1011. Impact of the COVID-19 epidemic on cancer burden and cancer care in Slovenia : a follow-up studyTina Žagar, Sonja Tomšič, Vesna Zadnik, Nika Bric, Mojca Birk, Blaž Vurzer, Ana Mihor, Katarina Lokar, Irena Oblak, 2022, original scientific article Abstract: In Slovenia, cancer care services were exempt from government decrees for COVID-19 containment. Nevertheless, cancer control can be impacted also by access to other health services and changes in health-seeking behaviour. In this follow up study, we explored changes in cancer burden and cancer care beyond the first months after the onset of the COVID-19 epidemic.Materials and methods. We analysed routinely collected data for the period January 2019 through July 2022 from three sources: (1) pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor (source: Slovenian Cancer Registry); (2) referrals issued for oncological services (source: e-referral system); and (3) outpatient appointments and diagnostic imaging performed (source: administrative data of the Institute of Oncology Ljubljana – IOL). Additionally, changes in certain clinical and demographic characteristics in patients diagnosed and treated during the epidemic were analysed using the Hospital-Based Cancer Registry of the IOL (period 2015–2021).Results. After a drop in referrals to follow-up cancer appointments in April 2020, in June-August 2020, there was an increase in referrals, but it did not make-up for the drop in the first wave; the numbers in 2021 and 2022 were even lower than 2020. Referrals to first cancer care appointments and genetic testing and counselling increased in 2021 compared to 2019 and in 2022 increased further by more than a quarter. First and follow-up outpatient appointments and cancer diagnostic imaging at the IOL dropped after the onset of the epidemic in March 2020 but were as high as expected according to 2019 baseline already in 2021. Some deficits remain for follow-up outpatients’ appointments in surgical and radiotherapy departments. There were more CT, MRI and PET scans performed during the COVID-19 period than before. New cancer diagnoses dropped in all observed years 2020, 2021 and until July 2022 by 6%, 3% and 8%, respectively, varying substantially by cancer type. The largest drop was seen in the 50−64 age group (almost 14% in 2020 and 16% in 2021), while for patients older than 80 years, the numbers were above expected according to the 2015–2019 average (4% in 2020, 8% in 2021).Conclusions. Our results show a varying effect of COVID-19 epidemic in Slovenia for different types of cancers and at different stages on the patient care pathway – it is probably a mixture of changes in health-seeking behaviour and systemic changes due to modifications in healthcare organisation on account of COVID-19. A general drop in new cancer cases reflects disruptions in the pre-diagnostic phase and could have profound long-term consequences on cancer burden indicators.
Keywords: cancer, covid-19, delay in diagnosis
Published in DiRROS: 25.07.2024; Views: 313; Downloads: 192
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1017. Abbreviated 13C-mixed triglyceride breath test for detection of pancreatic exocrine insufficiency performs equally as standard 5-hour test in patients after gastrectomy performed for gastric cancerDarko Siuka, Kristina Kumer, Borut Štabuc, David Štubljar, David Drobne, Rado Janša, 2022, original scientific article Keywords: abbreviated 13C-mixed triglyceride breath test, pancreatic exocrine insufficiency, gastrectomy, faecal elastase, gastric cancer
Published in DiRROS: 25.07.2024; Views: 429; Downloads: 103
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1019. Safety and efficacy of drug-eluting microspheres chemoembolization under cone beam computed tomography control in patients with early and intermediate stage hepatocellular carcinomaŠpela Koršič, Nastja Levašič, Rok Dežman, Lara Anja Lešnik Zupan, Blaž Trotovšek, Rado Janša, Lojze Šmid, Peter Popović, 2022, original scientific article Abstract: Background. Drug-eluting microsphere transarterial chemoembolization (DEM-TACE) is the standard of care in pa-tients with intermediate-stage hepatocellular carcinoma and ensures targeted and controlled cytotoxic and ischemic effects. Proper patient selection and optimized treatment techniques are associated with longer median survival. The aim of this single-institution retrospective study was to evaluate safety and efficacy of DEM-TACE under cone beam computed tomography (CBCT) control in patients with early and intermediate stagehepatocellular carcinoma.Patients and methods. A total of144 patients (mean age 67.9 ± 8.0 years, 127 males and 17 females) between February 2010 and December 2018 were studied. Microparticles of different dimensions according to two manufac-turers (diameter of 70–150 μm, 100–300 μm or 300–500 μm and 40-μm, 75-μm or 100-μm) were used and loaded with 50–150 mg of doxorubicin. The objective tumour response according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST), the time to progression, adverse events and overall survival were (OS) evaluated.Results. In total, 452 procedures were performed (median, 3 per patient). Four (0.9% of all procedures) major com-plications were noted. Postembolization syndrome occurred after 35% of procedures. At the first imaging follow-up 2–3 months after first treatment, 91% of patients achieved an objective response. The median time to progression was 10.2 months (95% CI: 8.3-12.1 months). OS rates at 1, 2, 3, 4, and 5 years were 85%, 53%, 33%, 20% and 14%, respectively. The median survival time was 25.8 months (95% CI: 22.1–29.5 months). Conclusions. DEM-TACE under CBCT control in patients with early and intermediate stagehepatocellular carcinoma is a safe and effective method of treatment with high objective tumour response and survival rates.
Keywords: hepatocellular carcinoma, drug-eluting microspheres, doxorubicin
Published in DiRROS: 25.07.2024; Views: 402; Downloads: 162
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1020. Crystalloids vs. colloids for fluid optimization in patients undergoing brain tumour surgeryJasmina Markovič Božič, Božidar Visočnik, Polona Mušič, Iztok Potočnik, Alenka Spindler-Vesel, 2022, original scientific article Abstract: Background. This randomised, double-blinded, single-centre study prospectively investigated the impact of goal directed therapy and fluid optimization with crystalloids or colloids on perioperative complications in patients un-dergoing brain tumour surgery. Main aim of the study was to investigate the impact of fluid type on postoperative complications.Patients and methods. 80 patients were allocated into two equal groups to be optimised with either crystalloids (n = 40) or colloids (n = 40). Invasive hemodynamic monitoring was used to adjust and maintain mean arterial pressure and cerebral oxygenation within the baseline values (± 20%) and stroke volume variation (SVV) ≤ 10%. Postoperative complications from different organ systems were monitored during the first 15 days after surgery. Hospital stay was also recorded.Results. Crystalloid group received significantly more fluids (p = 0.003) and phenylephrine (p = 0.02) compared to colloid group. This did not have any significant impact on perioperative complications and hospital stay, since no dif-ferences between groups were observed. Conclusions. Either crystalloids or colloids could be used for fluid optimization in brain tumour surgery. If protocol-ised perioperative haemodynamic management is used, the type of fluid does not have significant impact on the outcome.
Published in DiRROS: 25.07.2024; Views: 292; Downloads: 81
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