Peculiarities of routing women of childbearing age with oncological diseases of the reproductive sphere

The morbidity rate for the female population in Russia has reached the number of 365.6 cases per 100k of women, the growth for the previous 10 years is 20.7%. During periodic examination it is possible to detect only one in ten cases of the oncologic pathology, and the part of people with the first proven diagnosis of late detection, i.e., in the 4th stage, is 22.3%, therefore, one in five tumours is detected when distant metastases exist.[5] In addition, the quantity of people with first proven diagnosis who die within one year remains high – 33.9%. One of the main reasons of mortality of the female population in Russia for the previous ten years is malignant tumours of organs of the reproductive system, which have increased their specific gravity in the structure of the oncological morbidity more than twice. [2]

The enhancement of cancer care facilities, which involves first of all developing the diagnostic and treatment basis of oncological health care institutions, allowed to increase the life expectancy of oncologic patients by means of improving the detectability of malignant tumours at early stages. But the result could have been more sufficient if all drawbacks in succession, secondary prevention and rehabilitation of oncologic patients after the performed comprehensive treatment had been eliminated. [1, 3]

The starting point for analyzing the full routing of women of childbearing age, who suffer from malignant tumours of organs of the reproductive system, is studying the ways of detecting this pathology in them. In most cases the suspicion of malignant tumours was pronounced by healthcare professionals. At the same time 45.1% of women suspected having an oncologic pathology themselves in cases of malignant tumours of breasts, 12.2% – in cases of malignant tumours of the uterine cervix, 8.1% – in cases of malignant tumours of the ovary and 1.0% – in cases of malignant tumours of the uterine body. In order to confirm their concerns they addressed directly to clinics of oncologic centres for medical consultative assistance. Only 3.6% of them, having suspicion of malignant tumours of breasts, addressed to private oncologic centres.

Goal of research. To perform the analysis of the effectiveness and efficiency of routing and medical examination of women of childbearing age suffering from malignant tumors of the reproductive sphere.

Materials and methods. In order to make a research of routing patients we used the modelling approach including the construction of 'a tree of solutions', which is traditionally used in the process of the clinical and economic analysis (Vorobyev P. А., 2008).

In order to calculate the formula of the social effectiveness of routing oncologic patients one can use the concept which has been suggested by the group of scientists headed by L.G.Rosenfeld and which presupposes the comparison of the sum of a certain indicator value (∑ИП n ) for some years which precede the organizational decision being analyzed (n) with the product of the indicator value after the organizational decision being analyzed (ИП n+1 ) and the number of years which precede the organizational decision being analyzed (n).

In order to calculate the formula of the medical effectiveness of routing oncologic patients we used the idea suggested by V.А. Medik and V.K.Yuriev (2012), which says that «the parameter for evaluating the medical efficiency… can be the parameter of the portion of patients with the 1st-2nd stage of a malignant tumour».

Findings and Discussion. The analysis of routing women of childbearing age, who suffer from malignant tumours of organs of the reproductive system, which had been existing in the Chelyabinsk region prior to the Order of the Ministry of Healthcare and Social Development of the Russian Federation # 944н «Of Approving the Procedure of Medical Assistance to Oncologic Patients», demonstrated that the majority of patients (54.9% with malignant tumours of breasts - 94.5% with malignant tumours of the ovary) primarily addressed to healthcare professionals, who are not specialized in oncology. As a result, the period of receiving the specialized medical assistance was prolonged from 207+20.1 days (malignant tumours of breasts) to 468+33.5 days (malignant tumours of the ovary) and that fact made female patients soothe their condition with the help of 'self-treatment'. On the whole, 24.4% of patients with malignant tumours of the uterine cervix, 21.3% - with malignant tumours of breasts and 5.6% - with malignant tumours of the uterine body employed this method. Besides, the drawback of the existing routing is the fact that after the specialized treatment the dispensary observation was being carried out not in oncologic centres but in institution of primary healthcare at the place of residence where, as a rule, there were no oncologists. All those facts led to the situation that only from 51.2% (malignant tumours of the ovary) to 75.5% (malignant tumours of breasts) of women of childbearing age were being regularly examined. In order to analyze medical effectiveness and social efficiency we developed the methodology for their measurement. Here, basing on the above-mentioned idea of V. А. Medik and V.K. Yuriev (2012)  [4], which presupposes that in order to determine the medical effectiveness of the assistance for oncologic patients one can use the extensive parameter - 'the portion of patients with the detected 1st-2nd stages of a malignant tumour' - as an indicator value, we suggested the formula (1) for calculating the medical effectiveness of routing oncologic patients:

_МР=УВ 1-2ст_{пор – (УВ} 1-2ст_{1 +УВ} 1-2ст_{2 +УВ} 1-2ст_{3 +УВ} 1-2ст_{4 +УВ} 1-2ст_{n )              (1)}

n where:

МР – medical effectiveness;

УВ^1-2ст пор – portion of patients with the 1^st-2^nd stage of a malignant tumour within the period after the organizational decision;

(УВ^1-2ст 1 +УВ^1-2ст 2 +……+УВ^1-2ст n ) – average portion of patients with the 1^st-2^nd stage

The existence of the medical effectiveness is admitted in case if the result is positive «+», i.e., the detection of malignant tumours at the 1st-2nd stages after the organizational decision being analyzed (a new scheme of routing) is more than on the average for the period of existence of the previous scheme of routing.

On the basis of the concept which has been formulated by the group of scientists headed by L. G. Rosenfeld and which says that the social efficiency of a medical event is calculated as a difference between indicator values before and after adopting an organizational decision we suggested the formula (2) for calculating the social efficiency of routing and medical examination of oncologic patients:

СЭф     =     П пор      х     t     –     (П 1      +П 2 +…..+П i )

where:

СЭф – social efficiency;

П пор – indicator value for the period after the organizational decision;

t – period of time which is equal to the quantity before the organizational decision.

The social efficiency is admitted to be existing if the result is negative «– » for the values whose positive dynamics is the decrease (mortality, lethality within the first year after detecting the diagnosis and the like), or positive «+»

for the values whose positive dynamics is the increase (detectability of malignant tumours during check-up, five-year remission and the like) [6,7].

Conclusion. As a result of the research we have found out that the consistent scheme of routing oncologic patients, which was implemented by the Order # 944н of the Ministry of Healthcare and Social Development of the Russian Federation, led to the sufficient medical effectiveness and the social efficiency in treatment and dispensary observation of women of childbearing age with malignant tumours of breasts and the uterus as early as first years of its implementation but at the same time it pointed out the necessity of additional efforts in the sphere of medical assistance to women with malignant tumours of the ovary.

Under these circumstances the urgency of the issue of the objective evaluation of treatment and rehabilitation of women, who undergo the specialized treatment, increases more and more. The methodology of the 'Scoring Evaluation of Effectiveness of Dispensary Observation', which has been developed for these purposes, is based on results of the medical and social research of main trends of morbidity and mortality of women of childbearing age due to malignant tumours of the reproductive system, as the basis of which we took the introduction of the scoring system for evaluating main characteristics, which influence the health status and the development of metastasing of women after the specialized treatment. The suggested methodology has been tested and is being used in clinical expert practice in oncologic centres of the Chelyabinsk region.

Thus, the results which have been received on the basis of the performed comprehensive medical and social research demonstrate the fact that the implementation of the system of events for improving the medical assistance to patients with malignant tumours of organs of the reproductive system for women of childbearing age in the Chelyabinsk region will allow to make a sufficient impact on the health status and the development of metastasing after the specialized treatment.