Vpliv radona na pojavljanje pljučnega raka v Sloveniji

Izhodišče: Svetovna zdravstvena organizacija je opredelila radon v bivalnem okolju kot enega izmed 19 okoljskih karcinogenov. Radon je poleg tobačnega dima eden izmed najpomembnejših dejavnikov tveganja za razvoj pljučnega raka ter predstavlja približno 10-odstotni delež vseh primerov pljučnega raka. V naši raziskavi smo prvič preučili, kako radon vpliva na pojavljanje pljučnega raka v Sloveniji. Metode: Za 40-letno obdobje od leta 1978 do leta 2017 so bili na ravni naselij povezani trije viri podatkov: zboleli za pljučnim rakom (Register raka Republike Slovenije), prebivalci (Statistični urad Republike Slovenije) in Radonski zemljevid Slovenije. V modele prostorskega glajenja z Bayesovimi hierarhičnimi modeli je kot pojasnjevalna spremenljivka vključen radon v bivalnem okolju in izračunan pripisljivi delež raka. Relativno tveganje je ocenjeno s standardiziranim količnikom incidence. Rezultati: V Sloveniji za pljučnim rakom zaradi izpostavljenosti radonu v bivalnem okolju (analiza na ravni naselij) zboli približno 60 oseb letno, kar predstavlja 5 % vseh s to boleznijo. Analiza relativnega tveganja po spolu kaže, da imajo v Sloveniji zaradi izpostavljenosti radonu v bivalnem okolju povečano tveganje pljučnega raka predvsem moški. Ženske, ki bivajo na območjih, bolj obremenjenih z radonom, nimajo povečanega relativnega tveganja za nastanek pljučnega raka. Zaključek: Izpostavljenost radonu v bivalnem okolju je poleg kajenja med najpomembnejšimi nevarnostnimi dejavniki pljučnega raka v slovenski populaciji. Na območjih, kjer je radona veliko (predvsem južna in jugovzhodna Slovenija), je z javnozdravstvenega vidika ključno izvajanje preventivnih ukrepov, v prvi vrsti pa ozaveščanje in poučevanje prebivalstva o nevarnosti ter možnostih za preprečitev bolezni

Cancer patients’ survival according to socioeconomic environment in a high-income country with universal health coverage

Despite having an established systematic approach to population survival estimation in Slovenia, the influence of socioeconomic environment on cancer patients’ survival has not yet been evaluated. Thus, the main aim of our study was to quantify the potential impact of socioeconomic environment on cancer patients’ survival in our population in the 21st century. The net survival was calculated and stratified into quintiles of Slovenian version of the European Deprivation Index for all adult cancer patients diagnosed between 2004 and 2018 using the national cancer registry data. After accounting for basic demographic variables (age and gender), differences in stage at diagnosis, as well as the impact of the cancer treatment improvements over time, we found that cancer patients in Slovenia with lower socioeconomic status experience worse survival and have higher mortality. In particular, the odds of dying from oral, stomach, colorectal, liver, pancreatic, lung, breast, ovarian, corpus uteri, prostate, and bladder cancers, as well as for melanoma, leukemia, and non-Hodgkin lymphoma, are significantly higher in the socioeconomically most deprived group of patients compared to the most affluent group. The inequalities in cancer burden we found could help decision-makers to better understand the magnitude of this problem

Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies

Since the end of the previous century, there has not been a comprehensive review of European studies on socioeconomic inequality in cancer incidence. In view of recent advances in data source linkage and analytical methods, we aimed to update the knowledge base on associations between location-specific cancer incidence and individual or area-level measures of socio-economic status (SES) among European adults

Clinical registry of childhood cancer and late effects of childhood cancer treatment

V Sloveniji letno za rakom zboli okoli 70 otrok in mladostnikov, mlajših od 20 let. S časom incidenca narašča, preživetje pa se toliko izboljšuje, da posledično pada umrljivost in se povečuje število preživelih, ki zaradi tveganja za pojav poznih posledic potrebujejo doživljenjsko spremljanje. Standardni nabor podatkov Registra raka Republike Slovenije vsebuje preskope podatke za nekatere poglobljene raziskave o raku v otroštvu in mladostništvu ter poznih posledicah pri preživelih. V Registru raka smo zato leta 2020 začeli aktivnosti za vzpostavitev Kliničnega registra otroških rakov in poznih posledic zdravljenja raka v otroštvu, ki deluje kot populacijski register z razširjenim naborom podatkov. Njegov osnovni namen je sistematično beleženje poznih posledic zdravljenja raka, zasnovali pa smo ga v dveh modulih. Prvi, ki je namenjen Registru raka, z uporabo pristopa aktivne registracije prek dostopa do elektronskih zapisov o bolnikih Pediatrične klinike Ljubljana ter drugih ustanov omogoča natančen popis bolezni (skladno z mednarodnimi pravili), primarnega zdravljenja (operacije, kumulativne doze posameznih zdravil, kumulativne obsevalne doze, presaditev krvotvornih matičnih celic in druga zdravljenja), morebitnih stranskih učinkov zdravljenja in morebitne ponovitve bolezni, za katero je zdravljenje popisano enako podrobno kot primarno zdravljenje. Prvi modul že vsebuje podatke za incidenčno leto 2019, sledila bo pospešena registracija nadaljnjih let. Drugi modul je namenjen Enoti za ugotavljanje poznih posledic raka Onkološkega inštituta Ljubljana, kjer bodo zdravniki med obiskom bolnika imeli dostop do vseh zbranih podatkov in možnost prospektivnega beleženja obiskov, opravljenih preiskav, izpolnjenih vprašalnikov in ugotovljenih poznih posledic. Drugi modul je v postopku testiranja uporabniške prijaznosti, razvijamo pa tudi avtomatiziran opis zdravljenja (tako imenovani potni list za preživele) in priporočil za sledenje.Around 70 children and adolescents under the age of 20 are diagnosed with cancer in Slovenia every year. Incidence is rising over time, but survival is improving significantly, resulting in a decrease in mortality and an increase in the number of survivors who need lifelong follow-up because of the risk of late effects. The Slovenian Cancer Registry\u27s standard dataset contains data that is too scarce for some in-depth studies on childhood and adolescent cancers and late effects in survivors. At the Cancer Registry, we have therefore started activities in 2020 to establish a clinical registry of childhood cancer and late effects of childhood cancer treatment, which acts as a population-based registry with a highly expanded dataset. Its primary purpose is to systematically record the late effects of cancer treatment. It consists of two modules. The first is managed by the Cancer Registry and, using an active registration approach through access to the electronic patient records of the Ljubljana Paediatric Clinic and other institutions, it allows for a detailed inventory of the disease (in line with international rules), primary treatment (operations, cumulative doses of individual therapeutics, cumulative radiation doses, haematopoietic stem cell transplantation and other treatments, side effects of treatment) and recurrences, where the treatment is registered to the same level of detail as the primary treatment. The first module already contains data for the incidence year 2019, with accelerated registration of subsequent years to follow. The second module will be operated by the Late effects unit of the Institute of Oncology Ljubljana, where all collected data will be accessible during the patient\u27s visit, and where visits, tests performed, questionnaires completed and late effects identified can be prospectively recorded. The second module is undergoing testing for user-friendliness, and we are developing automation of the treatment summary (survivorship passport) and follow-up recommendations

Klinični register otroških rakov in poznih posledic zdravljenja raka v otroštvu

Around 70 children and adolescents under the age of 20 are diagnosed with cancer in Slovenia every year. Incidence is rising over time, but survival is improving significantly, resulting in a decrease in mortality and an increase in the number of survivors who need lifelong follow-up because of the risk of late effects. The Slovenian Cancer Registry's standard dataset contains data that is too scarce for some in-depth studies on childhood and adolescent cancers and late effects in survivors. At the Cancer Registry, we have therefore started activities in 2020 to establish a clinical registry of childhood cancer and late effects of childhood cancer treatment, which acts as a population-based registry with a highly expanded dataset. Its primary purpose is to systematically record the late effects of cancer treatment. It consists of two modules. The first is managed by the Cancer Registry and, using an active registration approach through access to the electronic patient records of the Ljubljana Paediatric Clinic and other institutions, it allows for a detailed inventory of the disease (in line with international rules), primary treatment (operations, cumulative doses of individual therapeutics, cumulative radiation doses, haematopoietic stem cell transplantation and other treatments, side effects of treatment) and recurrences, where the treatment is registered to the same level of detail as the primary treatment. The first module already contains data for the incidence year 2019, with accelerated registration of subsequent years to follow. The second module will be operated by the Late effects unit of the Institute of Oncology Ljubljana, where all collected data will be accessible during the patient's visit, and where visits, tests performed, questionnaires completed and late effects identified can be prospectively recorded. The second module is undergoing testing for user-friendliness, and we are developing automation of the treatment summary (survivorship passport) and follow-up recommendations.V Sloveniji letno za rakom zboli okoli 70 otrok in mladostnikov, mlajših od 20 let. S časom incidenca narašča, preživetje pa se toliko izboljšuje, da posledično pada umrljivost in se povečuje število preživelih, ki zaradi tveganja za pojav poznih posledic potrebujejo doživljenjsko spremljanje. Standardni nabor podatkov Registra raka Republike Slovenije vsebuje preskope podatke za nekatere poglobljene raziskave o raku v otroštvu in mladostništvu ter poznih posledicah pri preživelih. V Registru raka smo zato leta 2020 začeli aktivnosti za vzpostavitev Kliničnega registra otroških rakov in poznih posledic zdravljenja raka v otroštvu, ki deluje kot populacijski register z razširjenim naborom podatkov. Njegov osnovni namen je sistematično beleženje poznih posledic zdravljenja raka, zasnovali pa smo ga v dveh modulih. Prvi, ki je namenjen Registru raka, z uporabo pristopa aktivne registracije prek dostopa do elektronskih zapisov o bolnikih Pediatrične klinike Ljubljana ter drugih ustanov omogoča natančen popis bolezni (skladno z mednarodnimi pravili), primarnega zdravljenja (operacije, kumulativne doze posameznih zdravil, kumulativne obsevalne doze, presaditev krvotvornih matičnih celic in druga zdravljenja), morebitnih stranskih učinkov zdravljenja in morebitne ponovitve bolezni, za katero je zdravljenje popisano enako podrobno kot primarno zdravljenje. Prvi modul že vsebuje podatke za incidenčno leto 2019, sledila bo pospešena registracija nadaljnjih let. Drugi modul je namenjen Enoti za ugotavljanje poznih posledic raka Onkološkega inštituta Ljubljana, kjer bodo zdravniki med obiskom bolnika imeli dostop do vseh zbranih podatkov in možnost prospektivnega beleženja obiskov, opravljenih preiskav, izpolnjenih vprašalnikov in ugotovljenih poznih posledic. Drugi modul je v postopku testiranja uporabniške prijaznosti, razvijamo pa tudi avtomatiziran opis zdravljenja (tako imenovani potni list za preživele) in priporočil za sledenje.&nbsp

Impact of COVID-19 on cancer diagnosis and management in Slovenia

Background. The COVID-19 pandemic has disrupted the provision and use of healthcare services throughout the world. In Slovenia, an epidemic was officially declared between mid-March and mid-May 2020. Although all non-essential health care services were put on hold by government decree, oncological services were listed as an exception. Nevertheless, as cancer control depends also on other health services and additionally major changes in people’s behaviour likely occurred, we aimed to analyse whether cancer diagnosis and management were affected during the COVID-19 epidemic in Slovenia. Methods. We analysed routine data for the period November 2019 through May 2020 from three sources: (1) from the Slovenian Cancer Registry we analysed data on pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor(2) from the e-referral system we analysed data on all referrals in Slovenia issued for oncological services, stratified by type of referraland (3) from the administrative data of the Institute of Oncology Ljubljana we analysed data on outpatient visits by type as well as on diagnostic imaging performed. Results. Compared to the November 2019 – February 2020 average, the decrease in April 2020 was about 43% and 29% for pathohistological and clinical cancer notifications33%, 46% and 85% for first, control and genetic counselling referrals19% (53%), 43% (72%) and 20% (21%) for first (and control) outpatient visits at the radiotherapy, surgery and medical oncology sectors at the Institute of Oncology Ljubljana, and 48%, 76%, and 42% for X-rays, mammograms and ultrasounds performed at the Institute, respectively. The number of CT and MRI scans performed was not affected. Conclusions. Significant drops in first referrals for oncological services, first visits and imaging studies performed at the Institute, as well as cancer notifications in April 2020 point to a possibility of a delayed cancer diagnosis for some patients during the first surge of SARS-CoV-2 cases in Slovenia. The reasons for the delay cannot be ascertained with certainty and could be linked to health-seeking behaviour of the patients, the beliefs and practices of doctors and/ or the health system management during the epidemic. Drops in control referrals and control visits were expected and are most likely due to the Institute of Oncology Ljubljana postponing non-essential follow-ups through May 2020

Impact of COVID-19 on cancer diagnosis and management in Slovenia – preliminary results

Background. The COVID-19 pandemic has disrupted the provision and use of healthcare services throughout the world. In Slovenia, an epidemic was officially declared between mid-March and mid-May 2020. Although all non-essential health care services were put on hold by government decree, oncological services were listed as an exception. Nevertheless, as cancer control depends also on other health services and additionally major changes in people’s behaviour likely occurred, we aimed to analyse whether cancer diagnosis and management were affected during the COVID-19 epidemic in Slovenia. Methods. We analysed routine data for the period November 2019 through May 2020 from three sources: (1) from the Slovenian Cancer Registry we analysed data on pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor(2) from the e-referral system we analysed data on all referrals in Slovenia issued for oncological services, stratified by type of referraland (3) from the administrative data of the Institute of Oncology Ljubljana we analysed data on outpatient visits by type as well as on diagnostic imaging performed. Results. Compared to the November 2019 – February 2020 average, the decrease in April 2020 was about 43% and 29% for pathohistological and clinical cancer notifications33%, 46% and 85% for first, control and genetic counselling referrals19% (53%), 43% (72%) and 20% (21%) for first (and control) outpatient visits at the radiotherapy, surgery and medical oncology sectors at the Institute of Oncology Ljubljana, and 48%, 76%, and 42% for X-rays, mammograms and ultrasounds performed at the Institute, respectively. The number of CT and MRI scans performed was not affected. Conclusions. Significant drops in first referrals for oncological services, first visits and imaging studies performed at the Institute, as well as cancer notifications in April 2020 point to a possibility of a delayed cancer diagnosis for some patients during the first surge of SARS-CoV-2 cases in Slovenia. The reasons for the delay cannot be ascertained with certainty and could be linked to health-seeking behaviour of the patients, the beliefs and practices of doctors and/ or the health system management during the epidemic. Drops in control referrals and control visits were expected and are most likely due to the Institute of Oncology Ljubljana postponing non-essential follow-ups through May 2020

Impact of COVID-19 on cancer diagnosis and management in Slovenia – preliminary results

The COVID-19 pandemic has disrupted the provision and use of healthcare services throughout the world. In Slovenia, an epidemic was officially declared between mid-March and mid-May 2020. Although all non-essential health care services were put on hold by government decree, oncological services were listed as an exception. Nevertheless, as cancer control depends also on other health services and additionally major changes in people’s behaviour likely occurred, we aimed to analyse whether cancer diagnosis and management were affected during the COVID-19 epidemic in Slovenia