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IS
A PHYSICIAN A PROGNOSTIC FACTOR IN THE TREATMENT OF COLORECTAL
CANCER?
Boškov N, Hostić
D, Uifeljan-Ristić I.
General hospital
"Đ. Joanović", Department of Oncology, Zrenjanin, Serbia and Montenegro
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ABSTRACT
Colorectal
cancer in mid-Banat county shows significant increase in morbidity
and mortality, almost equal both in men and women. We observe that
these patients come for first oncologic examination in advanced
stage of the disease and thus initiation of adjuvant treatment is
often late. The aim of the study was to estimate the "lost" time
in the treatment of these patients that depends on physician and
on patient. Twenty patients were included in the study, 4 (20%)
women and 16 (80%) men, (median age, 67 years) who continued the
treatment in our hospital after surgery. Average follow-up period
was 20.5 months (range 8-60). Rectal carcinoma was found in 14/20
(70%) patients, carcinoma of the sigmoid colon in 3/20 (15%), and
carcinoma of the coecum in 3/20 (15%) patients. Dukes B, C and D
stage was evident in 30%, 55% and 15%. Median of "lost interval"
related to the patient was 6.5 months while "lost interval," related
to the physician was 6.5 months (1-54). Waiting period for histological
verification was 34 days (range 15-180). Adjuvant chemotherapy was
applied to 7 (35%) patients while 3 patients were treated with combined
chemotherapy and radiation therapy. In 42% of patients adjuvant
therapy was not initiated on time due to late histological verification
and late consult of the oncologist. Median time of first relapse
was 9.7(1-47) months. The most frequent first relapse was metastatic
liver disease and local recurrence. Total survival rate was 45%
while survival rate without disease recurrence was 35%. Our results
indicate that the decisions of physicians and the organization of
health institutions have significant influence on clinical stage,
initiation of adjuvant treatment and outcome of colorectal cancer.
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Keywords:
Colorectal cancer, Physician role, "Lost Time" |
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