1. Onkološko zdravstveno svetovanje na daljavoAleksandra Grbič, Dajana Glavan, Sara Brodarič, Irena Oblak, 2024, pregledni znanstveni članek Povzetek: Izhodišče: V začetku leta 2023 smo v okviru klicnega centra vzpostavili zdravstveno svetovanje z namenom opolnomočenja in podpore bolnikov ter njihovih bližnjih. V raziskavi smo analizirali pogostost in stopnjo pojavljanja simptomov, povezanih z boleznijo in zdravljenjem, z uporabo ocenjevalnega protokola in nadaljnjih napotitev glede na izraženost težav.
Metode: Izvedena je bila retrospektivna analiza telefonskih klicev na linijo zdravstvenega svetovanja v klicnem centru od 1. 10. 2023 do 31. 1. 2024. Za zbiranje podatkov o klicateljih je bilo potrjeno in uporabljeno ocenjevalno orodje v podatkovni bazi Redcap. Za izračun odstotnih deležev smo uporabili program Microsoft® Excel® for Office 365 in opisno statistiko.
Rezultati: Vzorec je vključeval 144 telefonskih klicev, kar je predstavljalo 60 % telefonskih klicev bolnikov in 39 % klicev bol-nikovih bližnjih. Vzrok telefonskih klicev je bil v 60,4 % posledica neželenih učinkov sistemskega zdravljenja, ki so bili najpogostejši do tedna dni od prejetja zadnjega zdravljenja. V analizi telefon-skih klicev so bili najpogosteje izraženi simptomi bolečina (10 %), slabost (10 %), izguba apetita (7 %), driska (7 %). Na podlagi tega je bilo izvedenih 144 zdravstvenih svetovanj, 87 napotitev na osebnega zdravnika ali lečečega onkologa in 14 napotitev na nujno medicinsko pomoč.
Zaključek: Zdravstveno svetovanje na daljavo je treba uporabiti kot priložnost za zagotavljanje dostopnosti do informacij in pravo-časne zdravstvene oskrbe prek informacijskih in telekomunikacij-skih sistemov, saj vpliva na spodbujanje samooskrbe, zmanjšanje števila hospitalizacij, znižanje stroškov zdravstvene oskrbe in nenazadnje na kakovost življenja onkoloških bolnikov.
Ključne besede: zdravstveno svetovanje, oddaljen dostop, ocenjevalni triažni protokol
Objavljeno v DiRROS: 26.07.2024; Ogledov: 11; Prenosov: 4
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2. 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, izvirni znanstveni članek Povzetek: 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.
Ključne besede: cancer, covid-19, delay in diagnosis
Objavljeno v DiRROS: 25.07.2024; Ogledov: 24; Prenosov: 7
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3. Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapyIvica Ratoša, Aljaša Jenko, Željko Šljivić, Maja Pirnat, Irena Oblak, 2020, izvirni znanstveni članek Povzetek: The aim of the study was to quantify planned doses to the heart and specific cardiac substructures in free-breathing adjuvant three-dimensional radiation therapy (3D-CRT) and tangential intensity modulated radiotherapy (t-IMRT) for left-sided node-negative breast cancer, and to assess the differences in planned doses to organs at risk according to patients% individual anatomy, including breast volume. Patients and methods. In the study, the whole heart and cardiac substructures were delineated for 60 patients using cardiac atlas. For each patient, 3D-CRT and t-IMRT plans were generated. The prescribed dose was 42.72 Gy in 16 fractions. Patients were divided into groups with small, medium, and large clinical target volume (CTV). Calculated dose distributions were compared amongst the two techniques and the three different groups of CTV. Results. Mean absorbed dose to the whole heart (MWHD) (1.9 vs. 2.1 Gy, P < 0.005), left anterior descending coronary artery mean dose (8.2 vs. 8.4 Gy, P < 0.005) and left ventricle (LV) mean dose (3.0 vs. 3.2, P < 0.005) were all significantly lower with 3D-CRT technique compared to t-IMRT. Apical (8.5 vs. 9.0, P < 0.005) and anterior LV walls (5.0 vs. 5.4 Gy, P < 0.005) received the highest mean dose (Dmean). MWHD and LV-Dmean increased with increasing CTV size regardless of the technique. Low MWHD values (< 2.5 Gy) were achieved in 44 (73.3%) and 41 (68.3%) patients for 3D-CRT and t-IMRT techniques, correspondingly. Conclusions. Our study confirms a considerable range of the planned doses within the heart for adjuvant 3D-CRT or t-IMRT in node-negative breast cancer. We observed differences in heart dosimetric metrics between the three groups of CTV size, regardless of the radiotherapy planning technique.
Ključne besede: breast cancer, radiotherapy, 3D-CRT
Objavljeno v DiRROS: 16.07.2024; Ogledov: 66; Prenosov: 34
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4. Impact of COVID-19 on cancer diagnosis and management in Slovenia : preliminary resultsVesna Zadnik, Ana Mihor, Sonja Tomšič, Tina Žagar, Nika Bric, Katarina Lokar, Irena Oblak, 2020, izvirni znanstveni članek Ključne besede: covid-19, oncology, oncology diagnosis, pandemic
Objavljeno v DiRROS: 12.07.2024; Ogledov: 99; Prenosov: 58
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5. Definitive radiochemotherapy in esophageal cancer : a single institution experienceFranc Anderluh, Miha Toplak, Vaneja Velenik, Irena Oblak, Ajra Šečerov Ermenc, Ana Jeromen, Jasna But-Hadžić, Marija Skoblar Vidmar, 2019, izvirni znanstveni članek Ključne besede: radiochemotherapy, definitive radiochemotherapy, esophageal cancer
Objavljeno v DiRROS: 05.07.2024; Ogledov: 133; Prenosov: 34
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6. Total neoadjuvant treatment of locally advanced rectal cancer with high risk factors in SloveniaMojca Tuta, Nina Boc, Erik Brecelj, Mirko Omejc, Franc Anderluh, Ajra Šečerov Ermenc, Ana Jeromen, Irena Oblak, Bojan Krebs, Vaneja Velenik, 2019, izvirni znanstveni članek Ključne besede: total neoadjuvant treatment, radiochemotherapy, rectal cancer
Objavljeno v DiRROS: 05.07.2024; Ogledov: 104; Prenosov: 30
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7. Induction chemotherapy, chemoradiotherapy and consolidation chemotherapy in preoperative treatment of rectal cancer : long-term results of phase II OIGIT-01 TrialDanijela Golo, Jasna But-Hadžić, Franc Anderluh, Erik Brecelj, Ibrahim Edhemović, Ana Jeromen, Mirko Omejc, Irena Oblak, Ajra Šečerov Ermenc, Vaneja Velenik, 2018, izvirni znanstveni članek Povzetek: The purpose of the study was to improve treatment efficacy for locally advanced rectal cancer (LARC) by shifting half of adjuvant chemotherapy preoperatively to one induction and two consolidation cycles. Patients and methods Between October 2011 and April 2013, 66 patients with LARC were treated with one induction chemotherapy cycle followed by chemoradiotherapy (CRT), two consolidation cycles, surgery and three adjuvant capecitabine cycles. Radiation doses were 50.4 Gy for T2-3 and 54 Gy for T4 tumours in 1.8 Gy daily fraction. The doses of concomitant and neo/adjuvant capecitabine were 825 mg/m2/12h and 1250mg/m2/12h, respectively. The primary endpoint was pathologic complete response (pCR). Results Forty-three (65.1%) patients were treated according to protocol. The compliance rates for induction, consolidation, and adjuvant chemotherapy were 98.5%, 93.8% and 87.3%, respectively. CRT was completed by 65/66 patients, with G % 3 non-hematologic toxicity at 13.6%. The rate of pCR (17.5%) was not increased, but N and the total-down staging rates were 77.7% and 79.3%, respectively. In a median follow-up of 55 months, we recorded one local relapse (LR) (1.6%). The 5-year disease-free survival (DFS) and overall survival (OS) rates were 64.0% (95% CI 63.89%64.11) and 69.5% (95% CI 69.39%69.61), respectively. Conclusions In LARC preoperative treatment intensification with capecitabine before and after radiotherapy is well tolerated, with a high compliance rate and acceptable toxicity. Though it does not improve the local effect, it achieves a high LR rate, DFS, and OS.
Ključne besede: rectal cancer, neoadjuvant chemotherapy, preoperative chemoradiotherapy
Objavljeno v DiRROS: 11.06.2024; Ogledov: 94; Prenosov: 54
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9. Spremljanje bolnikov po zaključenem zdravljenju raka debelega črevesa in dankeIrena Oblak, Aleksandra Grbič, 2024, objavljeni strokovni prispevek na konferenci Povzetek: Ob rasti incidence raka, vse kompleksnejšem zdravljenju in vse boljši ozdravljivosti ter eksponentni rasti prevalence bodo potrebe po spremljanju bolnikov z rakom le še naraščale. Običajno tradicionalno intenzivno pet- ali več-letno spremljanje (angl. follow-up) bolnikov po zaključku zdravljenja, ki se izvaja v rednih časovnih intervalih v ustanovi zdravljenja ter vključuje poleg kliničnega pregleda tudi različne slikovne in druge preiskave in merjenje tumorskih označevalcev, potrebuje nadgradnjo in spremembe. Izkazalo se je namreč, da tovrstno intenzivno spremljanje bolnikov nima vpliva na izboljšanje preživetja. Pri bolnikih z rakom debelega črevesa in danke vpliva le na zgodnejše odkritje ponovitve bolezni in več reševalnih operacij, vendar pa le-to nima vpliva na preživetje bolnikov. V okviru spremljanja bolnikov bi se morali bolj približati bolnikovim težavam in potrebam in jih obravnavati celostno od postavitve diagnoze raka, pa ves čas zdravljenja in po njem, in to ne le pet let po zaključku zdravljenja. Obravnava bi morala poleg psiho-fizičnih vidikov vključevati tudi socialnoekonomski ter poklicni vidik. Ob tem je nujna tudi opolnomočenost bolnika, saj mora skrbeti za zdrav življenjski slog, znati premagovati stres, depresijo in anksioznost, poznati svojo bolezen in zdravljenje, možne znake ponovitve bolezni, si želeti čim prejšnje vrnitve nazaj v svoje življenje. Vse to pa presega zmožnosti onkologov, nujna bo večja vključenost družinskih zdravnikov in ostalih strokovnjakov.
Ključne besede: bolniki, rak debelega črevesa in danke, spremljanje bolnikov
Objavljeno v DiRROS: 06.06.2024; Ogledov: 267; Prenosov: 90
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10. Treatment-related cardiovascular toxicity in long-term survivors of testicular cancerJasenka Gugić Kevo, Lorna Zadravec-Zaletel, Irena Oblak, 2017, pregledni znanstveni članek Povzetek: Testicular cancer is the most common malignancy in young men. Considering increasing incidence, exceptionally high cure rate, as well as long life expectancy, assessment of long term toxicity in testicular cancer survivors is of great importance. In the last decades a major effort has been made in order to reduce toxicity of treatment, while maintaining its high effectiveness. Conclusions Actual knowledge on treatment toxicity is based on outdated treatment modalities. Hopefully, modern treatment modalities could reduce toxicity, but, there is no firm confirmation for that at the moment, as data dealing with late sequelae of modern treatment of testicular cancer are not available yet due to the short period of observation. The life-threatening cardiovascular toxicity in testicular cancer survivors is major complication of platinum-based chemotherapy, mediastinal radiotherapy and even subdiaphragmatic radiotherapy.
Ključne besede: testicular cancer, cardiovascular toxicity, long-term survivors
Objavljeno v DiRROS: 24.05.2024; Ogledov: 277; Prenosov: 151
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