so bila objavljena Priporočila za obravnavo bolnikov s pljučnim rakom, ki so v slovenski prostor vnesla prepotrebno poenotenje diagnostike in zdravljenja z namenom izboljšanja preživetja bolnikov s pljučnim rakom. Posodobitev Priporočil tri leta po izidu izvirnika prinaša največ novosti v poglavju o sistemskem zdravljenju bolnikov s pljučnim rakom. To kaže na izjemen napredek na področju razumevanja onkogeneze in biologije pljučnega raka ter s tem razvoja novih zdravil. Breme pljučnega raka ostaja veliko, saj je pljučni rak pri nas in v svetu še vedno najpogostejši vzrok smrti zaradi raka. Za vsako peto smrt zaradi raka je odgovoren pljučni rak. Skoraj tretjina bolnikov s pljučnim rakom ne prejme specifičnega onkološkega zdravljenja, bodisi zaradi slabega stanja zmogljivosti, spremljajočih bolezni ali obsega bolezni. Polovica bolnikov ima ob diagnozi razsejano bolezen, zaradi česar izboljšanje preživetja z malimi koraki sledi napredku v zdravljenju bolnikov s pljučnim rakom. Ti podatki nas opominjajo, da se bomo morali za velike premike v obravnavi bolnikov s pljučnim rakom lotiti drugačnih pristopov. Kot najbolj obetavno se ponuja zgodnje odkrivanje bolezni, ko so možnosti ozdravitve pljučnega raka najboljše. Zapisana Priporočila so usmeritev za obravnavo bolnikov s pljučnim rakom. Le s sodobnim multidisciplinarnim pristopom obravnave lahko bolniku ponudimo zdravljenje, ki mu omogoča najboljši izhod prognostično neugodne bolezni
Uporaba deksmedetomidina za paliativno sedacijo: prikaz primera
Get PDFPalliative end-of-life care, in which signs of dying with the deterioration of vital organs develope and end with death, is a particularly important part of comprehensive palliative care. Palliative sedation must strictly adhere to the ethical aspects and in no way goes beyond the lines of euthanasia. Sedation should be carefully planned and discussed with the patient, relatives and other medical specialists. A multidisciplinary approach is imperative. Each of the specialists of the multidisciplinary team can illuminate their own aspect. At the Institute of Oncology Ljubljana, medical specialists from various disciplines are engaged in palliative medicine and palliative sedation. This paper describes the clinical case of a patient who initially decided for the palliative sedation. Since it was inpossible to achieve adequate sedation depth with standard agents, we decided to use dexmedetomidine. With dexmedetomidine shallow sedation was achieved. Dexmedetomidine is an effective and safe medication that seeks its place in palliative medicine. Only some case reports of this field have been published, but there is no randomised study yet published. We are planning such a study in the future.Paliativna oskrba ob koncu življenja, v katerem se pojavijo znaki pričetka umiranja s pešanjem vitalnih organov in se končajo s smrtjo, je pomemben del celostne paliativne oskrbe. Včasih, ob izredno težkih refraktarnih simptomih napredovale bolezni, je lahko primerna tudi paliativna sedacija. Paliativna sedacija je medicinski postopek, kjer je potrebno strogo upoštevati protokol izvedbe, in slediti etično moralnim vidikom in nikakor prekoračiti črte evtanazije. Paliativno sedacijo je potrebno skrbno načrtovati, se pogovoriti z bolnikom, svojci in s celotnim timom, ki bolnika oskrbuje (zdravniki in negovalno osebje), ga ustrezno dokumentirati in nadzorovati. Pomemben je multidisciplinarni pristop, ko vsak od vključenih zdravnikov specialistov in negovalnega osebja osvetli svoj vidik. V prispevku smo opisali klinični primer bolnice, ki se je zaradi refraktarnega simptoma sprva odločila za paliativno sedacijo, kasneje pa je svojo odločitev spremenila. Pri opisanem primeru s standardnimi učinkovinami sprva nismo uspeli doseči ustrezne globine paliativne sedacije, zato smo se odločili uporabiti deksmedetomidin. Z deksmedetomidinom smo dosegli plitvo sedacijo, ki je bolnici olajšala trpljenje do te mere, da se je tudi odločila za prekinitev paliativne sedacije. Deksmedetomidin je učinkovita in varna učinkovina, ki si išče svoje mesto tudi v paliativni medicini. V literaturi so objavljeni samo posamezni prikazi kliničnih primerov in pregledov področja, ni pa še objavljene randomizirane raziskave. V prihodnosti se taka raziskava načrtuje
Uvodnik
Get PDFno English abstractNovo uredništvo je nadaljevalo osnovno poslanstvo revije svojih predhodnikov: redno objavljanje strokovnih prispevkov, s katerimi bo revija pomagala zdravnikom, da bodo kar najhitreje dobili nove informacije in se seznanili s pomembnimi smermi razvoja stroke, posebej tistimi, ki jih potrebujejo za razumevanje in prakso pri svojem strokovnem delu. Hkrati pa si je zadalo nekaj novih nalog: sodobno oblikovno prenovo revije in spletno prenovo revije, odprtodostopno publiciranje rezultatov raziskav v skladu z načeli odprte znanosti, zagotovitev dodatnega (so)financiranja izhajanja revije ter uvrstitev/indeksiranje revije v mednarodne bibliografske zbirke
Povezanost med rakom in onesnaževali, ki nastanejo v procesih sežiga in sosežiga odpadkov: krovni pregled literature
Get PDFIntroduction: During the process of waste incineration, co-incineration and cement production, various emissions are released into the environment containing different pollutants. The aim was to assess a possible association between exposure to pollutants emitted from co-/incinerators and cement plants and cancer in occupationally exposed persons and residents living near these plants. Methods: Inclusion criteria for the umbrella review were meta-analyses and systematic literature reviews, English, period 1980– 2023. Searches were performed in 4 databases (PubMed, Scopus, Web of Science, Cochrane Reviews). The quality of documents was assessed by AMSTAR-2 (methodology) and GRADE (evidence) tools. Results: Of 7 701 documents, 14 were finally included (5 meta- -analyses, 9 systematic reviews). There is some low to moderate evidence of an association between soft tissue sarcomas and non-Hodgkin lymphomas in population exposed to dioxins near I. generation incinerators, but there is no evidence for next generation incinerators. To date, there is no evidence for co-incinerators. There is moderate evidence for an association between incidence of all cancers, lung, prostate, stomach and oropharyngeal cancer and exposure to chromium in occupationally exposed persons at I.-II. generation cement plants. Most of the evidence is limited due to mixed results, differences in questionˊ technique, heterogeneity, and potential bias. Conclusions: There is limited evidence for an association between cancer and exposure to pollutants emitted from I. generation incinerators and I.-II. generation cement plants. To evaluate the possible association between pollutant emissions from the most modern co-incinerators, it seems reasonable to plan targeted epidemiological studies and human biomonitoring studies.Izhodišča: V procesih sežiga in sosežiga odpadkov ter proizvodnje cementa se v okolje sproščajo izpusti, ki vsebujejo različna onesnaževala. Z namenom oceniti povezanost med rakom pri poklicno izpostavljenih in okoliških prebivalcih ter izpostavljenostjo okoljskim onesnaževalom iz sežigalnic, naprav za sosežig in cementarn smo si za cilj zadali izdelavo krovnega pregleda literature. Metode: V krovni pregled literature so bile vključene metaanalize in sistematični pregledi literature v angleščini v obdobju od leta 1980 do leta 2023. Iskanje je bilo izvedeno v štirih podatkovnih zbirkah (PubMed, Scopus, Web of Science, Cochrane Reviews). Kakovost je bila ocenjena z orodjema AMSTAR-2 (metodologija) in GRADE (dokazi). Rezultati: Izmed 7.701 opredeljenih dokumentov jih je bilo v končno analizo vključenih 14 (pet metaanaliz, devet sistematičnih pregledov). Obstajajo nizki do zmerni dokazi o povezanosti med sarkomom mehkih tkiv in ne-Hodgkinovim limfomom z izpostavljenostjo dioksinom v okolici sežigalnic I. generacije, česar študije niso dokazale za sežigalnice naslednjih generacij. Zaenkrat ne razpolagamo z dokazi za sosežig. Pri delavcih v cementarnah I. do II. generacije obstaja nekaj zmernih dokazov o povezanosti med incidenco vseh rakov, pljučnega raka, raka ustne votline in žrela, prostate in želodca z izpostavljenostjo šestvalentnemu kromu. Velika večina dokazov je omejenih zaradi mešanih rezultatov, razlik v tehniki vprašanj, heterogenosti in potencialni pristranosti. Zaključek: Obstajajo omejeni dokazi o povezanosti med rakom in izpostavljenostjo onesnaževalom iz sežigalnic I. in cementarn I. do II. generacije. Za oceno morebitne povezanosti med rakom in onesnaževali iz najsodobnejših naprav za sosežig je smiselno načrtovati ciljane epidemiološke študije in študije notranje izpostavljenosti z uporabo humanega biomonitoringa
Stresni zlomi medenice po zdravljenju z obsevanjem : pregled literature
Get PDFPelvic insufficiency fractures after radiation therapy are a long-known consequence of tumour irradiation in the pelvic area. Considering their frequency, especially in the sacral region, they are still often hard to diagnose due to their unspecific manifestation. In this literature review we gathered data on the etiology, incidence rate, risk factors, symptoms, diagnostics, treatment and prevention of pelvic insufficiency fractures after radiation therapy. As we were unable to find standardized recommedations, we attempted to use the data to summarize and present conclusions that could be of use in everyday radiation therapy clinical practice.Stresni zlomi medenice po obsevanju so že dolgo znana posledica obsevanja tumorjev v področju medenice. Čeprav so zlasti v področju sakruma relativno pogost pojav, je njihova diagnostika zaradi nespecifičnosti simptomov težavna. V tem preglednem članku smo pregledali literaturo, ki zajema etiologijo, incidenco, dejavnike tveganja, simptome in diagnostiko ter zdravljenje in preprečevanje stresnih zlomov medenice po obsevanju. Na podlagi pridobljenih podatkov smo poskušali strniti in predstaviti najdene ugotovitve z navedenih področij, ki bi nam bile lahko v pomoč v vsakodnevni radioterapevtski klinični praksi, saj standardiziranih priporočil na tem področju nismo našli