The role of artificial nutrition in gynecological cancer therapy.

Cancer patients are at risk of developing malnutrition from underlying disease as well as from cancer treatment. Moreover, weight loss is considered as a predictive factor for disease progression and shorter survival time. As many as 10-20% of patients with cancer die from the results of malnutrition, instead of from the cancer itself. In the case of cancer-related malnutrition, it is necessary to quickly implement individualized nutritional support depending on the type and stage of the disease, metabolic changes, the patient's condition, expected survival and the function of the gastrointestinal tract. Artificial nutrition reduces the side effects of chemotherapy and improves immunity. Perioperatively it reduces the risk of infection, facilitates wound healing and shortens the length of hospitalization, thereby reducing the costs of the treat- ment. Initially, a malnourished patient, without gastrointestinal dysfunction, qualifies for nutritional counseling. When the energy needs cannot be met by normal feeding, nutritional supplements, taken orally, are recommended. The next step is to feed the patient by nasogastric tube or percutaneous endoscopic gastrostomy. Parenteral nutrition, which results in more side effects, is only started when enteral nutrition is insufficient to ensure adequate nutritional status or in cases of gastrointestinal tract obstruction. The benefit of parenteral nutrition is that it especially provides for those patients with gynaecological cancer who have radiation-induced intestinal damage and post-surgical complications such as short bowel syndrome. Palliative nutrition must to relieve hunger and thirst. Nutritional interventions should be individualized and focused on the changing nutrient needs of the patient and should be supported by physical activity. Regular assessment of the nutritional status of the patient should be an inherent element of the oncological treatment.

[Bone loss in women with malignant genital neoplasms]. / Utrata masy kostnej u pacjentek z notwtworami zlosliwymi narzadów plciowych.

Nowadays, women with genital cancers live longer due to early diagnosis and better treatment schemes. Only few studies assessed bone mass in patients with genital cancer Osteoporosis is a condition characterized by progressive loss of bone mass, weakening of the spatial structure of the bone, and increased susceptibility to fractures. Osteopenia is a condition of reduced, but not yet reaching the pathological values, bone density in relation to norms for age and sex. Metastases are the primary cause of death in cancer patients. It is estimated that approximately half of people dying due to cancer have bone metastases. Osteoporosis in neoplastic disease may occur due to bone metastases or therapy-related adverse effects, i.e. reduced bone mineral density (BMD). Bone microenvironment provides a good medium for the growth of cancer cells. BMD of the femur and spine should be measured by DXA. Computed tomography (CT) and magnetic resonance imaging (MRI) are the techniques used to detect bone metastases. Lifestyle is the key to improving the quality of life and maximize any pharmacological treatment in cancer patients. It is proposed that treatment of cancer without bone metastases does not require therapy increasing bone mass. Further studies in women treated for gynecological malignancies undergoing oophorectomy and adjuvant treatment are needed to elucidate the mechanisms associated with bone loss.

[Costs of population cervical cancer screening program in Poland between 2007-2009]. / Koszty funkcjonowania polskiego populacyjnego programu profilaktyki i wczesnego wykrywania raka szyjki macicy w latach 2007-2009.

BACKGROUND: Screening programs may contribute to decreasing the mortality rate in a given population and their main target, in case of cervical cancer; is to find and to cure preclinical stages of this malignancy. Regularly repeated tests in defined time intervals can diagnose the illness at its early stages but the results come with a high cost. Population program of early detection of cervical cancer has been conducted since 2007 and is run by the Central Coordinating Center and 16 regional centers. Funds for promotional, educational, monitoring and medical activities are obtained from the National Health Service. AIM: The aim of this study was to present the cost-effectiveness of the Program between 2007 and 2009. MATERIAL AND METHODS: The material for the analysis was obtained from the SIMP system, where all the data about women participating in the Program are implemented. The analysis of the cervical carcinoma treatment and procedure costs was made on the basis of the National Health Service estimates. The number of new cervical carcinoma cases was calculated with the help of the newly introduced system code--C53. RESULTS: Between 2007 and 2009 the cost of one cytological smear was similar in all regions (about 10 PLN). The highest costs were noted in Lubuski and Swietokrzyski regions. The costs of promotional and educational activities amounted up to 4.5 million PLN. A single cervical smear test cost for one woman has increased in the analyzed years from 3.95 up to 7.34 PLN. The total cost of one woman cytological examination--medical and non-medical elements--was more than 60 PLN. In 2009, 622 new cases of cervical cancer were found thanks to the Program. The cost of one case of cervical cancer diagnosis was 15 000 PLN. The total costs of all cases of cervical cancer in 2009 was 45.5 million PLN. CONCLUSIONS: The situation calls for creating new and effective tools for monitoring medical, epidemiological and financial parameters of the Program. Otherwise, the estimates of the health and social impact of the Program will fail to be plausible. Increased attendance at the Program will only marginally lower the costs of the tests. Not to mention, that different means and solutions regarding cervical cancer prevention need to be suggested due to the fact that Polish population does not yet seem to have developed the habit of taking preventive tests.