.....based on available and relevant information
Prague, 22 October 2009 The Czech Republic is among the countries with the highest oncology burden in the world; every year more than 68,000 patients are newly diagnosed with cancer and more than 27,000 patients die from cancer. As of the year 2006, there had been more than 380,000 patients who were treated for malignant neoplasms. It is obvious that we are facing a large, society-wide problem. The future prospects are not optimistic since the numbers of newly diagnosed patients have been steadily increasing for many cancer diagnoses. Our population is also affected by demographic ageing, which leads to an increase in the number of patients at high-risk age for development of malignant neoplasms. An increasing number of patients will be associated with an increased burden on Czech hospitals and increased treatment costs.
It is logical that evaluation of cancer care becomes a centre of interest not only for directors and managers of hospitals but also for the general public. Nevertheless, not every quality assessment leads to an improved treatment. Analyses of real Czech data are the most important in this respect and adoption of foreign data cannot contribute to the management of our national problems. The Czech Society for Oncology of the Czech Medical Association of JEP (CSO) is well aware of this issue and has cooperated with other institutions to build an information system covering the main areas of therapeutic care assessment. The main source of information on the epidemiology of malignant neoplasms is the National Cancer Register of the Czech Republic (NOR). Today, the NOR is an integral part of comprehensive cancer care and with a 100%representative coverage of the Czech population, it contains more than 1.4 million records for the period 1976-2006. The data is available to the public at the web portal www.svod.cz.
Evaluation of the quality of therapeutic care is a complex issue that cannot be solved by an analysis of a single indicator. The CSO is continually developing a comprehensive quality assessment system that is able to evaluate in particular the following aspects: availability of appropriate care for the patient, early provision of treatment, compliance with the defined treatment procedures, safety and results of treatment, including evaluation of patient survival. The CSO has not attempted to create a false image characterised by the success of cancer treatment. On the contrary, it provides a true description of the achieved success and unsolved problems. Only this approach will enable establishment of an open dialogue with patients and the public.
The main achievements of Czech oncology during the last 15 years include but are not limited to the following:
- Despite the increasing number of newly diagnosed patients, we stabilised mortality for malignant neoplasms on the long-term basis; hence, more and more patients are cured.
- In some of the diagnoses (prostate, kidney, breast cancer) the percentage rate of early detected stages with a high chance of cure has markedly increased.
- Survival of cancer patients has demonstrably improved for most cancer diagnoses, when comparing the recent periods 1995-2000 vs. 2000-2006. Analyses show that survival rates achieved in the Czech Republic are high and comparable with results of developed countries in the world, especially for less advanced clinical stages. However, a chance of long-term survival is markedly reduced in the most advanced clinical stage IV.
- Equipment in cancer centres has significantly improved, the number of state-of-the-art radiation therapy devices has been growing and the latest medications have become available to cancer patients over the last three years.
- Three national screening programs have been started in the Czech Republic focusing on early detection of breast cancer, cervical cancer, and colorectal cancer; screening of breast cancer especially has achieved visible successes.
On the contrary, the biggest problems of the current cancer care in the Czech Republic cannot be ignored:
- High numbers of patients are still diagnosed at advanced stages, with only a little chance for cure; this fact can worsen the result of comparison of the Czech Republic with some international statistics.
- In terms of early detection, the worst situation is found in colorectal cancer, where 54% of 8,300 newly diagnosed patients annually are detected with an advanced clinical stage.
- For some types of cancer treatment, equal availability of treatment is not available in all regions of the Czech Republic, and a high number of patients often create barely manageable logistic issues.
Conclusion: The Czech Society for Oncology analyses all available population data and tries to collect real data from clinical practice in order to evaluate the quality of therapeutic care. In this way, high-quality Czech data are used to document Czech results and manage Czech problems. A positive report for patients is that the results of care measured as the survival of patients during the last 15 years has significantly improved. In order for this positive trend to continue, we should focus on cancer prevention. This is where people can take a more active role. Early detection of the most common diseases will be strongly supported by regular screening, which is available for breast cancer, colorectal cancer and cervical cancer in the Czech Republic. People can get more information at the website of the CSO (www.linkos.cz) or at the portals dedicated to the aforementioned screening programs (www.mamo.cz, www.kolorektum.cz, www.cervix.cz).
Table 1. Overview of the epidemiology of malignant neoplasms (MN) in the Czech Republic1
|Annual incidence of MN (year 2006)
|Absolute number of newly diagnosed MN (year 2006)||63,246||35,932||32,314|
|Annual mortality rate for MN (year 2006)
|Absolute number of deaths for MN (year 2006)||27,895||15,354||12,541|
|Three most frequently occurring diagnoses
(% of newly reported diagnoses in the year 2006)
1 All malignant neoplasms including other skin neoplasms (C00-C97)
Incidence: number of new cases of the disease in a given population at a certain time.
Mortality: number of deaths for the given diagnosis in a given population at a certain time.
Prevalence: an indicator of the current morbidity in the population caused by a certain diagnosis. In the epidemiology of malignant diseases, prevalence means the number of registered living individuals within the population that have or have had cancer as per 31 December of a given year.
Table 2. Examples of outputs from the information system held by the CSO, Czech Medical Association of JEP – predicted number of treated patients in the year 2010 (on the example of two very commonly diagnosed malignant neoplasms)
|Diagnosis Clinical stage (CS)||Predicted numbers of treated patients
in the year 2010 (90% confidence interval)
|Breast cancer: newly diagnosed patients|
|KS I||2 847 (2 658; 3 036)|
|KS II||2 057 (1 897; 2 216)|
|KS III||828 (732; 924)|
|KS IV||436 (381; 490)|
|Breast cancer: recurrence of previously treated cancer||1426 (1316; 1536)|
|Colorectal carcinoma: newly diagnosed patients|
|KS I||1475 (1327; 1620)|
|KS II||1872 (1715; 2030)|
|KS III||1878 (1746; 2012)|
|KS IV||1310 (1218; 1403)|
|Colorectal carcinoma: recurrence of previously treated cancer||1738 (1581; 1894)|
Table 3. Reference values of the five-year relative survival rates of cancer patients in the Czech Republic1
Diagnosis / clinical
|5-year survival of patients treated in various time periods
|Comparison of two older periods||Comparison of two recent periods|
|1990 - 1994||1995 - 1999||2000 - 2002||2003-2005|
|All clinical stages together||70,1||77,6||79,6||83,5|
|All clinical stages together||49,0||53,3||54,8||57,0|
1 Demonstrated on the example of two most frequently occurring diagnoses of malignant neoplasms. Assessment of the survival rates in treated cancer patients with verified diagnosis of cancer.