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Waiting time for treatment of women with breast cancer in Podlaskie Voivodeship (Poland) in view of place of residence. A population study

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Maslach D. , Krzyzak M. , Szpak A. , Owoc A. , Bielska-Lasota M.

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nr 1

EN

Introduction: Treatment delay is a major problem of contemporary oncology. Knowing the time interval between diagnosis and initiation of treatment, together with monitoring this adverse prognostic factor, is an important element of the treatment planning process in the population and can contribute to the improvement of patients’ curability. Objective: To assess the waiting time for first treatment of women diagnosed with breast cancer in 2001-2002 in Podlaskie Voivodeship. Materials and methods: During 2001-2002, there were 709 cases of women with breast cancer who reported to the Voivodeship Cancer Registry in Bialystok. 659 women were diagnosed with a primary invasive breast tumour. A cohort of 499 women who were treated with a curative intent was selected from this group. The waiting time in the created cohort was calculated as the number of days between the date of the breast cancer diagnosis and date of the first treatment. Results: The average time between the date of diagnosis and date of the first treatment was 38 days. The median was 14 days. 28.6% of patients from the selected cohort waited longer than 28 days. The treatment of rural women was initiated faster than the treatment of urban patients.

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Does place of residence affect patient satisfaction with hospital health care?

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Maslach D. , Karczewska B. , Szpak A. , Charkiewicz A. , Krzyzak M.

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nr 1

3

Trends of premature mortality in Swietokrzyskie Province (Poland), years 2002-2010

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Gozdz S. , Krzyzak M. , Maslach D. , Wrobel M. , Bielska-Lasota M.

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nr 3

EN

Background. Premature mortality in younger age groups influences the society as far as social and economic aspects are concerned. Therefore, it is important to come up with a tool which will allow to assess them, and will enable to implement only these health care measures that bring tangible benefits. That is the reason for introducing PYLL rate (PYLL - potential years of life lost), which is an addition to the analysis of premature mortality as it includes the number of deaths due to a particular cause and the age at death. Objective. The purpose of this study was to analyse the level and trends of PYLL rate according to death causes in years 2002 -2010in Świętokrzyskie Province. Material and methods. The material for the analysis was the information from the Central Statistical Office on the number of deaths due to all causes registered among the inhabitants of Świętokrzyskie Province in years 2002-2010. Causes of death were coded according to the 10th revision of the International Classification of Diseases. The analysis of premature mortality was carried out with the use of PYLL rate. PYLL rate was calculated according to the method proposed by Romeder, according to which the premature mortality was defined as death before the age of 70. The analysis of time trends of PYLL rate and the APC (annual percent change) of the PYLL rate were calculated usingjointpoint model as well as the Jointpoint Regression Program (Version 4.0.1 - January 2013). Results. In men, in years 2002 - 2007 PYLL rate increased by 1.5% per year (p<0.05). From year 2007 the trend went downward and PYLL rate decreased on average by 3.1% per year till year 2010. External causes of death, cardiovascular diseases and cancers in years 2002 - 2010 were the reason for almost 74.0% PYLL in men. In year 2010 PYLL rate due to all death causes amounted to 89 13.8/105 and was three times higher than in women (29 75.5/105). In women, however, during the analysed period PYLL rate did not change significantly, and was dominated by cancers, cardiovascular diseases and external death causes. Similarly to men, those three groups of death causes were responsible for an average 76.0% PYLL. Conclusions. The analysis of the causes of premature mortality in Świętokrzyskie Province shows that in the majority of cases it is due to preventable deaths, which calls for the necessity of more intensive measures in primary and secondary prevention as well as the improvement in treatment standards, mainly of cardiovascular diseases, cancers, injuries and accidents.

PL

Wprowadzenie. Przedwczesna umieralność w młodszych grupach wieku wpływa na funkcjonowanie społeczeństwa zarówno pod względem społecznym jak i ekonomicznym. Dlatego ważne stało się opracowanie narzędzia, które pozwoli na ich ocenę i podejmowanie tylko tych działań z zakresu ochrony zdrowia, które przynoszą wymierne efekty. Dlatego wprowadzono wskaźnik PYLL (Potential "Years of Life Lost), który jest uzupełnieniem analizy umieralności przedwczesnej, gdyż uwzględnia liczbę zgonów z powodu określonej przyczyny oraz wiek, w którym nastąpił zgon. Cel. Celem badań była analiza poziomu oraz trendów współczynnika potencjalnych utraconych lat życia (PYLL) według przyczyn w województwie świętokrzyskim w latach 2002-2010. Materiał i metody. Materiał stanowiły publikowane informacje Głównego Urzędu Statystycznego o liczbie zgonów z powodu ogółu przyczyn zarejestrowanych wśród mieszkańców województwa świętokrzyskiego w latach 2002-2010. Przyczyny zgonów były kodowane zgodnie z X Rewizją Międzynarodowej Klasyfikacji Chorób i Problemów Zdrowotnych. Analizę umieralności przedwczesnej przeprowadzono z wykorzystaniem wskaźnika potencjalnych utraconych lata życia (PYLL - Potential Years of Life Lost). Liczbę potencjalnych utraconych lat życia obliczono z zastosowaniem metodologii zaproponowanej przez Romedera. Za umieralność przedwczesną przyjęto zgon przed 70 rokiem życia. Analizy trendów czasowych współczynnika PYLL oraz wartości średniej rocznej zmiany (APC - annual percent change) współczynnika PYLL obliczono za pomocą modeli joinpoint i programu Joinpoint Regression Program (Version 4.0.1- January 2013). Wyniki. U mężczyzn w latach 2002-2007 współczynnik PYLL wzrastał o 1,5% rocznie (p<0,05). Od roku 2007 trend zmienił kierunek na malejący, a wartość współczynnika do 2010 roku obniżała się średnio o 3,1% rocznie. Zewnętrzne przyczyny zgonu, choroby układu krążenia oraz nowotwory złośliwe w latach 2002-2010 były przyczyną utraty średnio 74,0% PYLL u mężczyzn. W 2010 roku wartość wskaźnika PYLL z powodu wszystkich przyczyn u mężczyzn wynosiła 89 13,8/105 i była 3-krotnie wyższa niż u kobiet (2975,5/105). U kobiet przyczyną utraty PYLL były nowotwory złośliwe, choroby układu krążenia oraz zewnętrzne przyczyny zgonów. Podobnie jak u mężczyzn, te trzy grupy przyczyn zgonu były odpowiedzialne za utratę średnio 76,0% PYLL. Wnioski. Analiza przyczyn umieralności przedwczesnej w województwie świętokrzyskim wskazuje, że w zdecydowanej większości jest ona spowodowana „zgonami możliwymi do uniknięcia”, co wskazuje na konieczność intensyfikacji działań profilaktyki pierwotnej i wtórnej oraz poprawę standardów leczenia, głównie chorób układu krążenia i nowotworów złośliwych oraz wypadków i urazów.

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Breast cancer survival gap between urban and rural female population in Podlaskie voivodship, Poland, in 2001-2002. Population study

86%

Krzyzak M. , Maslach D. , Bielska-Lasota M. , Juczewska M. , Rabczenko D. , Marcinkowski J. T. , Szpak A.

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nr 2

277-282

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Differences in results of breast cancer curative treatment between urban/rural female population in Podlaskie Voivodship of Poland before introduction of the National Cancer Control Programme

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Maslach D. , Krzyzak M. , Szpak A. , Owoc A. , Gebska-Kuczerowska A. , Bielska-Lasota M.

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nr 1

EN

The aim of the study was to evaluate differences in the results of the curative treatment received by women with breast cancer in urban and rural area in Podlaskie Voivodship in 2001-2002 before the introduction of the National Cancer Control Programme. The analysis was based on 449 women with breast cancer, who received curative treatment in years 2001-2002. Relative 5-year survival rates as function of age and stage among urban and rural women population were calculated. The results showed that survival rates in Podlaskie Voivodship among curatively treated women with breast cancer were 81.9% but they differed between urban and rural areas. Patients living in rural areas had much lower survivals than those living in urban areas at local and regional stage of disease. In all age groups considered in the study survivals in rural areas were lower than in urban ones in which survivals were higher in 55-64 age group. These results indicated the necessity intervention in order to increase the access to the health care system and effectiveness of early detection and also improved treatment standards for more disadvantaged rural areas. These results should be also considered in monitoring of the National Cancer Control Programme introduction in Poland in 2006.

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The breast-conserving surgery of women with breast cancer in Podlaskie voivodship (Poland). Population study

86%

Maslach D. , Krzyzak M. , Szpak A. , Bojar I. , Bielska-Lasota M. , Owoc A.

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tom 20

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nr 2

EN

Introduction. The results of breast cancer treatment depend mainly on better detection in mammography screening and, consequently, a higher proportion of women with early stage of the disease. They depend also on a better access to health care services and the effectiveness of oncological treatment. One of the methods of breast cancer control is a breastconserving surgery. With a proper patients’ classification for the treatment, the results of the breast-conserving surgery do not differ in relation to mastectomy. That’s why, the availability of breast-conserving surgical methods is particularly important, especially in a population in which a population screening is conducted. Objective. The analysis of the selected aspects of the breast cancer treatment’s standard in Podlaskie Voivodeship. Patients and methods. In years 2001–2002, 709 cases of women with breast cancer were reported to the Voivodeship Cancer Registry in Bialystok. 659 women were diagnosed with a primary invasive breast cancer. Based on a cohort of 499 women treated with radical methods the following indicators, recommended by WHO for the evaluation of the breastconserving surgery’s availability, were calculated: a percentage of patients with whom breast-conserving surgery was used, a proportion of breast cancer cases receiving post-operative breast radiotherapy after breast-conserving surgery and a proportion of breast-conserving surgery in pT1 cases. Results. The breast-conserving surgery has been used much less frequently in Podlaskie Voivodeship than in Western Europe, but more frequently than in Poland in general. Conclusion. It should be aimed to provide a surgical treatment with the use of breast-conserving surgical methods to the highest possible percentage of patients. The increase of the percentage of patients treated with breast-conserving surgery methods can be a result of an effective screening realisation.