Prof. László Mangel
Survey of the effectiveness of modern radiotherapy technologies and general cancer care
Based on the oncological awareness and the well-organised national oncological structure it would be expected that the oncological patients get in the healthcare system in a relatively fast and professional way, however, avoiding unnecessary examinations, then having a complex diagnosis the patients can be provided with suitable treatment (and fewer patients get lost in the system).
This patient pathway consists of countless participants and junctions, the relations can be quite far-reaching. The role of the General Practitioners is excessively important, the private providers also have an important role especially during the examination, and the decisions of the patients (rejection of further examination and treatment, alternative cures or turning to other providers). The questions are: what are the real role and importance of these factors and actors? When does the time factor matter? Who has the bigger responsibility, the patient or the medical provider? When and to what extent do we have to utilise the opportunities of modern diagnostics and therapy? When can we say that these methods are not cost-effective and they do not influence the progression of the illness in any way? In addition to the continuously growing costs, the protocol thinking, the rationality, the fundamental role of evidence-based medicine, the preference of cost-effective factors are typical to the development of oncology. These are the factors that we have to adapt to when managing a patient pathway.
Methodology: During the given year (2017 or 2018), defining the providing units (university, private provider, external hospital, etc.) and the particular phases of the patient pathways (occurrence of the first symptom – visit at the doctor’s – examination by a specialist – making a diagnosis – oncoteam decision – starting the treatment) of newly diagnosed and registered patients in the most common and frequent disease types (lung cancer, small- and large intestinal carcinoma, breast cancer, prostate cancer, perhaps, head and neck tumours, cervical cancer, pancreas carcinoma). Separate analysis of the first assessed period, from the appearance of the first symptoms to visiting the doctor, assessing the health awareness and own responsibility, furthermore defining the typical associated diseases like metabolic syndrome and overweight and the lifestyle problems (e.g. smoking, regular alcohol consumption).
Goal: Methodological survey of presenting complaints, laboratory variatons, routine imaging examination and verifications of relapses in the most common disease types. Defining the concrete therapeutical consequences. Health-economic assessment of follow-up examinations.
Background: Nowadays regarding the patients treated based on the international literature and practice, the follow-up – mainly imaging- examinations are indicated much more rarely, compared to the Hungarian practice, and the routine clinical tracking has a much bigger role.
Method: In the case of the most common types of tumours (lung cancer, prostate cancer, breast cancer, small- and large intestinal tumours, etc.) during the given period of time or year (e.g. 2012 or 2017) defining the treatment events, detecting the form and the number of follow-up examinations, assessing the expenses, and evaluating the real and expected effect of the treatment applied in reoccurrence.
Background: The double oncoteam system, a significant method is used at the Oncotherapy Department of the Clinical Center, University of Pécs for more than 10 years. Its legal, educational and psychological effect is almost obvious, but naturally the professional and health-economic projection could be questionable and be examined.
Goal: In the given period (the year of 2012 or 2017) examination of the differences between planned therapy and real treatment. Examination of the proportion and efficiency of the expensive treatments. In cases of adequately fast data collection the examination can be extended to the last 10 years.
In the case of the so-called “itemized” high-value, targeted biological medical treatments it is very important to determine whether the clinical results are eligible to the expectations of the registration examination and the international practice, or we can only apply these expensive therapies for a shorter period of time (“outcome” type of survey). The data could also be extracted from the Hungarian National Health Insurance Fund’s database, but this way we could attach a professional explanation for the incidental alterations.
Background: Significantly in the country, a highest level radiation technology has been available for more than 7 years in the Oncotherapy Department of the Clinical Center, University of Pécs therefore long-term professional consequences can be seen.
Method: Defining the health condition of prostate cancer patients treated at least 7 years ago (in 2012 or 2013) with the most up-to-date technology and determining the health condition of not high-risk brain tumour patients treated with fractionated brain stereotactic radiation therapy. Comparing curing results and side-effect rate with the international experiences.
A separate chapter for examination of planning parameters of radiation therapy.
Goal: The question is, can we actually improve survival chances by involving modern technology, and for example in the case of a quite common disease (prostate cancer) can we reduce the number of unnecessary hospitalization and treatments caused by side-effects (rectal bleeding, urination problems). Another goal is reducing the costs and improving efficiency of the therapies applied in cases of relapse.
Background: There is an exemplary cooperation with the palliative experts at the Oncotherapy Department of the Clinical Center, University of Pécs they often participate in the oncoteam discussions, visits. In addition there is an opportunity to place patients receiving palliative care at the department.
Goal: In the given period of time (e.g. first half of 2017) examination of the additional expenses and hospital registration of treated and deceased patients.
It is well-known that the healthcare system spends the most on treating health problems in the last 6 month of a patient’s life. (This is just partially true in the case of oncological patients, because the number of treatments can be highly expensive from the beginning.) It is also well-known that in this “end-of-life” period the quality of life and sense of security of the patient receiving palliative treatment is much better, in fact an excessively important international survey proved that the lifetime of a recipient of a symptomatic treatment increases.
The need of proving the effect of the involvement of palliative care in the end-of-life period in avoiding additional hospitalization and emergency appearances, and reducing healthcare expenses might seem logical.
Goal: Evaluation of the progress of the disease and extensions of the disease based on controlling imaging examinations in common types of illnesses and treated metastatic patients.
Background: Follow up of metastatic tumour patients and evaluation of treatment results with cross-sectional imaging, mainly CT. Spatial evaluation of the quantity of tumours and extension of the illness based on the most important information from the CT scan. Naturally, this might change after starting the therapy, during progression, and at the time of consequential change of therapy. (In the Hungarian practice the progression is almost always followed by change of therapy.)
Based on all this, the alteration and evolvement of the disease can be determined in the long run. (The clinical examinations usually assess the alterations of one treatment period.)
Patients, materials and methods, and goals: selecting 30 or 50 patients having one of the common types of each disease (e.g. lung cancer, small- and large intestinal carcinoma, breast cancer, prostate cancer, perhaps head-neck tumours, cervical cancer, pancreatic carcinoma), establishing a mathematical criteria and processing the data of the follow-up patients, then drawing the professional conclusion.