In the Polish healthcare system, the primary care physician is responsible for directing patients to outpatient specialist care if such need occurs. This is usually performed basing on the physical and subjective examination alone, because often it is not possible to perform more advanced diagnostic imaging that can confirm or rule out a disease requiring specialist intervention. Cancer diseases are a group of diseases where the time from diagnosis to treatment is particularly important and plays a key role in prognosis. Oncological surgery is a field of medicine, that deals with the surgical treatment of a close group of cancers

Agata Krajewska

Magdalena Żukowska

Piotr Krajewski

Journal of Education Health and Sport

Krajewski, Piotr

Krajewska, Agata

Żukowska, Magdalena

Akademicka Platforma Czasopism

1260  Krajewski Piotr, Krajewska Agata, Żukowska Magdalena. Analysis of patients' reports to the oncological surgery clinic. Journal of Education, Health and Sport. 2018;8(9):1260-1263 eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1430836 http://ojs.ukw.edu.pl/index.php/johs/article/view/6053       The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eissn 2391-8306 7  © The Authors 2018; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.  The authors declare that there is no conflict of interests regarding the publication of this paper.  Received: 02.08.2018. Revised: 18.08.2018. Accepted: 21.09.2018.      Analysis of patients' reports to the oncological surgery clinic  Krajewski Piotr1, Krajewska Agata2, Żukowska Magdalena3  1Pomeranian Medical University, Doctoral Studies at the Faculty of Medicine and Dentistry 2Pomeranian Medical University, Doctoral College of the Faculty of Medicine 3Pomeranian Medical University, Study of the Faculty of Health Sciences  Keywords:Oncology; oncological surgery; preventive examination   Introduction In the Polish healthcare system, the primary care physician is responsible for directing patients to outpatient specialist care if such need occurs. [1] This is usually performed basing on the physical and subjective examination alone, because often it is not possible to perform more advanced diagnostic imaging that can confirm or rule out a disease requiring specialist intervention. Cancer diseases are a group of diseases where the time from diagnosis to treatment is particularly important and plays a key role in prognosis. [2]Oncological surgery is a field of medicine, that deals with the surgical treatment of a close group of cancers.  Aim of the study The aim of the study is to determine whether the system of referring patients to the oncological surgery clinic is appropriate.  1261  Material and methodology The research material comprises of a group of patients (1081 people of different sex, over 18 years of age) reporting to the oncological surgery clinic of the West Pomeranian Center of Oncology. The study was retrospective. The analyzed data was that included in patient history reports of the patients consulted in July 2018. The considered data was the reason for the patient's admission to specialist counseling, whether diagnostic imaging was ordered or whether full oncological diagnostics were taken leading to an operation. The patients were divided into three groups: 1. Patients who have been fully diagnosed oncologically and were directed to the ward for surgery (67 people) 2. Patients referred to the counseling center in which the tests were performed without finding any neoplastic disease (322) 3. People who came to the clinic and did not have imaging tests or oncological diagnostics because there was no need for further diagnostics (692).  Methodology It was determined what percentage of all patients are patients who have been fully diagnosed and which percentage of all patients reporting are patients who had to undergo imaging tests to exclude an oncological disease requiring surgical treatment.  Results Patients who required the implementation of a complete oncological diagnosis resulting in an operation were 6.2% of all patients. Patients who did not require the implementation of diagnostics constituted 64% of patients, and patients who required a diagnostic test to exclude cancer were 29.8% of all patients reporting.  Discussion A patient reporting to a oncological surgery clinic in whom cancer is suspected is directed to specialized imaging or invasive tests (depending on suspicion of MMG, USG, CT, MRI, markers, biopsies, endoscopes, etc.). A large percentage of patients who come to the clinic (from all 3 groups) bring with them previously performed tests (those that are available to be ordered by a Primary Care Physician), some of these tests require only proper interpretation to explicitly exclude cancer, some of those tests required further diagnostic procedures because basing on the tests ordered by the primary care physician solely it was impossible to explicitly 1262  confirm or exclude the presence of a neoplastic disease. Some patients who did not require further oncological diagnostics (group 3) - were misdiagnosed or no evidence of cancer was found in the collected interview or re-examined medical documentation. The costs of running an out-patient health care is very high. Such Out-patient wards require the employment of many specialists. It happens that running specialist outpatient care brings losses to the hospital budget and is economically unprofitable. A very large percentage of patients reporting to the out-patient clinic without clear indications suggests  that out-patient specialist care is not being managed in the right way.  Summary Treatment and detection of cancer in Poland is at a very low level compared to Western European countries or the USA. [3] This is due to low budget spent on health services dictated by the general state of the economy. [4]The majority of patients (93.8%) came to the specialist clinic unnecessarily, using the financial resources of the health service. The funds consumed in this way surely could be distributed in a better way. Something that could positively influence the improvement of the profile of patients reporting to the oncological surgery clinic would be the education of the public in the field of cancer prevention, risk factors and symptoms that may be indicative of the onset of the disease. [5,6] A real way to reduce costly specialist care is to extend the diagnostic possibilities of the primary care physicians, and to unify the tests they carry out, even providing a diagnostic scheme for Primary care physicians. [7] The problem of outpatient specialist care does not only concern oncological surgery. There are many specialties requiring urgent changes [8] in the scope of the functioning system in order to strive for European standards of treatment.            1263  Bibliography 1. Morawiec – Sztandera  A, Morawiec Z. Onkologia. W: Latkowski B, Kosiek K. Sygnały alarmowe u chorych i pilne decyzje lekarzy POZ. Wyd. I. PZWL Warszawa 2013, 13-36. 2. Hiom S. C., Diagnosing cancer earlier: reviewing the evidence for improving cancer survival, Br J Cancer. 2015 Mar 31; 112(Suppl 1): S1–S5. PMID: 25734391 3.Jensen H, Svanholm H, Støvring H, Bro F. A primary healthcare - based intervention to improve a Danish cervical cancer screening programme: a cluster randomised controlled trial. J Epidemiol Community Health. 2009; 63(7): 510-515. 4. Nieszporska S., Priorities in the Polish health care system, Eur J Health Econ. 2017; 18(1): 1–5.PMID: 27682073 5.Spanou C, Simpson SA, Hood K, Edwards A, Cohen D, et al.: Preventing  disease through opportunistic, rapid engagement by primary care teams using behaviour change counselling (PRE - EMPT): protocol for a general practice - based cluster randomised trial. BMC Fam Pract. 2010; 11: 69. 6.Nemeth L. S., Nietert P. J., Ornstein S. M., High Performance in Screening for Colorectal Cancer: A Practice Partner Research Network (PPRNet) Case Study, J Am Board Fam Med. 2009; 22(2): 141–146. 7. Gazdecka-Szpecht K , Rola lekarza rodzinnego w profilaktyce wybranych nowotworów złośliwych., Katedra i Zakład Medycyny Rodzinnej Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu, Poznań 2013 8.Wagner K, Studies in Innovation: Redirecting High-Cost Care , Leadership +, 2016  

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Analysis of patients' reports to the oncological surgery clinic

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