In the Czech Republic more than 67 000 tumour diseases are newly diagnosed every year and almost 28 000 deaths a year are tumour-related. The number of citizens living with a malignant tumour or having previously suffered with it has exceeded 380 000 in the year 2005.
The most complex and most expensive oncological care cannot be provided in just any hospital. So in 2006 the Czech Society for Oncology of ČLS JEP (COS) accredited a network of 18 workplaces to which the most complex and expensive care has subsequently been transferred. The patients were therefore guaranteed complex care in the area of diagnostics and treatment of tumour diseases. In the second half of 2008 audits were carried out at these selected workplaces by the Ministry of Health. The aim was to assess the quality of provided care and compare quality levels between the different Complex Oncological Centres (KOC). During the auditing, individual workplaces demonstrated different levels of technical, professional and organizational quality. There were differences also in capacity and staffing of the Centres. In some of the Centres, not all diagnoses were being covered and consecutive palliative treatment was not available. In others, modern radiation technology was found to be missing. The audit resulted in the reduction of the number of KOCs from eighteen to thirteen. The centres that did not manage to uphold their status will continue to function as previously but they will not be able to provide biological therapy as the coverage of such treatment is conditioned by the insurance companies by KOC status. “Biological treatment is currently rendered to eight to ten per cent of the oncologically ill,” says professor MUDr. Jiří Vorlíček, CSc., the President of the Czech Society for Oncology. The patients that are indicated biological treatment will be assured treatment in all the 13 KOCs. On top of that, in Prague and Brno also contracted workplaces that serve as cooperating integral part of the local KOCs will provide care.
The Czech Society for Oncology approaches expensive biological treatment with great responsibility, keeping in mind the spirit of the Czech National Cancer Control Programme’s motto “the right treatment for the right patient at the right time and at the right place.” COS in cooperation with the Institute of Biostatistics and Analyses of the Masaryk University (IBA), Masaryk Oncological Institute and Complex Oncological Centres keeps long-term registrars of expensive care, namely of the following medicines: trastuzumab, lapatinib, bevacizumab, cetuximab, erlotinib, pemetrexed, sunitinib, sorafenib, cetuximab a imatinib. Two basic principles are adhered to when working with the registrars – prediction (estimation of the number of patients treated in future years) and retrospect (following the process and results of expensive treatment). The retrospective data assesses such aspects of treatment as correct indication of the observed therapy, the process of therapy and its safety, the causes of premature ending and its frequency, immediate and long-term results of treatment. Collective of authors from COS and IBA elaborated an analysis of all the mentioned drug registrars (as of December 15 2008) which states that expensive treatment is distributed among oncological patients in a controlled manner, and only to those patients with fully finalized diagnosis. Biological treatment is only given to patients whose general state allows them to profit from the care offered. The up till now collected data prove amelioration or at least stabilization of a tumour disease in more that 80% of the ill with finalized treatment. Termination of medication for its toxicity is under 5 per cent, in case of lung tumours under 10%. The Czech Society for Oncology has complete population data for the Czech Republic; it follows the trend in epidemiology of malignant tumours and is capable of precise forecasts of numbers of treated patients in the following years. The COS-processed data on this level was forwarded to the medical insurance companies in 2008 and so assured accessibility of the most modern oncological treatment for all patients that are in need of it with regard to their condition and accurate diagnosis.
How to obtain specialized treatment from a KOC? First, one must describe his or her problems to a general practitioner who will examine the patient and send him to a specialist. Depending on the type of problems it can be for example a surgeon, internist, gastroenterologist, gynaecologist, urologist etc. If the symptoms are not assessed by the practitioner as severe and if the patient is not dully examined despite persisting problems, he must seek a specialist by other means. Specialist examination may discover a malignant tumour. Successful treatment requires cooperation of experienced pathologists, surgeons, radiotherapists, oncologists and other specialists, but also the patient himself and his family. It is important that the patient or his family communicate with the doctor in charge, look up essential information on the disease and make arrangements with the most easily accessed oncologist whether he will treat the patient himself or whether he wants to transfer the patient to a Complex Oncological Centre. If the patient’s disease is suitable for biological treatment, he should be sent to a KOC in every case. After consultation in a KOC the patient returns under care of the local oncologist and the Centre merely controls the process of biological treatment or the KOC accepts the patient for treatment. “It is important that every person actively takes care of his or her health, looks up the right kind of information, counsels the doctor in charge and checks information against several sources,” advises prof. Vorlíček.
This is because only a well informed patient can actively take part in making decisions affecting his own treatment. And this is also the reason why the COS has been trying for several years to raise the medical literacy of the Czech public. These efforts are aided by the COS website www.linkos.cz, being the guaranteed source of information about oncology. It is designed not only for the professional public, but in its specialized section also for the oncologically ill, their families and friends. The web is regularly updated and fed with new information. The project “National Oncological Programme On-line” is aimed at professional public. On its web at www.onconet.cz it presents the network of Complex Oncological Centres, their equipment and projects in progress. Information on epidemiology of malignant tumours in the Czech Republic is available to all citizens at the national interactive portal www.svod.cz.
prof. MUDr. Jiří Vorlíček, CSc.
President of the Czech Society for Oncology of ČLS JEP
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