open access

Vol 10, No 4 (2014)
Review paper
Published online: 2014-08-29
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Colorectal cancer — the social significance of changes in the epidemiology and treatment options in Poland

Rafał Zyśk, Piotr Wysocki, Lucjan Wyrwicz
Onkol. Prak. Klin 2014;10(4):212-223.

open access

Vol 10, No 4 (2014)
REVIEW ARTICLES
Published online: 2014-08-29

Abstract

The cancer registries in 2011 received information on more than 144.3 thousand of new cases and more than 92.5 thousand of deaths in Poland. There was an increase in incidence (approximately 3.7 thousand of new cases), while the number of deaths decreased again compared to the previous year. It is estimated (taking into account the completeness of registration) that in Poland in 2011, approximately 154 thousand people were diagnosed with cancer and were more than 320 thousand persons lived with diagnosis of cancer made during the previous five years. The second most common type of cancer is colorectal cancer (colon and rectum). Tumors of the colon are characterized an increasing trend of morbidity and mortality. Preliminary data of National Health Fund in 2013 indicates a prevalence exceeding 91 thousand patients with this diagnosis (C18–C21) and the sum of expenditures on health care services (diagnostic and therapeutic) provided to the sick at the level of 1.083 mln PLN. According to the analysis carried out by the National Health Fund, colorectal cancer is now the second (after breast cancer) most cost-consuming cancer for the public health care system regarding the total costs of diagnostic and therapeutic services. Analyzing Social Security Insitution expenses on social welfare benefits associated with this cancer (138.3 mln PLN in 2010), colorectal cancer is the second most cost-consuming for Social Security Insitution (after breast cancer) due to sickness absence and incapacity to work among patients with oncological diseases. For the last few years molecularly targeted treatment has brought beneficial effects on prognosis of patients with advanced colorectal cancer. The results of the last years of randomized trials II and III phase and retrospective analyzes indicate that this type of treatment may contribute to the improvement of results, among others, overall survival, progression-free survival and objective response rate. The use of targeted therapies anti-EGFR in the first line treatment of advanced colorectal cancer allows for improvement in median of overall survival in some patients up to 6–8 months compared to classical chemotherapy regimens. However, the fact of obtaining clinical benefits in some patients only, determines the need for selective enrollment of patients and the identification of predictive factors. Thus the knowledge of predictive factors became the basis for the introduction into clinical practice standard for determining the presence of a specific gene mutations. Moreover, we are knowledgable to prevent the administration of the drug to the patient, in whom targeted therapy does not work or deteriorates prognosis. An essential condition for further improving the results of treatment of patients with advanced colorectal cancer will therefore not only enables patients to undergo targeted therapies in first-line therapy but also allow them to obtain molecular and genetic diagnostics optimally financed by the public payer.

Abstract

The cancer registries in 2011 received information on more than 144.3 thousand of new cases and more than 92.5 thousand of deaths in Poland. There was an increase in incidence (approximately 3.7 thousand of new cases), while the number of deaths decreased again compared to the previous year. It is estimated (taking into account the completeness of registration) that in Poland in 2011, approximately 154 thousand people were diagnosed with cancer and were more than 320 thousand persons lived with diagnosis of cancer made during the previous five years. The second most common type of cancer is colorectal cancer (colon and rectum). Tumors of the colon are characterized an increasing trend of morbidity and mortality. Preliminary data of National Health Fund in 2013 indicates a prevalence exceeding 91 thousand patients with this diagnosis (C18–C21) and the sum of expenditures on health care services (diagnostic and therapeutic) provided to the sick at the level of 1.083 mln PLN. According to the analysis carried out by the National Health Fund, colorectal cancer is now the second (after breast cancer) most cost-consuming cancer for the public health care system regarding the total costs of diagnostic and therapeutic services. Analyzing Social Security Insitution expenses on social welfare benefits associated with this cancer (138.3 mln PLN in 2010), colorectal cancer is the second most cost-consuming for Social Security Insitution (after breast cancer) due to sickness absence and incapacity to work among patients with oncological diseases. For the last few years molecularly targeted treatment has brought beneficial effects on prognosis of patients with advanced colorectal cancer. The results of the last years of randomized trials II and III phase and retrospective analyzes indicate that this type of treatment may contribute to the improvement of results, among others, overall survival, progression-free survival and objective response rate. The use of targeted therapies anti-EGFR in the first line treatment of advanced colorectal cancer allows for improvement in median of overall survival in some patients up to 6–8 months compared to classical chemotherapy regimens. However, the fact of obtaining clinical benefits in some patients only, determines the need for selective enrollment of patients and the identification of predictive factors. Thus the knowledge of predictive factors became the basis for the introduction into clinical practice standard for determining the presence of a specific gene mutations. Moreover, we are knowledgable to prevent the administration of the drug to the patient, in whom targeted therapy does not work or deteriorates prognosis. An essential condition for further improving the results of treatment of patients with advanced colorectal cancer will therefore not only enables patients to undergo targeted therapies in first-line therapy but also allow them to obtain molecular and genetic diagnostics optimally financed by the public payer.

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Keywords

colorectal cancer, epidemiology, molecularly targeted therapy, healthcare reimbursement, access to targeted therapies, cancer treatment costs, economic burden of cancer, Poland, National Health Fund

About this article
Title

Colorectal cancer — the social significance of changes in the epidemiology and treatment options in Poland

Journal

Oncology in Clinical Practice

Issue

Vol 10, No 4 (2014)

Article type

Review paper

Pages

212-223

Published online

2014-08-29

Bibliographic record

Onkol. Prak. Klin 2014;10(4):212-223.

Keywords

colorectal cancer
epidemiology
molecularly targeted therapy
healthcare reimbursement
access to targeted therapies
cancer treatment costs
economic burden of cancer
Poland
National Health Fund

Authors

Rafał Zyśk
Piotr Wysocki
Lucjan Wyrwicz

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