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Izkušnje z zdravilom olaparib pri zdravljenju recidivnega epitelijskega raka jajčnikov z mutacijami v genih BRCA 1 in BRCA 2
Get PDFIntroduction: Olaparib is used as maintenance oral therapy of patients with BRCA 1/2 mutated relapsed epithelial ovarian cancer.Aim of study: To evaluate the safety and efficacy of olaparib in treatment of patients with BRCA 1/2 mutated relapsed epithelial ovarian cancer.Methods: Retrospective analysis of patients with BRCA 1/2 mutated relapsed epithelial ovarian cancer treated with olaparib at the Institute of Oncology Ljubljana in the period from 1st november 2015 to 31th december 2020. The end points of the study were safety and efficacy (progression-free survival, overall survival). The study was approved by our institutional ethics board.Results: In the observed period, a total of 88 patients with BRCA 1/2 mutated relapsed epithelial ovarian cancer were treated with olaparib. Median age of patients was 60 years. Majority of patients (61%) had 1st relapse of the disease. Majority of patients (74%) had germline BRCA 1 gene mutation. Majority of patients (85%) had at least one adverse event during olaparib treatment. The most common adverse events (all grades) were: nausea (59%), fatigue (59%), anemia (25%), dispepsia (14%), diarrhea (11%), dysgeusia (10%), neutropenia (6%) and arrhythmia (1%). Severe adverse events (grade 3/4) had 10% of patients: anemia 9%, nausea 1%. Median follow up was 40 months. Median progression-free survival was 14,3 months, median overall survival was 20,4 months. Progression-free survival was in correlation to the type of BRCA gene mutation: 80% of patients with somatic BRCA 1/2 gene mutation were progression-free, 55% of patients with germline BRCA 2 gene mutation were progression-free, while 32% of patients with germline BRCA 1 gene mutation were progression-free (p=0,021). The type fo BRCA 1/2 gene mutation did not correlate with overall survival.Izhodišče: Zdravilo olaparib uporabljamo za vzdrževalno peroralno zdravljenje recidivnega epitelijskega raka jajčnikov z mutacijami v genih BRCA 1 in BRCA 2 pri bolnicah, ki se odzovejo na kemoterapijo s preparati platine.Namen: Prikazati varnost in učinkovitost zdravljenja s poli-ADP riboza polimeraznim (PARP) inhibitorjem olaparibom v redni klinični praksi v sklopu vzdrževalnega zdravljenja recidivnega epitelijskega raka jajčnikov z mutacijami v genih BRCA 1 in BRCA 2.Metode: V retrospektivno analizo smo vključili bolnice z recidivnim epitelijskim rakom jajčnikov z mutacijami v genih BRCA 1 in BRCA 2, ki so se začele zdraviti z olaparibom na Onkološkem inštitutu Ljubljana v obdobju od 1. novembra 2015 do 31. decembra 2020. Cilja raziskave sta bila oceniti varnost in učinkovitost zdravila olaparib (preživetje brez ponovitve bolezni, celokupno preživetje). Raziskavo je odobrila etična komisija na Onkološkem inštitutu Ljubljana.Rezultati: V opazovanem obdobju je bilo z olaparibom zdravljenih 88 bolnic z recidivnim epitelijskim rakom jajčnikov z mutacijami v genih BRCA 1 in BRCA 2. Mediana starost bolnic je bila 60 let. Večina (61 %) je imela prvi recidiv bolezni, prav tako večina (74 %) je imela tudi zarodno mutacijo v genu BRCA 1. Večina bolnic (85 %) je nadalje imela vsaj en neželeni učinek zdravljenja z olaparibom. Najpogostejši (vse stopnje) so bili: slabost (59 %), utrujenost (59 %), anemija (25 %), dispepsija (14 %), tekoče blato (11 %), spremembe okusa (10 %), nevtropenija (6 %) in aritmija (1 %). Resne neželene učinke (stopnje 3/4) je imelo 10 % bolnic: pojavljali sta se anemija (9 %) in slabost (1 %). Mediani čas sledenja je bil 40 mesecev. Mediano preživetje brez ponovitve bolezni je bil 14,3 meseca, mediano celokupno preživetje pa 20,4 meseca. Preživetje brez napredovanja bolezni je bilo odvisno od vrste mutacije v genih BRCA: pri somatski mutaciji v genih BRCA 1/2 je bilo 80 % bolnic brez progresa bolezni, pri zarodni mutaciji BRCA 2 je bilo teh 55 % bolnic, pri zarodni mutaciji BRCA 1 pa 32 % (p = 0,021). Vrsta mutacije v genih BRCA 1/2 ni imela vpliva na celokupno preživetje bolnic
Priporočila Onkološkega inštituta za obravnavo bolnikov z adenokarcinomom tankega črevesa
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Zdravljenje intrahepatalnega holangiokarcinoma s stereotaktičnim obsevanjem: prikaz primera
Get PDFA case report of a patient with loccally adanced intrahepatic cholangiocarcinom, which is a rare malignancy with a unique clinical course, is presented in this paper. Most patients with this type of cancer have advanced disease at the time of diagnosis and are candidates for non-surgical treatments – chemotherapy, radiotherapy or chemoradiotherapy. The main limiting factor with external beam radiotherapy is the dose that is delivered to the liver and adjacent radiosensitive organs. Particularly, due to its ability to deliver a high and focused dose, stereotactic body radiation therapy is a promising treatment technique. Studies published on this topic have shown promising results regarding treatment of patients with unresectable disease with the intent of extending the overall survivor.V prispevku je opisan primer bolnice z lokalno napredovalim holangiokarcinomom intrahepatalnih žolčnih vodov, ki je redek malignom s svojevrstnim kliničnim potekom. Ob postavitvi diagnoze ima večina bolnikov napredovalo obliko bolezni in so posledično kandidati le za nekirurško zdravljenje – kemoterapijo, kombinacijo kemoterapije in radioterapije ali samo radioterapijo. Glavna omejitev pri zdravljenju z radioterapijo je doza, ki jo prejmejo jetra in priležni cevasti organi, zato se v zadnjem času čedalje bolj uveljavlja zdravljenje s stereotaktično radioterapijo, ki omogoča, da dovedemo visoko dozo na tumor ob tem, da ščitimo rizične organe. Raziskave, ki so bile objavljene v zadnjih letih, so pokazale dobre rezultate zdravljenja inoperabilne bolezni z namenom poskusa zazdravitve bolezni in podaljšanja celokupnega preživetja
Državni program obvladovanja raka: dosežki in izzivi
Get PDFComprehensive systemic approaches are needed to address cancer, which is a major public health issue. In 2010, Slovenia adopted the first National Cancer Control Plan. A new document, for the period 2022–2026, will include issues set forward in the Europe's Beating Cancer Plan, which was adopted in 2021. The National Cancer Control Plan has three strategic goals: (1) to slow the increase in the incidence of cancer, (2) to improve survival, and (3) to improve the quality of life of cancer patients through comprehensive rehabilitation and palliative care and here we present achievements and indicate our future challenges.Prevention programmes for chronic non-communicable diseases and the introduction of national screening programs for cervical and colorectal cancer had significant impact on the incidence of preventable cancers. Of concern, however, is the rising trend of lung cancer in women. The survival of all cancer patients improved, more cancers were detected at an earlier stage and modern treatments are widely available. Our challenge in the future is to establish monitoring of quality of care by establishing clinical registries for the five most common cancers. To improve the quality of life of patients, a pilot project for breast cancer patients has been launched in the field of integrated rehabilitation in two regions. Its results will serve as a model for implementation in the whole country and also for other types of cancer. In the field of palliative care, we are facing many challenges that we are only slowly overcoming. Comprehensive rehabilitation and palliative care are certainly areas to which we need to pay more attention.Za obvladovanje raka, ki predstavlja veliko breme za sodobne družbe, so potrebni celoviti sistemski pristopi. Slovenija je v ta namen leta 2010 sprejela prvi strateški dokument: Državni program obvladovanja raka. Trenutno je v pripravi že tretji petletni program in sicer za obdobje 2022–2026, ki bo vključeval usmeritve Evropskega načrta za boj proti raku, predstavljenega v letu 2021. Državni program obvladovanja raka ima zastavljene tri strateške cilje: (1) upočasniti povečevanje incidence raka, (2) povečati preživetje in (3) izboljšati kakovost življenja bolnikov z rakom s celostno rehabilitacijo in paliativno oskrbo.V prispevku predstavljamo dosedanje aktivnosti v povezavi s strateškimi cilji in nakazujemo izzive za v prihodnje. Na področju incidence smo v Sloveniji veliko dosegli z uvedbo državnih presejalnih programov za raka (Program ZORA – rak materničnega vratu in Program Svit – rak debelega črevesa in danke), prav tako so svoj delež prispevali ukrepi primarne preventive kroničnih nenalezljivih bolezni na področju zdravega življenjskega sloga. Zaskrbljujoč je trend naraščanja pljučnega raka pri ženskah. V 10-letnem obdobju se je preživetje vseh bolnikov z rakom izboljšalo, predvsem na račun odkrivanja rakov v zgodnejših stadijih. V prihodnje bodo naši ukrepi usmerjeni v vzpostavitev in spremljanje kakovosti in enakosti obravnave z vzpostavitvijo t. i. kliničnih registrov, in sicer za pet najpogostejših rakov. Za izboljševanje kakovosti življenja bolnikov z rakom se je na področju celostne rehabilitacije pričel izvajati pilotni projekt za bolnice z rakom dojk v dveh regijah, ki bo služil kot model za širitev celostne rehabilitacije na celo državo in na druge vrste raka. Na področju paliativne oskrbe se soočamo s številnimi izzivi, ki jih le počasi premagujemo, zagotovo pa sta tako celostna rehabilitacija in paliativna oskrba področji, ki jima moramo posvetiti več pozornosti
Vloga imunskega sistema in imunoterapija pri trojno negativnem raku dojk
Get PDFInteraction between tumor and immune cells in tumor stroma is very important for formation, developement and progression of cancer. The most evaluated are the tumor lymphocite infiltration (TIL) and the progrmmed death ligand 1 (PD-L1) expression. Higher TIL density is independent prognostic factor for achievement of complete pathologic remission (pCR) after neoadjuvant systemic treatment in HER2-positive and triple negative breast cancer. In triple negative breast cancer TIL is also prognostic for overall survival. Many studies with immunotherapy (check-point inhibitors) are ongoing in triple negative breast cancer. In the routine clinical practice patients can be treated with atezolizumab+Nab-paclitaxel in primary metastatic breast cancer and those with progression after more than 12 months after end of adjuvant treatment, if their tumors expres PD-L1. Many studies adressing mechanisms of immune system mechanisms and biomarkers are ongoing, to unreveal why only a substs of patients profits from immunotherapy.Interakcija med tumorskimi celicami in imunskimi celicami v tumorski stromi je pomembna za nastanek, razvoj in progresijo raka. Pri raku dojk je najbolj preučena vloga tumorskega limfocitnega infiltrata (TIL) in izraženosti liganda za programirano smrt-1 (PD-L1). Večja izraženost TIL je neodvisni napovedni dejavnik za dosego popolne patološke remisije po neoadjuvantni sistemski terapiji pri HER2+ in trojno negativnem podtipu raka dojk in za celotno preživetje pri trojno negativnem raku dojk. Največ raziskav z zaviralci kontrolnih točk (imunoterapijo) poteka pri metastaskem trojno negativnem raku dojk. V klinični praksi se že uporablja atezolizumab v kombinaciji z nab-paklitakselom pri primarno metastatskih bolnicahh in tistih s progresom več kot 12 mesecev po adjuvantni terapiji, če imajo prekomerno izražen PD-L1. Še vedno pa se raziskuje, kateri mehanizmi in biomarkerji so udeleženi pri reakciji imunskega sistema na tumor, saj ima le majhen delež bolnikov dolgotrajno dobrobit od imunoterapije
Poznavanje dejavnikov tveganja za nastanek raka med slovenskimi najstniki
Get PDFINTRODUCTION: Based on current trends, one can expect that one in two teenage boys and one in three teenage girls will be diagnosed with cancer at the age of 75. According to the National Cancer Management Program, as many as 40% of cancers could be prevented through healthy lifestyles and avoidance of risk factors, and teens should be well aware of risk factors in order to reduce the incidence of this dangerous and common disease in the future.PURPOSE: The main aim of our study was to determine how well teenagers are aware of the cancer risk factors and to check for sex and age related differences in knowledge.METHODS: We included 185 teenagers between the ages of 12 and 15 (54% boys, 46% girls) who completed an international questionnaire on cancer risk factors. We then transmitted the questionnaires electronically using the online tool 1KA, which allowed us to prepare and partially process the results.RESULTS: 58% of teenagers worry about being diagnosed with cancer, with a significant gender gap, with 74% of girls and only 44% of boys expressing this concern. Smoking (55%), alcohol (24%), radiation (14%) and unhealthy nutrition (14%) are among the most important cancer risk factors for Slovenian teenagers. Among teenagers, 83% agree that certain foods increase the chance of cancer. When asked about the number of daily servings of fruits and vegetables required for the cancer prevention, the average answer was 3.5 servings out of the recommended 5. Most students (69%) believe that red meat is a risk factor for cancer, and only half know that we should consume less 5 g of salt daily. 81% of schoolchildren agree that maintaining a healthy body weight is one of the most important ways to prevent cancer, and 85% believe that physical activity is related to preventing cancer. 87% are well aware of the dangers of UV radiation (sunbathing) and are also good at identifying alcohol as a risk factor, although 74% are not convinced that all alcoholic beverages have the same effect.CONCLUSIONS: The study found that Slovenian teenagers are well aware of the risk factors for cancer, as they have correctly identified 6.7 factors among the top ten, which is more than e.g. in the UK, where teenagers correctly identified only 4.4 factors. We have shown that there is a difference between the sexes in the knowledge of the factors in the assessment of the risk of smoking and the influence of healthy body mass. It turns out that there are no significant differences in the knowledge of cancer risk factors among differently aged children.UVOD: Glede na trenutne trende lahko pričakujemo, da naj bi eden od dveh fantov in ena od treh deklet današnjih najstnikov do 75. leta starosti zboleli za rakom. Po podatkih državnega programa za obvladovanje raka, bi lahko kar 40 % rakov preprečili z zdravim načinom življenja in izogibanjem dejavnikom tveganja, zato bi morali najstniki dobro poznati dejavnike tveganja, da bi v prihodnosti zmanjšali pojavnost te bolezni.NAMEN: Glavni namen naše raziskave je bil ugotoviti, kako dobro najstniki poznajo dejavnike tveganja nastanka raka ter preveriti, ali obstaja razlika v znanju med spoloma ter med različno starimi najstniki.METODE DELA: V raziskavo smo vključili 185 najstnikov, starih med dvanajst in petnajst let (54 % fantov, 46 % deklic), ki so izpolnili mednarodni vprašalnik o poznavanju dejavnikov tveganja nastanka raka. Vprašalnike smo nato prenesli v elektronsko obliko s pomočjo spletnega orodja 1KA, ki nam je omogočil pripravo in tudi delno obdelavo rezultatov.REZULTATI: 58 % učencev skrbi, da bodo zboleli za rakom, pri tem pa med spoloma obstaja bistvena razlika, saj to skrb izraža 74 % deklet in le 44% fantov. Med najpomembnejšimi dejavniki tveganja slovenski najstniki na prvem mestu navajajo kajenje (55 %), na drugem alkohol (24 %), na tretjem sevanje (14 %) in na četrtem nezdravo prehrano (14 %). Med učenci se jih 83 % strinja, da nekatera živila povečajo možnost nastanka raka. Pri vprašanju o številu potrebnih dnevnih porcij sadja in zelenjave je povprečen odgovor 3,5 porcij od priporočenih 5. Večina učencev (69 %) meni, da je rdeče meso dejavnik tveganja za nastanek raka, samo polovica pa ve, da je treba dnevno zaužiti manj kot 5 g soli. Da je vzdrževanje zdrave telesne mase eden najpomembnejših načinov preprečitve raka se strinja 81 % učencev, 85 % pa jih meni, da je telesna dejavnost povezana s preprečevanjem nastanka raka. 87% učencev dobro pozna nevarnost sončenja, prav tako pa dobro opredeljujejo alkohol kot dejavnik tveganja, čeprav jih 74 % ni prepričanih ali imajo vse alkoholne pijače enak učinek.ZAKLJUČKI: V raziskavi smo ugotovili, da najstniki dobro poznajo dejavnike tveganja za nastanek raka, saj so med najpogostejšimi desetimi dejavniki pravilno opredelili 6,7 dejavnikov, kar je več kot npr. v Veliki Britaniji, kjer so najstniki pravilno opredelili samo 4,4 dejavnikov. Pokazali smo, da med spoloma obstaja razlika v poznavanju dejavnikov pri oceni nevarnosti kajenja in vpliva telesne mase. Izkazalo se je, da med različno starimi otroci ni bistvenih razlik v poznavanju dejavnikov tveganja nastanka raka
Ocena kadrovskih potreb za izvajanje zdravljenje raka v Republiki Sloveniji
Get PDFAccording to epidemiological indicators, cancer is a major public health burden in Slovenia, as it is the leading cause of death among men and number two among women. Adequate staffing is necessary to ensure adequate care for cancer patients in the future, as sufficient and suitably qualified human resources represent the basis for the comprehensive implementation of oncology care in Slovenia. Within the target research project - Analysis and estimation of requirements of human resources for cancer treatment in Slovenia, a flexible forecasting model was developed for planning the required healthcare staff for cancer treatment and palliative care of cancer patients. An estimate of staffing needs was made for the short term until 2021 and the long term until 2030. The results show staffing estimates based on data on the number of new cancer cases for all cancers combined and for common cancers, i.e. colorectal cancer, lung cancer, breast cancer, prostate cancer and together for other cancers. Staffing estimates for the implementation of cancer treatment were calculated for each listed cancer location according to the type of treatment and by healthcare workers. Staffing needs for palliative care were based on mortality data for all cancers together by palliative care levels. The presented methodology enables various stakeholders in the short-term 5-year period to quickly calculate annual staffing needs only on the basis of incidence and mortality data, and for longer periods and in case of major changes in the health system allows in-depth analysis of staffing needs and testing of different scenarios.
Epidemiološki kazalci kažejo, daje rak v Sloveniji veliko javnozdravstveno breme. Rak je med vzroki smrti na prvem mestu pri moških in na drugem mestu pri ženskah. Za zagotavljanje primerne oskrbe bolnikov z rakom v bodoče je nujna primerna kadrovska zasedba, saj zadostni in primerno usposobljeni človeški viri predstavljajo osnovo za celostno izvajanje onkološke oskrbe v Sloveniji. V okviru Ciljnega raziskovalnega projekta Analiza stanja in ocena kadrovskih potreb za izvajanje zdravljenje raka v Republiki Sloveniji je bil razvit fleksibilen napovedovalni model za načrtovanje potrebnega zdravstvenega osebja za zdravljenje raka in paliativno oskrbo onkoloških bolnikov. Narejena je bila ocena kadrovskih potreb za kratkoročno obdobje do 2021 ter dolgoročno obdobje do leta 2030. V rezultatih so prikazane ocene kadrovskih potreb na podlagi podatkov o številu novih primerov raka za vse rake skupaj in za pogoste rake, to je rak debelega črevesa in danke, rak pljuč, rak dojke, rak prostate ter skupaj za ostale rake. Kadrovske ocene za izvajanje zdravljenje raka so bile izračunane za vsako navedeno lokacijo raka glede na vrsto zdravljenja ter po poklicnih skupinah v zdravstvu. Kadrovske potrebe za paliativno oskrbo so bile narejene na podlagi podatkov o umrljivosti za vse rake skupaj po nivojih paliativne oskrbe. Predstavljena metodologija omogoča različnim deležnikom v kratkoročnem 5-letnem obdobju hitre izračune letnih kadrovskih potreb le na podlagi podatkov o incidenci in umrljivosti, na daljša obdobja in v primeru večjih sprememb v zdravstvenem sistemu pa omogoča poglobljeno analizo kadrovskih potreb in testiranje različnih scenarijev
Naše izkušnje z zdravilom bevacizumab v primarnem zdravljenju epitelijskega raka jajčnikov
Get PDFIntroduction: Bevacizumab is used in advanced epithelial ovarian cancer patients as a part of standard primary sistemic therapy together with paclitaksel and carboplatin combination chemotherapy since 2013.Aim of study: To evaluate safety and efficacy of bevacizumab in treatment of patients with advanced epithelial ovarian cancer in daily clinical practice.Methods: Retrospective analysis of patients with advanced epithelial cancer treated with bevacizumab at Institute of Oncology Ljubljana in the period of Jan 1st 2013 – Dec 31th 2016. The end points of study were safety and efficacy (relapse-free survival, overall survival). Study has been approved by our institutional ethic board.Results: In the observed period overall 111 patients with advanced epithelial ovarian cancer were treated with bevacizumab. The most common adverse events were: pain (52%), bleeding (45%), arterial hypertension (44%). Serious adverse events (grade 3/4) were observed in 12% of patients: 3% venous thrombosis/embolism, 3% proteinuria, 2% arterial hypertension, 2% bleeding, 1% pain, 1% fistula. Median follow up was 59 months. Median progression-free survival was 18 months, median overall survival was 41 months.Conclusions: Treatment with bevacizumab in daily clinical practice is safe and effective – in concordance with published data from prospective studies GOG 218 and ICON 7.Izhodišče: Zdravilo bevacizumab uporabljamo v sklopu primarnega sistemskega zdravljenja napredovalega epitelijskega raka jajčnikov v kombinaciji s paklitakselom in karboplatinom od leta 2013.Namen: Prikazati učinkovitost in varnost zdravljenja z bevacizumabom v redni klinični praksi v sklopu primarnega zdravljenja raka jajčnikov.Metode: V retrospektivno analizo smo vključili bolnice z epitelijskim rakom jajčnikov, ki so pričele zdravljenje z bevacizumabom na Onkološkem inštitutu Ljubljana v obdobju 1.1.2013 – 31.12.2016. Cilja raziskave sta bila varnost in učinkovitost (preživetje brez ponovitve bolezni, celokupno preživetje) zdravljenja z bevacizumabom. Raziskavo je odobrila etična komisija na Onkološkem Inštitutu Ljubljana.Rezultati: V opazovanem obdobju je bilo z bevacizumabom zdravljenih 111 bolnic z napredovalim epitelijskim rakom jajčnikov. Najpogostejši neželeni učinki so bili: bolečine (52%), krvavitev (45%), arterijska hipertenzija (44%). Resne neželene učinke (stopnja 3/4) je imelo 12% bolnic: 3% venska tromboza/embolija, 3% proteinurija, 2% arterijska hipertenzija, 2% krvavitev, 1% bolečine, 1% fistula. Mediani čas sledenja je bil 59 mesecev. Mediano preživetje brez ponovitve bolezni je bilo 18 mesecev, mediano celokupno preživetje je bilo 41 mesecev.Zaključki: Zdravljenje z bevacizumabom v redni klinični praksi je varno in učinkovito - v skladu z do sedaj znanimi rezultati prospektivnih raziskav GOG 218 in ICON 7
Ocena zamikov pri napotitvi, izvedbi diagnostike in prvega zdravljenja pri bolnikih z raki sečnega mehurja in ledvic v Sloveniji
Get PDFThe average annual incidence of kidney cancer in Slovenia is 370, and the incidence of bladder cancer is 320. Consortium of three research organizations: the Institute of Oncology Ljubljana, Department of Family Medicine, University of Ljubljana and the Clinical Department of Urology at the University Clinical Center Ljubljana, launched the project Comprehensive analysis of management of urological cancer patients with an assessment of possible delays in referrals, realization of diagnostics procedures and first treatment in 2017. Its main objective was to retrospectively analyse the health care of Slovenian patients with cancer of the kidney, bladder or prostate. The study included all Slovenian patients diagnosed in 2014. This article presents the results of an assessment of delays in referrals, diagnostics procedures and first treatment in bladder and kidney cancer patients.
The median system interval (time from first examinations to initiation of treatment) was 35 days in patients with bladder cancer and 22 days in patients with kidney cancer. In both cases, the greatest amount of time elapsed between the first diagnostic procedures and the first specialist visit what points to a bottleneck in performing diagnostic procedures at both the primary and secondary levels of our health system.Pri nas za ledvičnim rakom na leto povprečno zboli 370 ljudi, za rakom sečnega mehurja 320. Preživetje slovenskih bolnikov in bolnic pri teh dveh oblikah raka je že vrsto let slabše od evropskega povprečja. V povezavi treh raziskovalnih organizacij, Onkološkega inštituta Ljubljana, Katedre za družinsko medicino Univerze v Ljubljani in Kliničnega oddelka za urologijo Univerzitetnega kliničnega centra Ljubljana, smo leta 2017 uvedli projekt Celostna analiza zgodnje obravnave bolnikov z urološkimi raki z oceno zamikov pri napotitvi, izvedbi diagnostike in prvega zdravljenja, v katerem smo retrospektivno analizirali zdravstveno oskrbo slovenskih bolnikov in bolnic z raki ledvic, sečnega mehurja ali prostate. V raziskavo smo vključili vse zbolele v Sloveniji leta 2014. V tem prispevku prikazujemo rezultate ocene zamikov v zdravljenju bolnikov in bolnic z rakom ledvic in rakom sečnega mehurja.
Median interval zdravstvenega sistema (čas od prvih preiskav do začetka zdravljenja) je bil pri bolnikih z rakom sečnega mehurja 35 dni, pri bolnikih z ledvičnim rakom pa 22 dni. Pri obeh rakih je največ časa poteklo med prvimi diagnostičnimi postopki in prvim pregledom pri specialistu, kar nakazuje na ozko grlo pri izvedbi diagnostičnih postopkov