The profession of psycho-oncologist in Poland as an example of inadequate legal regulation in the area of health care. / Zawód psychoonkologa w Polsce jako przyklad niewlasciwej regulacji prawnej w obszarze ochrony zdrowia.

The profession of psycho-oncologist in Poland is not sufficiently regulated by law. The issue is further complicated by the fact that this profession has not been classified by the legislature in the group of medical professions, but only in the group of allied health professions. Currently, according to the Regulation of the Minister of Health on guaranteed services in the field of hospital treatment, a psycho-oncologist is a person with higher medical education, i.e. a graduate of a medical university, for example a doctor or a nurse, who has fulfilled the additional condition of completing postgraduate studies in psycho-oncology. It is thus clear that the legal definition of the profession of a psycho-oncologist remaining in force is inconsistent with the regulation of this profession in force since 2018, resulting from the announcement of the same minister in the Polish Qualifications Framework (PQF - Polska Rama Kwalifikacji, abbrev. PRK). This is because the PQF limits the group of persons who may obtain a qualification in the area of psycho-oncological diagnosis and treatment to psychologists and psychiatrists only, thus limiting the group of persons authorised to practise the profession of a psycho-oncologist. An additional legal problem results from significant differences in the nature of the professions of a medical doctor and psychologist, due to the fact that the Act on the Profession of a Psychologist does not apply in practice, despite remaining in force formally. Thus, a psychologist who practises the profession of a psycho-oncologist, might additionally be a subject to the lack of legal regulation of their "foundation profession", for example due to the fact that it is impossible for a psychologist to obtain a licence to practise their profession, as there is no body to grant them such a licence. Finally, it should not be overlooked that, in addition to the two contradictory regulations of the profession of a psycho-oncologist mentioned above (Regulation of the Minister of Health and the PQF), there also exists a third path to obtain the so-called psycho-oncologist certificate, awarded by the Polish Psycho-oncology Society (Polskie Towarzystwo Psychoonkologiczne - PTPO). At present, persons certified via this path, who include, apart from psychologists and doctors, also representatives of other professions, such as nurses or clergy employed in hospices, will in the majority of cases not be able to formally practise the profession, because the legislature has not provided for the recognition of certificates issued by the PTPO as equivalent to obtaining a psycho-oncological qualification in the context of the above-mentioned regulations.

Indications for sexology consultation in women after surgical treatment due to breast cancer.

INTRODUCTION AND OBJECTIVES: Surgical treatment due to brest cancer have an impact on women sexuality. There is a need for research about effective indications for sexology consultation in women after such treatment. The aim of this study is to determine the indications for sexology consultation in women after surgical treatment for breast cancer. MATERIAL AND METHODS: We tested 42 women patients diagnosed with breast cancer who had undergone mastectomy 3 months before the study. 3 months after the surgery the women were surveyed using the Polish version of FSFI assessing sexual functioning in women. The result of PL-FSFI were compared with the control group. RESULTS: It was found that the mean score of PL-FSFI in the study group 3 months after the surgery was 13.33 points (score range: 1.2-31.7; median 8.3 points) with a statistically significant difference in terms of areas: desire, arousal, lubrication and orgasm in favour of the control group. The total score of PL-FSFI was significantly lower in women after mastectomy than in women after breast-conserving surgery. It has been shown that sexually active women in whom the surgery concerned the right breast (on the side of the dominant hand) scored lower on the scale "sexual functioning" of QLQ-BR-23 than women with surgery of the left breast, with this difference being statistically significant. There was a statistically significant correlation between the baseline performance status on the Zubrod scale and the scales: desire, lubrication and satisfaction of PL-FSFI. Living in a small town proved to be statistically significant for predicting a lower risk of sexual dysfunction among the surveyed women. CONCLUSIONS: The women who underwent surgery due to breast cancer had a higher risk of sexual dysfunction compared to the general population. Higher risk of sexual dysfunction especially concerns women after mastectomy, those who underwent breast surgery on the side of the dominant hand, and those with a worse preoperative overall level of functioning of > = 1 point on the Zubrod scale. A lower risk of disorders was observed in women living in smaller towns. The above factors indicate the advisability for sexology consultation in women with breast cancer.

Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery. / Badanie jakosci zycia kobiet z rakiem piersi, ze szczególnym uwzglednieniem satysfakcji seksualnej i perspektyw na przyszlosc oraz obrazu ciala w zaleznosci od zastosowanej metody leczenia operacyjnego.

OBJECTIVES: Both because of the large number of women undergoing surgery and a high cure rates, psychological rehabilitation of the consequences of breast cancer and side effects of their treatment is a major challenge of modern psychooncology. Aim. The study analyzed the quality of life in women with breast cancer, with particular emphasis on indicators of sexual satisfaction, future perspectives and body image, depending on the method of surgery. METHODS: The study included 42 women aged 35-70 years, 3 months after surgery due to early breast cancer, treated with adjuvant chemotherapy. The following research tools were used in the study: two EORTC questionnaires: QLQ-C30, BR23, and sexual function questionnaire: PL-FSFI. RESULTS: There was no significant difference in the overall quality of life, depending on the type of surgery. The greatest local complaints were reported by patients after breast conserving surgery (BCT) with axillary lymphadenectomy. A higher level of cognitive functioning but a greater severity of systemic side effects was found in women undergoing mastectomy compared to BCT-patients. Women who underwent surgery of the right breast reported increased problems in sexual functioning (p = 0.034). Multiple regression analysis showed a positive correlation of the emotional functioning variable with the assessment of future perspectives (p = 0.01) and body image (p = 0.007). CONCLUSIONS: The type of surgical technique does not affect the overall quality of life and sexual satisfaction. Problems with memory and attention do not correlate directly with the side effects, and as such require an independent diagnostics. Women undergoing treatment of the dominant-side breast should be the candidates for sexology consultation. There is a risk of disturbances in the body image and in the assessment of future perspectives in patients with emotional disorders observed within 3 months after surgery.

Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO2 laser ablation.

Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach-among others, laser application-are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22-42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO2 laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level.